Surprise Billing Legislation; Drug Pricing Reform Stalls; GOP's ACA Repeal
Surprise medical bills—a long-time problem for patients and consumers—was not on the legislative radar until recently. In short order, the issue has quickly moved through the House Energy and Commerce Committee, one of the most powerful on Capitol Hill, to offer some hope for consumers. Part of the committee’s mark up added an amendment allowing for arbitration to address specific medical charges if hospitals disagreed with the agreed-upon rate. Some committee members felt that without it, providers would have limited recourse in special circumstances.
President Releases Executive Order on Healthcare Transparency
As challenges mount to find new and innovative ways to provide quality health care at affordable prices for patients, a battle is brewing over what patients can and cannot know about their healthcare costs. On June 24, President Trump released an executive order directing his administration to take steps to improve healthcare prices and transparency to address the pricing woes patients face.
Pain Management Task Force Issues First Report on Pain Control Best Practices
According to the Centers for Disease Control and Prevention, 50 million Americans experience acute and chronic pain daily. Managing the pain is debilitating and costly, and the impact on the economy is felt through employment issues along with a heightened burden on the healthcare system.
CMS Seeks Changes in Telehealth, Palliative Care Payments, and Electronic Health Record Interoperability
In March and April 2019, the Centers for Medicare and Medicaid Services (CMS) issued several proposed and final rules that affect patient coverage for cancer-related benefits, payment models, and the paperwork nurses often complete to ensure those benefits are billed correctly.
CMS’s Final Medicare Part D Ruling Preserves Patient Access to Certain Cancer Drugs
Medicare Part D will continue to give patients access to certain cancer drugs, according Centers for Medicare and Medicaid Services’ (CMS’s) final ruling issued May 16, 2019. The final rule does not allow for utilization controls like step therapy and prior authorizations for patients who are already in an established treatment regimen; does not restrict drugs that have had certain price increases over a specified time period; and does not restrict new formulations of an existing protected class drug.
Kentucky Illustrates Success of Medicaid Expansion
The state of Kentucky has seen some of the most success in reducing its uninsured rate thanks to the Affordable Care Act’s Medicaid expansion that took effect on January 1, 2014. The results of a new study, published in the Journal of the American College of Surgeons, showed that as the number of insured individuals rose, so too did important cancer screening rates.
Government-Led Drug Pricing; CMS Reimbursement Updates; Playing Cards Reaction
As Washington attempts to address the soaring costs of prescription medications, some experts are attempting to shed light on the many complicated aspects of the drug pricing issue. The free-market system has countless moving parts, and perhaps so-called big government ownership isn’t the answer to inflating drug costs. As the author aptly states, “From a public-relations standpoint, drug companies are often their own worst enemies. Occasionally, a breathtakingly awful company taints the image of the whole industry.”
Senators Investigate Juul; Dems Drug Pricing Woes; New Medicare for All
On April 8, 2018, nearly a dozen Democratic senators announced they would investigate the marketing practices of e-cigarette giant Juul along with a new deal to sell a minority stake of the company to Altria, maker of Marlboro cigarettes. Not long ago, the U.S. Food and Drug Administration (FDA) and Juul—along with others in the smoking cessation community—supported efforts to use electronic tobacco mechanisms to help 60 million Americans quit smoking. However, along the way, the U.S. surgeon general and FDA discovered that youth smoking and vaping have seen a dramatic increase from the advertising, marketing, and distribution of e-cigarettes.
Drug Pricing Discussions Make Headway in Congress
The 116th congressional session is well underway. Committee meetings are being held and policy discussions are taking shape all over Capitol Hill. In January 2019, the U.S. House and Senate held separate public hearings on the biggest healthcare issue from the 2018 midterm election: drug pricing.
DOJ Says ACA Invalid; Pre-Existing Condition Protections; Medicaid Work Requirements
In a move that echoed the Department of Justice’s (DOJ’s) previous stance on the Affordable Care Act (ACA), the Trump administration’s DOJ announced it was siding with a lower court’s ruling that stated ACA was invalid and unconstitutional. Siding with conservative state attorneys general who sued and won a lower federal court judgment on the constitutionality of law, DOJ issued a terse, two-sentence letter supporting the judge’s decision to strike the law down.
CMS Projects Health Expenditures to Reach $6 Trillion by 2027
Health care remains a top domestic policy issue for Americans. Across the board—regardless of political ideology—Americans are concerned about the quality of health care, access to providers, and rising costs associated with medications and treatment. In February 2019, the Centers for Medicare and Medicaid Services’ (CMS) Office of the Actuary released a report outlining the projected growth in national health spending from 2018–2027.
Trump Administration Proposes Lower Drug Costs
For the past year, President Trump has championed efforts to lower drug prices for Americans to more accessible and affordable medications. Lowering soaring prescription costs is an issue with wide bipartisan support in Congress. To date, several Congressional committees have held hearings in early 2019 with pharmaceutical executives.
CMS Proposes Medicare Coverage for CAR T-Cell Therapy
To improve access to new cancer therapies and provide national consistency in coverage, on February 15, 2019, the Centers for Medicare and Medicaid Services (CMS) announced a proposed plan of coverage with evidence development for CAR T-cell therapy. The public is invited to share comments for the next 30 days.
HHS Proposes Policy Changes for Medicare Advantage, Part D Drug Pricing
U.S. drug pricing systems are difficult for patients to understand, cumbersome to maneuver, and limited in access and affordability. In Medicare’s current structure, certain medications are designated as a protected class of drug, and Medicare Part D plans are obligated to cover them.
Proposed Medicare Payment Model Based on International Drug Prices Would Lower Patient Costs
On October 25, 2018, U.S. Department of Health and Human Services (HHS) Secretary Alex Azar announced an advanced notice of proposed rulemaking (ANPRM) calling for a demonstration project to more closely align Medicare payment for certain Medicare Part B drugs and biologics with international prices, which an HHS analysis showed to be 1.8 times lower on average than in the United States. The proposal is a follow-up to the president’s prescription drug blueprint and HHS request for information to reduce patient out-of-pocket costs for prescription drugs. HHS estimates a savings of $17.2 billion over five years.
CMS Proposes Changes to Medicare and Doctor-Patient Relationships
One of the biggest challenges in medical practice is finding a way to spend enough time with each patient amid all the regulatory paperwork. To streamline workflows and encourage better provider-patient relationships, the Centers for Medicare and Medicaid Services (CMS) proposed new reforms to roll back certain regulatory efforts that were saddling clinicians with cumbersome paperwork. As part of those efforts, CMS reevaluated some of its reimbursement methods to improve efficiency with its required paperwork.
Medical Aid in Dying Patient Chooses His Last Day; Arkansas Medicaid Work Requirements Could Cost Thousands Coverage; CVS Launches Program in Response to Trump Administration Blueprint to Lower Drug Costs
With more states legalizing medical aid in dying options for patients, the process is often vague and misunderstood. One patient, Aaron McQ, shared his story as he prepared to self-administer his life-ending medication. His story explains the nurse's key role in education and shared decision making to address the concerns of the patient.
At Stake in the 2018 Midterms: Medicaid Expansion; Health Groups Call on FDA to Speed Up Regulation of E-Cigarettes, Cigars; New Study Ignites Debate Over Cost of Medicare for All
Healthcare reform has been a hot political topic since before the introduction of the Affordable Care Act. Potential changes in the American healthcare system will be at the hands of which party controls the House of Representatives and the Senate. The upcoming midterm elections in November 2018 could determine a shift in power and potentially add further Medicaid expansion to the list of incoming health care changes.
GOP Chairman in Talks With Trump Officials on Restarting Key Obamacare Payments; Oklahoma Medicaid Approved for Drug Pricing Experiment; House Panel Advances Bill That Would Temporarily Halt Obamacare’s Employer Mandate
On July 16, 2018, Kevin Brady (R-TX), House Ways and Means Committee chair, announced that he’s working with the Trump administration to restore funding to key Affordable Care Act (ACA) payments. Previously, the White House suspended more than $10.4 billion in payments to insurers, which brought criticism from Democrats and stern warnings of rising healthcare premiums.
HHS Drug Reform RFI Aims to Help Patients Better Afford Cancer Drugs
ONS shared the perspective of nurses caring for patients who may struggle to afford cancer drugs in comments submitted to the Department of Health and Human Services (HHS) on its Prescription Drug Reform Request for Information.
Trump Officials Considering Cuts to Obamacare Outreach Groups; Those Who Don't Qualify for Government Aid Aren't Buying Obamacare Plans; Judge Blocks Kentucky Medicaid Work Requirement Hours Before Implementation
An initial proposal from the Trump administration might cut funds for outreach related to the Affordable Care Act (ACA). As of yet no decisions are finalized and funding may still remain consistent, but limiting funding for outreach of the ACA, known to most as Obamacare, isn't a new move for the current administration. In 2017, it cut funding for navigators who educated and enrolled Americans in the ACA marketplace, leading to confusion among potential applicants and lower enrollment numbers. If funding is cut again this year, new or returning enrollees are unlikely to find success when looking for coverage.
Early Oncology Care Model Data Show Reduced Hospital Admissions
Improving quality and reducing costs in a practice are two of the Oncology Care Model’s (OCM) key goals, and one of the best ways to achieve them is to reduce unnecessary emergency department (ED) visits and hospitalizations. During a study presented at the 2018 American Society of Clinical Oncology Annual Meeting, researchers described a campaign implemented to reach those objectives.
APNs Have a Role in Leading Value-Based Care
Recent care delivery models have focused on providing value-based care to patients. The changes provide opportunity for APNs to take a leadership role in implementing models and systems to effectively deliver that care. Here’s what APNs need to know about the new models.
CMS Finalizes Rule Reducing Medicare Part B Payments to 340B hospitals
The Centers for Medicare and Medicaid Services (CMS) finalized a rule on November 1, 2017 that would reduce the current Medicare Part B drug payment to 340B hospitals from average sales price (ASP) plus 6% to ASP minus 22.5%. However, rural sole community hospitals (SCHs), children’s hospitals, and PPS-exempt cancer hospitals are excluded from this payment adjustment in 2018.
ONS Supports Medicare Coverage of Lymphedema Compression Supplies
On August 25, 2017, ONS submitted comments to the House Ways and Means Health Subcommittee in response to its Medicare Red Tape Relief Project. The initiative, sponsored by subcommittee chairman Pat Tiberi (R-OH), asked providers for input on ways to improve health care for seniors and reduce Medicare regulations and mandates.