CMS Finalizes Medicare Prescription Drug Pricing Rule. Last week, CMS finalized a rule that will improve the transparency of prescription drug costs in Medicare Part D and Medicare Advantage health plans and lower beneficiary out-of-pocket costs. For example, beginning in 2021, the Explanation of Benefits that Part D plans send members must display drug price increases as well as lower cost therapeutic alternatives. In addition, beginning in 2020, Part D sponsors cannot prohibit or penalize a pharmacy from disclosing a lower cash price to an enrollee. About 70 percent of rural Medicare beneficiaries had prescription drug coverage in 2017, mostly through stand-alone Part D plans as opposed to Medicare Advantage plans.
Hardship Exclusion for Medicare Interoperability Announced
Hardship Exclusion for Medicare Interoperability – July 1. Beginning in 2019, all eligible professionals (EPs), eligible hospitals, dual-eligible hospitals, and Critical Access Hospitals (CAHs) are required to use 2015 edition certified electronic health record technology (CEHRT) to meet the requirements of the Promoting Interoperability (PI) Programs. Eligible hospitals and CAHs may be exempted from the Medicare downward payment adjustment if they can show that compliance with the requirements would result in a significant hardship. Hardship exceptions are valid for only one payment adjustment year, so hospitals must submit an exclusion application each year. The deadline to submit an application is July 1, 2019 for eligible hospitals and November 30, 2019 for CAHs.
CDC Announces Opioid Rapid Response Teams
CDC Opioid Rapid Response Teams. The Centers for Disease Control and Prevention (CDC) is working with the U.S. Public Health Service Commission Corps to support state and local agencies when there is a spike in opioid-related overdoses or closure of a clinic where patients are prescribed opioid therapy. The Opioid Rapid Response Teams (ORRTs) include technical expertise in epidemiology, clinical provider outreach, and community outreach, providing short term (28 days) support to public health partners, while also working to build a jurisdiction’s long-term response capacity.
2018 Sub-County Population Estimates
Estimates of the population for sub-county geographies (municipalities) as of July 1, 2018 have been today by the U.S. Census Bureau. A look at Pennsylvania’s cities shows that Philadelphia had the highest numeric increase since 2010, adding over 58,000 persons. Erie had the highest numeric decrease, losing over 5,000 persons during the same time.
How did other cities fare? And how did Pennsylvania’s boroughs and townships hold up? Click here to read the full brief.
The Best, and Worst, States for Health Care
U.S. News & World Report last week released its state health care rankings, which are based on measures of states’ access to care, health care quality, and public health. Hawaii topped the list as the best state for health care, while Mississippi ranked last. (Source: Becker’s Hospital Review.
The Struggle To Hire And Keep Doctors In Rural Areas Means Patients Go Without Care
Heard on NPR All Things Considered
Taylor Walker is wiping down tables after the lunch rush at the Bunkhouse Bar and Grill in remote Arthur, Nebraska, a tiny dot of a town ringed by cattle ranches.
The 25-year-old has her young son in tow, and she is expecting another baby in August.
“I was just having some terrible pain with this pregnancy and I couldn’t get in with my doctor,” she says.
Visiting her obstetrician in North Platte is a four-hour, round-trip endeavor that usually means missing a day of work. She arrived to a recent visit only to learn that another doctor was on call and hers wasn’t available.
“So then we had to make three trips down there just to get into my regular doctor,” Walker says.
This inconvenience is part of life in Arthur County, a 700-square-mile slice of western Nebraska prairie that’s home to only 465 people. According to census figures, it’s the fifth least-populated county in the nation.
CDC Releases Digital Measles Toolkit
The Centers for Disease Control & Prevention (CDC) has created a digital measles toolkit to support health care providers during the current multi-state measles outbreak. It contains products for clinicians and patients about vaccines and measles that include accurate, science-based evidence that can help counter misinformation about measles and MMR vaccine. It helps to support effective vaccine conversation with parent and resources to share with them. New resources will be added as they become available. For up-to-date answers to patients’ frequently asked questions about measles, visit Frequently Asked Questions About Measles in the U.S.
AAMC Releases Report on Physician Shortage
The American Association of Medical Colleges (AAMC) has released the AAMC Report on Physician Shortage, its annual report on workforce shortages for health care across the nation. This year’s report projects a primary care physician shortage of 21,100 to 55,200 physicians by 2032. The shortfall range reflects the projected rapid growth in the supply of advance practice RNs and physician assistants and their role in care delivery, trends that might strengthen the nation’s primary care foundation and improve access to preventive care. The projection is based on an estimate by the Health Resources and Services Administration that nearly 14,472 primary care physicians are needed to remove the primary care shortage designation from all currently designated shortage areas. Causes of the shortfall include increasing demand from an aging population, expected retirements of many aging physicians, shorter work hours demanded by today’s physician workforce, and the growth in demand from striving to meet population health goals.
New Report Examines Financial Health of Pennsylvania Hospitals
The Pennsylvania Health Care Cost Containment Council (PHC4), the independent state agency that collects and analyzes comparative information on healthcare organizations, has released its latest report on hospitals. PHC4 Executive Director Joe Martin noted the report shows Pennsylvania general acute care hospitals’ uncompensated care again decreased, as it has in each of the past five years, to $750 million in fiscal year 2018 from $766 million the previous year. The decline can be tied to provisions in the Affordable Care Act that improve access to health insurance, particularly for those unable to get coverage at their place of employment. The independent state agency’s study also showed the statewide average operating margin for hospitals decreased to 4.76% from 5.15% during the same time period.
New Brief Comparing Characteristics of Communities served by Critical Access Hospitals
The Flex Monitoring Team has published a new brief comparing the characteristics of communities served by Critical Access Hospitals (CAHs) predicted to be at high risk of financial distress to communities served by all other CAHs. Using data from 2017, the Financial Distress Index (FDI) model assigns CAHs to high, mid-high, mid-low, or low predicted risk levels for 2019 using Medicare cost reports and Neilsen-Claritas data summed to market areas.
CAHs predicted to be at high risk of financial distress were found to serve communities with significantly higher percentages of non-White individuals (Black individuals in particular), lower high school graduation rates, higher unemployment rates, and worse health status.