Thursday, December 6, 2018
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In a proposal released last week, the Centers for Medicare & Medicaid Services unveiled plans to limit which drugs must be included in protected classes under Medicare Part D—thereby putting boundaries around the free reign pharmaceutical companies have for pricing those drugs. Instead, Part D plans can impose prior authorization and step therapy, or exclude a drug from a formulary if the drug is just a new formulation of an older drug. Plans can also exclude a drug if its price increases faster than the consumer price index in a given year
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(
Benefits Pro
;
American Journal of Managed Care
)
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Democrats opposed to single-payer “Medicare for All” health care policy are working on a moderate alternative that would allow people ages 50 to 65 to “buy in” to Medicare. Rep. Brian Higgins is behind the idea, and threw his support behind Nancy Pelosi’s bid as House Speaker to gain her support for his buy-in plan. Other democrats, however, say they’re dead-set against any option other than single payer
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(
The Hill
)
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Innovation & Transformation
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Telehealth visits have increased sharply, according to a study of insurance data from 32 states with telehealth and insurance reimbursement parity laws. Overall, telehealth accounted for more than 7 visits per 1,000 people in 2017, compared to 1 visit per 1,000 in 2005. The study found telemedicine usage by the insured appears to be growing most quickly where there’s a shortage of mental health providers. “If the growth rates we are observing continue, in a decade telemedicine will be seen as quite common,” said lead study author Dr. Michael Barnett of the Harvard T. H. Chan School of Public and Brigham and Women’s Hospital in Boston.
(
Reuters
)
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Beacon Health Options, a Boston-based behavioral health services company, recently opened an outpatient mental health clinic in a Walmart outside Dallas, Texas. While some question whether the retail giant is an appropriate host for mental health care, Russell Petrella, president and CEO of Beacon Health Options, says it’s time to move mental illness out of the shadows and into the mainstream. “Having it available in a setting like this provides opportunities for people to reach out and get care in a comfortable place,” he says. The clinic is not intended for people with serious mental health problems, and clinic personnel can’t write prescriptions. More than 500 have shown interest since the clinic opened its doors.
(
Today.com
)
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Beginning in January, hospitals nationwide will be required to post their charges in a "machine-readable format" that patients can access. But prices already posted in 45 states aren’t relevant to consumers because they don’t reflect the negotiated prices insurance companies get from hospitals. In this thought piece, health care research analyst Paul Keckley uses his own billing experience to offer context to hospital price transparency. Market forces, he believes, will play a bigger role in bringing down costs than posting prices that have little connection to what most consumers pay.
(
The Keckley Report
)
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Electronic health records often store the most critical information in the provider notes section or in images and test results that are appended to the record—and that makes it hard for providers to easily tease out information that can greatly impact patient care. Amazon’s new HIPAA-compliant service, AWS Comprehend Medical, is capable of analyzing reams of data in EHRs to identify and process useful information anywhere in the record. That could be a game changer for health care. Early clients are using the software to identify patients for clinical trials and to create personalized care pathways.
(
Forbes
;
The Wall Street Journal
[subscription required]
)
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CMS launches surgery price tool
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Consumers can see the national average cost for outpatient surgical procedures on the Center for Medicare & Medicaid Services’ new Procedure Price Lookup. The results compare the facility cost for a range of procedures done in an ambulatory surgical center versus the same procedure done in a hospital-based outpatient unit.
(
HealthLeaders
)
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CVS-Aetna merger may not be a go
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CVS and Aetna may have assumed too much when they announced their merger had passed all regulatory hurdles last week. U.S. District Court Judge Richard Leon chastised both parties for treating his part of the approval process as a “rubber stamp.” At a hearing Monday, Leon said he would order both sides to offer arguments as to why he shouldn’t block the merger until he approves the Justice Department consent agreement.
(
CNBC
)
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About a third of the nation’s hospital emergency rooms have violated a law requiring that they medically screen and offer stabilization services for patients, regardless of ability to pay. In the past two years, at least 34 patients have died as a result of violations, according to a WebMD and Georgia Health News investigation. Hospitals with fewer than 100 beds account for more than a third of the problems because they may not have a qualified practitioner on duty (and didn’t alert federal regulators that they lacked the resources to serve patients). Patients died when hospitals didn’t transfer dire cases to another provider. Three hospitals in North Carolina boarded dozens of mental health patients in their emergency rooms rather than admitting them to their own psychiatric units—a decision based on payment source rather than patient need. (
WebMD
)
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MarketVoices...quotes worth reading
“What we want to do is make sure our beneficiaries are getting the drugs that they need at affordable prices. If the medication isn’t affordable, they aren’t going to be able to access it.”-- CMS Administrator Seema Verma, as quoted by
Benefits Pro.
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Editor
Sandy Mau
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