Entries in Current News (44)

Friday
Dec082017

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition
 

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week:

 

House tax writers weigh plan to suspend Obamacare insurer tax

House Republican tax writers are considering delaying Obamacare's health insurance tax for only limited markets next year, leaving out small businesses and possibly private Medicaid plans, according to sources on and off Capitol Hill. They would suspend it for all markets in 2019.

Politico

Thursday, December 7, 2017

Hospitals Find Asthma Hot Spots More Profitable To Neglect Than Fix

Months of reporting and rich hospital data portray life in the worst asthma hot spot in one of the worst asthma cities: Baltimore. The medical system knows how to help. But there’s no money in it.

Kaiser Health News

Wednesday, December 6, 2017

Providers See CMS Continuing Value-Based Care Push Despite Project Rollbacks

Though the Trump administration last week rolled back several Obama-era projects designed to shift the U.S. health care system away from fee-for-service care to models that pay doctors and hospitals based on the quality of care, industry groups believe the government is likely to continue with the push toward value-based care.

Morning Consult

Tuesday, December 5, 2017

States get big Medicaid savings from social services, outreach to sickest patients

Some states have achieved dramatic savings in health care costs for their sickest Medicaid patients by providing intensive one-on-one assistance and social services that help the patients better address their multiple, overlapping ailments.

USA Today

Tuesday, December 5, 2017

CVS likely wants FTC antitrust review, not Justice Department, of Aetna deal

It is uncertain who in the U.S. government will carry out an antitrust review of CVS Health Corp’s (CVS.N) deal to buy health insurer Aetna Inc (AET.N), but the drugstore company is likely hoping the potentially more lenient Federal Trade Commission gets the nod, antitrust experts say.

Reuters

Tuesday, December 5, 2017

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.

 
Monday
Dec042017

The President’s Commission on Combating Drug Addiction and the Opioid Crisis

Sandhya Gardner, MD, Chief Medical Officer, Relias, December 4, 2017

There has been no shortage of attention given to the current opioid abuse and overdose epidemic sweeping the U.S. Near-daily media reports highlight the staggering number of people who are addicted to prescription and illicit opioids and who die from them daily. Nor have suggested remedies been neglected. Federal regulatory agencies, including the FDA and the CDC, professional medical associations, public health organizations, the insurance industry, and others have all recently issued new guidelines and policies on the proper administration of opioids and the treatment of individuals with opioid addiction.

Despite, or perhaps because of this attention, the President’s Commission report was eagerly anticipated. When released in final form on November 1, 2017, the report was widely praised for its comprehensive attention to the many factors that have combined to create the perfect storm that is today’s opioid crisis. There were reservations, however, because the Commission did not recommend any specific funding amounts to implement its recommendations. Moreover, President Trump’s decision to declare the opioid epidemic a public health crisis rather than a national health emergency also meant that no new funding has yet been allocated. The President’s Commission did advocate, however, that an unspecified amount of increased resources be put towards implementing its 56 recommendations.

We will highlight some critique and opinions about these recommendations specifically for healthcare providers and prescribers, organizations, funders and insurers, government and law enforcement agencies, and patients.

Providers and prescribers will see that the recommendations are largely extensions of current practice and therefore are relatively unsurprising. Adopting policies to ensure that patients give informed consent before receiving an opioid is consistent with current practice standards. Physicians should of course always discuss risks, benefits, and alternatives of any intervention they recommend for their patients. The concern here is that the informed consent procedure policies adopted be balanced. Opioids are proven effective analgesics for both acute and, in some instances, chronic pain and there are patients for whom they are clearly indicated. Informed consent procedures should, therefore, not be designed to frighten or discourage patients who need opioids.

Noteworthy, although not a departure from current policies and recommendations, is standardizing guidelines and extending them to specialists. Right now, there is a patchwork of opioid prescribing guidelines that have been created by multiple agencies. Many of them apply only to primary care providers. Currently, some states, like New York, have mandatory opioid continuing education requirements for relicensing and require that prescribers consult the state’s on-line Prescription Drug Monitoring Program (PDMP) before prescribing an opioid. These requirements would be extended to all states and a standardized national opioid prescribing curriculum would be created. It is unclear how effective continuing education programs are in improving opioid prescribing practices, so the benefits must be weighed against the burden it places upon physicians who must spend time taking more courses. Similarly, although there is some evidence that PDMP use reduces opioid abuse, it remains unknown whether this will have a significant effect in stemming opioid abuse.

Physician groups have complained that questions about how pain was handled that are included in patient satisfaction surveys contribute to unnecessary opioid prescribing. Fearing that negative reviews will be held against them; physicians report feeling pressured to prescribe opioids to patients with pain complaints to boost their ratings. The new recommendations mandate that CMS remove pain questions entirely from patient satisfaction surveys. This seems like a very positive step towards reducing inappropriate opioid prescribing.

Current practice is to refer patients reporting to the Emergency Department (ED) with signs and symptoms of opioid abuse or withdrawal to outpatient providers, but this can lead to poor follow-up and/or retention in treatment. Studies have shown that treatment, particularly with medications like buprenorphine/naloxone (Suboxone), can be started in the ED for such patients, who then are much more likely to enter outpatient treatment and remain drug-free for extended periods of time.  Although some emergency physicians in the past have been reluctant to start medication assisted treatment (MAT) for patients in the ED, the recommendation to initiate substance abuse and addiction treatment in the emergency department could substantially improve outcomes for opioid addicted individuals. 

Healthcare insurers will likely see an increase in their costs because of these recommendations. Nevertheless, these recommendations are all consistent with expert opinion. Right now, insurers incentivize physicians to prescribe opioids rather than alternative analgesic interventions, a policy that is widely criticized. For example, it is less expensive for patients to fill a prescription for a generic opioid than it is to have acupuncture or cognitive-behavioral therapy, even though both of the latter are among the non-opioid interventions that can be effective and far less risky in treating pain than opioids. The President’s Commission appropriately recommends modification of rate-setting policies that discourage use of non-opioid treatments for pain. It also calls for insurers to remove barriers for all forms of substance use disorder (SUD) treatment, including MAT. There is widespread agreement among experts that MAT is a safe and effective treatment for SUD and that its use should be expanded significantly. Finally, the recommendations call for stricter enforcement and stiffer penalties for insurers that violate mental health and parity laws. Although this last recommendation will certainly win the approval of advocates, enforcing the parity laws currently in effect has proven to be extremely difficult.

The creation of drug courts in all 93 federal judicial districts has already won widespread approval. Individuals with an SUD who violate parole would be referred to a drug court rather than sent to prison. Sending SUD patients to prison is generally seen as counterproductive and diversion to treatment via drug courts reduces recidivism.

Of course, all the above will have tremendous impact on patients who have pain-related illnesses or who are struggling with problematic opioid use. One recommendation that has not been met with much approbation, however, is for a media campaign to address “the hazards of substance use, the danger of opioids, and the stigma.” Some have criticized this recommendation as being too vague. It is unclear that such a campaign would significantly alter public perception or behavior. It also runs the risk of discouraging people who are legitimately taking opioids for severe pain, such as cancer patients, from adhering to prescribed regimens. The hope is that if a media campaign is pursued, that it is carried out in an evidence-based manner that incorporates what is known from social science about effective methods for changing attitudes and behavior.

Conclusions:

The most immediate concern about the President’s Commission report is that no funding is yet attached to its recommendations. One member of the Commission, former Rhode Island congressman Patrick Kennedy, was quoted as estimating that Congress needs to appropriate at least $10 billion immediately for the Commission’s recommendations to be carried out.   

Another concern is whether the President’s Commission report takes into consideration the need to balance medically-indicated opioid prescribing with abuse/overdose prevention. Opioids are effective analgesics that can be a highly appropriate treatment for severe pain in both acute and chronic situations. But there is no question that they are currently prescribed in many situations for which other, less perilous, alternatives are effective and available. Nor is there any disagreement that opioid misuse and abuse have reached epidemic proportions and that the quantity of opioids prescribed must be reduced. However, patients who need to take opioids must not be stigmatized, nor must physicians be frightened to prescribe them when its necessary.

Overall, barring the concerns about funding and some skepticism around the proposed media campaign, the recommendations have been met with optimism. They provide a multi-prong approach to an enormous problem and include many evidence-based recommendations.

For further information on this topic, a free webinar will be taking place on Tuesday, December 12 at 2pm EST. Titled, Opioid Commission Final Report: Recommendations and Effects on Payers, Insurers, and Providers, the webinar will be led by Susan Kansagra, MD, MBA – Section Chief -  North Carolina Division of Public Health, Chronic Disease and Injury Section, North Carolina Department of Health and Human Services, and Jason E. Vogler, Ph.D., CS SBB, Senior Director - Division of Mental Health, Developmental Disabilities and Substance Abuse Services
North Carolina Department of Health and Human Services. Registration for the webinar is available here.

Friday
Dec012017

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition
 

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week:

 

Congress Isn’t Really Done With Health Care — Just Look At What’s In The Tax Bills

Having failed to repeal and replace the Affordable Care Act, Congress is now working on a tax overhaul. But it turns out the tax bills in the House and Senate also aim to reshape health care.

Kaiser Health News

Friday, December 1, 2017

CMS makes it official: Two mandatory bundled-pay models canceled

The CMS has finalized its decision to toss two mandatory bundled-payment models and cut down the number of providers required to participate in a third.

Modern Healthcare

Thursday, November 30, 2017

CVS Nears Deal to Acquire Health Insurer Aetna

CVS Health Corp. is nearing an agreement to acquire health insurer Aetna Inc. for more than $65 billion, according to a person familiar with the negotiations, in a deal that could reshape the pharmacy and health insurance industries.

Bloomberg

Thursday, November 30, 2017

Marketplace Confusion Opens Door To Questions About Skinny Plans

Consumers coping with the high cost of health insurance are the target market for new plans claiming to be lower-cost alternatives to the Affordable Care Act that fulfill the law’s requirement for health coverage.

Kaiser Health News

Monday, November 27, 2017

As Health Care Changes, Insurers, Hospitals and Drugstores Team Up

They seem like odd couples: Aetna, one of the nation’s largest health insurers, is in talks to combine with CVS Health, which manages pharmacy benefits. The Cleveland Clinic, a highly regarded health system, joined forces with an insurance start-up, Oscar Health, to offer individuals a health plan in Ohio.

NY Times

Sunday, November 26, 2017

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.

 
Friday
Nov172017

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition
 

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week:

 

Medicaid Expansion Takes A Bite Out Of Medical Debt

As the Trump administration and Republicans in Congress look to scale back Medicaid, many voters and state lawmakers across the country are moving to make it bigger.

Kaiser Health News

Friday, November 17, 2017

Medicare Seeks Comment On Ways To Cut Costs Of Part D Drugs

Noting that the true price of a drug is often hidden from consumers, Medicare officials requested comments late Thursday on how to use discounts and rebates to help decrease what enrollees pay for prescriptions.

Kaiser Health News

Thursday, November 16, 2017

Remembering Health Care Economist Uwe Reinhardt

Reinhardt, who died on Monday, helped shape the debate about health care by advocating for individual mandates and universal health care. Originally broadcast in 2009.

NPR

Thursday, November 16, 2017

Sign-ups hit 1.5 million in first two weeks of ACA open enrollment

HealthCare.gov sign-ups continue to outpace last year's, with nearly 1.5 million people selecting plans during the first two weeks of open enrollment.

Modern Healthcare

Wednesday, November 15, 2017

Bill Gates says big data can help solve the Alzheimer's puzzle

Through his foundation, Bill Gates has focused on reducing global poverty, finding cures for infectious diseases, and promoting education and sustainable energy. Now Gates is getting into an area that's new for him: Alzheimer's disease.

Monday, November 13, 2017

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.

 
Friday
Nov032017

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition
 

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week:

 

House Tax Bill Would Scrap Deduction For Medical Expenses

The tax bill unveiled by Republicans in the House on Thursday would not, as had been rumored, eliminate the tax penalty for failure to have health insurance. But it would eliminate a decades-old deduction for people with very high medical costs.

Kaiser Health News

Thursday, November 2, 2017

Hospital groups to sue CMS over $1.6 billion cut to 340B program

Less than an hour after the CMS released the final rule, America's Essential Hospitals, the American Hospital Association and the Association of American Medical Colleges said they believe the agency has overstepped its statutory authority by cutting 340B drug payments by $1.6 billion, or 22.5% less than the average sales price.

Modern Healthcare

Wednesday, November 1, 2017

Panel Recommends Opioid Solutions but Puts No Price Tag on Them

President Trump’s bipartisan commission on the opioid crisis made dozens of final recommendations on Wednesday to combat a deadly addiction epidemic, ranging from creating more drug courts to vastly expanding access to medications that treat addiction, including in jails.

The New York Times

Wednesday, November 1, 2017

U.S. states allege broad generic drug price-fixing collusion

A large group of U.S. states accused key players in the generic drug industry of a broad price-fixing conspiracy, moving on Tuesday to widen an earlier lawsuit to add many more drugmakers and medicines in an action that sent some company shares tumbling.

Reuters

Tuesday, October 31, 2017

Money For Health Law Navigators Slashed — Except Where It’s Not

Despite all the efforts in Congress to repeal the health law this summer and fall, the Affordable Care Act is still the law of the land. People can start signing up for health insurance for 2018 starting Nov. 1. But the landscape for that law has changed a lot.

Kaiser Health News

Monday, October 30, 2017

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.