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Rheumatologists see little value in MOC
Among the 515 rheumatologists responding to the survey, 74.8% “did not think there is significant additional value in MOC, beyond what is already achieved from Continuing Medical Education,” Amr Sawalha, MD, and Patrick Coit, both of the University of Michigan, Ann Arbor, wrote in Arthritis Care & Research. The survey was sent to 3,107 rheumatologists in the United States.
The survey also found that 63.5% of respondents “did not believe board recertification and MOC are valuable in terms of improving patients’ care,” although 65.6% did perceive that staying current with new knowledge was a positive effect of participating in the MOC process, Dr. Sawalha and Mr. Coit wrote.
On the flip side, requiring MOC was perceived to be a contributor to physician burnout by 77.7% of respondents and to early retirements by 67.4% of respondents.
“If participation in MOC indeed does not have a significant value on improving patient care in rheumatology, as indicated by the perception of practicing rheumatologists, and if it remains a requirement to practice for at least over a third of rheumatologists in the United States, then an argument can be made that elimination of MOC might be a way to sustain and improve the rheumatology workforce without compromising quality,” Dr. Sawalha and Mr. Coit wrote. “To our knowledge, there have not been any studies to show that rheumatologists participating in MOC activities provide better care.”
Another aspect that the survey revealed is the rheumatologists’ perception of certifying organizations.
“A striking finding from our study is the indication that there seems to be a lack of trust in [the] board-certifying organization and their motives among practicing rheumatologists in the United States,” the authors wrote. “When asked to rank in order what is thought to be the reason for creating MOC programs, financial well-being of board-certifying organizations was the highest ranked answer. Improving patient care, which is the motive claimed by board-certifying organizations, was the least likely ranked answer.”
Indeed, about 60% of respondents believe alternative organizations, such as the American College of Rheumatology, should be administering or overseeing the board certification process for rheumatologists.
“Regardless of what the motive might be, these results suggest that practicing physicians, and in this case rheumatologists, do not trust board-certifying organizations,” Dr. Sawalha and Mr. Coit wrote. “Therefore, we suggest that these organizations revisit their relationship with practicing physicians and facilitate true collaboration with physicians to determine the best way to assess and ensure physician competence and knowledge.”
The authors declared that they have no financial conflicts of interest.
SOURCE: Sawalha A and Coit P. Arthritis Care Res. 2018 Dec 20. doi: 10.1002/acr.23823
The fact that survey respondents say with almost identical affirmation that MOC helps them stay current on medical knowledge and is redundant with CME suggests that rheumatologists favor continuing to learn about their profession throughout the life of their career but want that learning in an environment they have more control over.
Given the expansion of technology, physicians have access at their fingertips to information, which questions the need for exams that require memorization of details.
New ways are needed to help physicians maintain certification in ways that take advantage of current information technology in a manner that can be more customizable to their practice rather than a one-size-fits-all examination.
David Karp, MD, PhD , is chief of the division of rheumatic diseases at the University of Texas Southwestern Medical Center, Dallas. His comments are paraphrased from an editorial accompanying the survey report (Arthritis Care Res. 2018 Dec 20. doi: 10.1002/acr.23822 ). He had no relevant disclosures.
The fact that survey respondents say with almost identical affirmation that MOC helps them stay current on medical knowledge and is redundant with CME suggests that rheumatologists favor continuing to learn about their profession throughout the life of their career but want that learning in an environment they have more control over.
Given the expansion of technology, physicians have access at their fingertips to information, which questions the need for exams that require memorization of details.
New ways are needed to help physicians maintain certification in ways that take advantage of current information technology in a manner that can be more customizable to their practice rather than a one-size-fits-all examination.
David Karp, MD, PhD , is chief of the division of rheumatic diseases at the University of Texas Southwestern Medical Center, Dallas. His comments are paraphrased from an editorial accompanying the survey report (Arthritis Care Res. 2018 Dec 20. doi: 10.1002/acr.23822 ). He had no relevant disclosures.
The fact that survey respondents say with almost identical affirmation that MOC helps them stay current on medical knowledge and is redundant with CME suggests that rheumatologists favor continuing to learn about their profession throughout the life of their career but want that learning in an environment they have more control over.
Given the expansion of technology, physicians have access at their fingertips to information, which questions the need for exams that require memorization of details.
New ways are needed to help physicians maintain certification in ways that take advantage of current information technology in a manner that can be more customizable to their practice rather than a one-size-fits-all examination.
David Karp, MD, PhD , is chief of the division of rheumatic diseases at the University of Texas Southwestern Medical Center, Dallas. His comments are paraphrased from an editorial accompanying the survey report (Arthritis Care Res. 2018 Dec 20. doi: 10.1002/acr.23822 ). He had no relevant disclosures.
Among the 515 rheumatologists responding to the survey, 74.8% “did not think there is significant additional value in MOC, beyond what is already achieved from Continuing Medical Education,” Amr Sawalha, MD, and Patrick Coit, both of the University of Michigan, Ann Arbor, wrote in Arthritis Care & Research. The survey was sent to 3,107 rheumatologists in the United States.
The survey also found that 63.5% of respondents “did not believe board recertification and MOC are valuable in terms of improving patients’ care,” although 65.6% did perceive that staying current with new knowledge was a positive effect of participating in the MOC process, Dr. Sawalha and Mr. Coit wrote.
On the flip side, requiring MOC was perceived to be a contributor to physician burnout by 77.7% of respondents and to early retirements by 67.4% of respondents.
“If participation in MOC indeed does not have a significant value on improving patient care in rheumatology, as indicated by the perception of practicing rheumatologists, and if it remains a requirement to practice for at least over a third of rheumatologists in the United States, then an argument can be made that elimination of MOC might be a way to sustain and improve the rheumatology workforce without compromising quality,” Dr. Sawalha and Mr. Coit wrote. “To our knowledge, there have not been any studies to show that rheumatologists participating in MOC activities provide better care.”
Another aspect that the survey revealed is the rheumatologists’ perception of certifying organizations.
“A striking finding from our study is the indication that there seems to be a lack of trust in [the] board-certifying organization and their motives among practicing rheumatologists in the United States,” the authors wrote. “When asked to rank in order what is thought to be the reason for creating MOC programs, financial well-being of board-certifying organizations was the highest ranked answer. Improving patient care, which is the motive claimed by board-certifying organizations, was the least likely ranked answer.”
Indeed, about 60% of respondents believe alternative organizations, such as the American College of Rheumatology, should be administering or overseeing the board certification process for rheumatologists.
“Regardless of what the motive might be, these results suggest that practicing physicians, and in this case rheumatologists, do not trust board-certifying organizations,” Dr. Sawalha and Mr. Coit wrote. “Therefore, we suggest that these organizations revisit their relationship with practicing physicians and facilitate true collaboration with physicians to determine the best way to assess and ensure physician competence and knowledge.”
The authors declared that they have no financial conflicts of interest.
SOURCE: Sawalha A and Coit P. Arthritis Care Res. 2018 Dec 20. doi: 10.1002/acr.23823
Among the 515 rheumatologists responding to the survey, 74.8% “did not think there is significant additional value in MOC, beyond what is already achieved from Continuing Medical Education,” Amr Sawalha, MD, and Patrick Coit, both of the University of Michigan, Ann Arbor, wrote in Arthritis Care & Research. The survey was sent to 3,107 rheumatologists in the United States.
The survey also found that 63.5% of respondents “did not believe board recertification and MOC are valuable in terms of improving patients’ care,” although 65.6% did perceive that staying current with new knowledge was a positive effect of participating in the MOC process, Dr. Sawalha and Mr. Coit wrote.
On the flip side, requiring MOC was perceived to be a contributor to physician burnout by 77.7% of respondents and to early retirements by 67.4% of respondents.
“If participation in MOC indeed does not have a significant value on improving patient care in rheumatology, as indicated by the perception of practicing rheumatologists, and if it remains a requirement to practice for at least over a third of rheumatologists in the United States, then an argument can be made that elimination of MOC might be a way to sustain and improve the rheumatology workforce without compromising quality,” Dr. Sawalha and Mr. Coit wrote. “To our knowledge, there have not been any studies to show that rheumatologists participating in MOC activities provide better care.”
Another aspect that the survey revealed is the rheumatologists’ perception of certifying organizations.
“A striking finding from our study is the indication that there seems to be a lack of trust in [the] board-certifying organization and their motives among practicing rheumatologists in the United States,” the authors wrote. “When asked to rank in order what is thought to be the reason for creating MOC programs, financial well-being of board-certifying organizations was the highest ranked answer. Improving patient care, which is the motive claimed by board-certifying organizations, was the least likely ranked answer.”
Indeed, about 60% of respondents believe alternative organizations, such as the American College of Rheumatology, should be administering or overseeing the board certification process for rheumatologists.
“Regardless of what the motive might be, these results suggest that practicing physicians, and in this case rheumatologists, do not trust board-certifying organizations,” Dr. Sawalha and Mr. Coit wrote. “Therefore, we suggest that these organizations revisit their relationship with practicing physicians and facilitate true collaboration with physicians to determine the best way to assess and ensure physician competence and knowledge.”
The authors declared that they have no financial conflicts of interest.
SOURCE: Sawalha A and Coit P. Arthritis Care Res. 2018 Dec 20. doi: 10.1002/acr.23823
FROM ARTHRITIS CARE & RESEARCH
Key clinical point: Nearly 75% of respondents saw little value in MOC beyond what’s achieved with Continuing Medical Education.
Major finding: Nearly two-thirds of respondents did not believe MOC is valuable in improving patients’ care.
Study details: A survey was sent to 3,107 rheumatologists in the United States to ascertain the perceived value and impact of MOC on rheumatology practice and patient care. There were 515 responses received.
Disclosures: The study authors declared that they have no financial conflicts of interest.
Source: Sawalha A and Coit P. Arthritis Care Res. 2018 Dec 20. doi: 10.1002/acr.23823
EHR stress linked to burnout
Physicians who experience stress related to the use of health information technology are twice as likely to experience burnout.
Rebekah Gardner, MD, of Brown University in Providence, R.I., and her colleagues surveyed all 4,197 Rhode Island physicians in 2017 to learn how the use of electronic health records affected their practices and their job satisfaction.
Just over a quarter (25.0%) of 1,792 respondents reported burnout. Among electronic health record users (91% of respondents), 70% reported health IT-related stress (J Am Med Inform Assoc. doi: 10.1093/jamia/ocy145).
“After adjustment, physicians reporting poor/marginal time for documentation had 2.8 times the odds of burnout (95% confidence interval, 2.0-4.1; P less than .0001) compared to those reporting sufficient time,” according to the researchers.
The team looked at three stress-related variables: whether the EHR adds to the frustration of one’s day; whether physicians felt they had sufficient time for documentation; and the amount of time spent on the EHR at home. Variables were measured on a four- or five-point scale depending on the question related to the specific stress variable.
Almost two-thirds (64.2%) of respondents “agreed” or “strongly agreed” that EHRs add to the frustration of their day.
“It was the most commonly cited HIT-related stress measure in almost every specialty, with the highest prevalence among emergency physicians (77.6%),” the investigators wrote.
More than a third of physicians (37.7%) reported “moderately high” or “excessive” time spent on EHRs at home; this metric was the most commonly cited stress measure among pediatricians (63.6%).
Nearly half (46.4%) of physicians reported “poor” or “marginal” sufficiency of time for documentation.
“Presence of any 1 of the HIT-related stress measures was associated with approximately twice the odds of burnout among physician respondents,” Dr. Gardner and her colleagues noted, adding that “measuring and addressing HIT-related stress is an important step in reducing workforce burden and improving the care of our patients.”
To alleviate burnout, the authors recommended increased use of scribes, use of medical assistants to help create a more team-based documentation function, improved EHR training, providing more time during the day for documentation, and streamlining documentation expectations, with certain culture shifts needed in some cases (i.e., banning work-related email and clinical tasks for vacationing physicians).
SOURCE: Gardner R et al. J Am Med Inform Assoc. doi: 10.1093/jamia/ocy145.
Physicians who experience stress related to the use of health information technology are twice as likely to experience burnout.
Rebekah Gardner, MD, of Brown University in Providence, R.I., and her colleagues surveyed all 4,197 Rhode Island physicians in 2017 to learn how the use of electronic health records affected their practices and their job satisfaction.
Just over a quarter (25.0%) of 1,792 respondents reported burnout. Among electronic health record users (91% of respondents), 70% reported health IT-related stress (J Am Med Inform Assoc. doi: 10.1093/jamia/ocy145).
“After adjustment, physicians reporting poor/marginal time for documentation had 2.8 times the odds of burnout (95% confidence interval, 2.0-4.1; P less than .0001) compared to those reporting sufficient time,” according to the researchers.
The team looked at three stress-related variables: whether the EHR adds to the frustration of one’s day; whether physicians felt they had sufficient time for documentation; and the amount of time spent on the EHR at home. Variables were measured on a four- or five-point scale depending on the question related to the specific stress variable.
Almost two-thirds (64.2%) of respondents “agreed” or “strongly agreed” that EHRs add to the frustration of their day.
“It was the most commonly cited HIT-related stress measure in almost every specialty, with the highest prevalence among emergency physicians (77.6%),” the investigators wrote.
More than a third of physicians (37.7%) reported “moderately high” or “excessive” time spent on EHRs at home; this metric was the most commonly cited stress measure among pediatricians (63.6%).
Nearly half (46.4%) of physicians reported “poor” or “marginal” sufficiency of time for documentation.
“Presence of any 1 of the HIT-related stress measures was associated with approximately twice the odds of burnout among physician respondents,” Dr. Gardner and her colleagues noted, adding that “measuring and addressing HIT-related stress is an important step in reducing workforce burden and improving the care of our patients.”
To alleviate burnout, the authors recommended increased use of scribes, use of medical assistants to help create a more team-based documentation function, improved EHR training, providing more time during the day for documentation, and streamlining documentation expectations, with certain culture shifts needed in some cases (i.e., banning work-related email and clinical tasks for vacationing physicians).
SOURCE: Gardner R et al. J Am Med Inform Assoc. doi: 10.1093/jamia/ocy145.
Physicians who experience stress related to the use of health information technology are twice as likely to experience burnout.
Rebekah Gardner, MD, of Brown University in Providence, R.I., and her colleagues surveyed all 4,197 Rhode Island physicians in 2017 to learn how the use of electronic health records affected their practices and their job satisfaction.
Just over a quarter (25.0%) of 1,792 respondents reported burnout. Among electronic health record users (91% of respondents), 70% reported health IT-related stress (J Am Med Inform Assoc. doi: 10.1093/jamia/ocy145).
“After adjustment, physicians reporting poor/marginal time for documentation had 2.8 times the odds of burnout (95% confidence interval, 2.0-4.1; P less than .0001) compared to those reporting sufficient time,” according to the researchers.
The team looked at three stress-related variables: whether the EHR adds to the frustration of one’s day; whether physicians felt they had sufficient time for documentation; and the amount of time spent on the EHR at home. Variables were measured on a four- or five-point scale depending on the question related to the specific stress variable.
Almost two-thirds (64.2%) of respondents “agreed” or “strongly agreed” that EHRs add to the frustration of their day.
“It was the most commonly cited HIT-related stress measure in almost every specialty, with the highest prevalence among emergency physicians (77.6%),” the investigators wrote.
More than a third of physicians (37.7%) reported “moderately high” or “excessive” time spent on EHRs at home; this metric was the most commonly cited stress measure among pediatricians (63.6%).
Nearly half (46.4%) of physicians reported “poor” or “marginal” sufficiency of time for documentation.
“Presence of any 1 of the HIT-related stress measures was associated with approximately twice the odds of burnout among physician respondents,” Dr. Gardner and her colleagues noted, adding that “measuring and addressing HIT-related stress is an important step in reducing workforce burden and improving the care of our patients.”
To alleviate burnout, the authors recommended increased use of scribes, use of medical assistants to help create a more team-based documentation function, improved EHR training, providing more time during the day for documentation, and streamlining documentation expectations, with certain culture shifts needed in some cases (i.e., banning work-related email and clinical tasks for vacationing physicians).
SOURCE: Gardner R et al. J Am Med Inform Assoc. doi: 10.1093/jamia/ocy145.
FROM JAMIA
Key clinical point: EHR-related stress is a measurable predictor of physician burnout.
Major finding: Seventy percent of EHR users who responded to a survey reported stress related to the use of health information technology.
Study details: Survey of all 4,197 physicians in Rhode Island; 1,792 (43%) responded.
Disclosures: The Rhode Island Department of Health funded the study. The authors reported no conflicts of interest.
Source: Gardner R et al. J Am Med Inform Assoc. doi: 10.1093/jamia/ocy145.
With hemp now legal, FDA reaffirms rules for cannabis compounds
The newly enacted Agriculture Improvement Act of 2018 legalizes hemp production and use, but the Food and Drug Administration’s regulation of cannabis and cannabis-derived products remains unchanged.
The act (H.R. 2) revamps federal authorities’ regulatory approach to hemp production. The law removes hemp from the Controlled Substances Act, which means it is no longer an illegal substance. Hemp is now defined as cannabis and derivatives of cannabis that have extremely low concentrations (less than 0.3%, on a dry weight basis) of the psychoactive compound delta-9-tetrahydrocannabinol (THC).
Despite hemp’s new legal status, FDA Commissioner Scott Gottlieb, MD, said the FDA’s regulation of cannabis and cannabis-derived products remains the same.
“In short, we treat products containing cannabis or cannabis-derived compounds as we do any other FDA-regulated products,” FDA Commissioner Scott Gottlieb, MD, said in a Dec. 20 statement published on the FDA website. That means “they’re subject to the same authorities and requirements as FDA-regulated products containing any other substance.”
The regulation of those products will be the same regardless of the source of the substance, including from plants classified as hemp. The FDA will require cannabis and cannabis-derived products to undergo testing similar to other drug products, given the concern regarding medical claims made about those products.
“Cannabis and cannabis-derived products claiming in their marketing and promotional materials that they’re intended for use in the diagnosis, cure, mitigation, treatment, or prevention of diseases (such as cancer, Alzheimer’s disease, psychiatric disorders and diabetes) are considered new drugs or new animal drugs,” Dr. Gottlieb explained. And they “must go through the FDA drug approval process for human or animal use before they are marketed in the United States.”
Selling unapproved products with unsubstantiated claims is a “violation of the law.”
In addition, “it’s unlawful under the [Food, Drug & Cosmetics Act] to introduce food containing added CBD [cannabidiol] or THC into interstate commerce, or to market CBD or THC products as, or in, dietary supplements, regardless of whether the substances are hemp derived,” Dr. Gottlieb noted. That’s because both CBD and THC are active ingredients in FDA-approved drugs.
Commissioner Gottlieb also noted that “pathways remain available for the FDA to consider whether there are circumstances in which certain cannabis-derived compounds might be permitted in a food or dietary supplement.” The FDA announced plans for a future meeting to discuss the lawful marketing of hemp-derived foods that do not contain CBD or THC.
The newly enacted Agriculture Improvement Act of 2018 legalizes hemp production and use, but the Food and Drug Administration’s regulation of cannabis and cannabis-derived products remains unchanged.
The act (H.R. 2) revamps federal authorities’ regulatory approach to hemp production. The law removes hemp from the Controlled Substances Act, which means it is no longer an illegal substance. Hemp is now defined as cannabis and derivatives of cannabis that have extremely low concentrations (less than 0.3%, on a dry weight basis) of the psychoactive compound delta-9-tetrahydrocannabinol (THC).
Despite hemp’s new legal status, FDA Commissioner Scott Gottlieb, MD, said the FDA’s regulation of cannabis and cannabis-derived products remains the same.
“In short, we treat products containing cannabis or cannabis-derived compounds as we do any other FDA-regulated products,” FDA Commissioner Scott Gottlieb, MD, said in a Dec. 20 statement published on the FDA website. That means “they’re subject to the same authorities and requirements as FDA-regulated products containing any other substance.”
The regulation of those products will be the same regardless of the source of the substance, including from plants classified as hemp. The FDA will require cannabis and cannabis-derived products to undergo testing similar to other drug products, given the concern regarding medical claims made about those products.
“Cannabis and cannabis-derived products claiming in their marketing and promotional materials that they’re intended for use in the diagnosis, cure, mitigation, treatment, or prevention of diseases (such as cancer, Alzheimer’s disease, psychiatric disorders and diabetes) are considered new drugs or new animal drugs,” Dr. Gottlieb explained. And they “must go through the FDA drug approval process for human or animal use before they are marketed in the United States.”
Selling unapproved products with unsubstantiated claims is a “violation of the law.”
In addition, “it’s unlawful under the [Food, Drug & Cosmetics Act] to introduce food containing added CBD [cannabidiol] or THC into interstate commerce, or to market CBD or THC products as, or in, dietary supplements, regardless of whether the substances are hemp derived,” Dr. Gottlieb noted. That’s because both CBD and THC are active ingredients in FDA-approved drugs.
Commissioner Gottlieb also noted that “pathways remain available for the FDA to consider whether there are circumstances in which certain cannabis-derived compounds might be permitted in a food or dietary supplement.” The FDA announced plans for a future meeting to discuss the lawful marketing of hemp-derived foods that do not contain CBD or THC.
The newly enacted Agriculture Improvement Act of 2018 legalizes hemp production and use, but the Food and Drug Administration’s regulation of cannabis and cannabis-derived products remains unchanged.
The act (H.R. 2) revamps federal authorities’ regulatory approach to hemp production. The law removes hemp from the Controlled Substances Act, which means it is no longer an illegal substance. Hemp is now defined as cannabis and derivatives of cannabis that have extremely low concentrations (less than 0.3%, on a dry weight basis) of the psychoactive compound delta-9-tetrahydrocannabinol (THC).
Despite hemp’s new legal status, FDA Commissioner Scott Gottlieb, MD, said the FDA’s regulation of cannabis and cannabis-derived products remains the same.
“In short, we treat products containing cannabis or cannabis-derived compounds as we do any other FDA-regulated products,” FDA Commissioner Scott Gottlieb, MD, said in a Dec. 20 statement published on the FDA website. That means “they’re subject to the same authorities and requirements as FDA-regulated products containing any other substance.”
The regulation of those products will be the same regardless of the source of the substance, including from plants classified as hemp. The FDA will require cannabis and cannabis-derived products to undergo testing similar to other drug products, given the concern regarding medical claims made about those products.
“Cannabis and cannabis-derived products claiming in their marketing and promotional materials that they’re intended for use in the diagnosis, cure, mitigation, treatment, or prevention of diseases (such as cancer, Alzheimer’s disease, psychiatric disorders and diabetes) are considered new drugs or new animal drugs,” Dr. Gottlieb explained. And they “must go through the FDA drug approval process for human or animal use before they are marketed in the United States.”
Selling unapproved products with unsubstantiated claims is a “violation of the law.”
In addition, “it’s unlawful under the [Food, Drug & Cosmetics Act] to introduce food containing added CBD [cannabidiol] or THC into interstate commerce, or to market CBD or THC products as, or in, dietary supplements, regardless of whether the substances are hemp derived,” Dr. Gottlieb noted. That’s because both CBD and THC are active ingredients in FDA-approved drugs.
Commissioner Gottlieb also noted that “pathways remain available for the FDA to consider whether there are circumstances in which certain cannabis-derived compounds might be permitted in a food or dietary supplement.” The FDA announced plans for a future meeting to discuss the lawful marketing of hemp-derived foods that do not contain CBD or THC.
Next legal ruling on ACA could come on New Year’s Eve
As Democratic governors scramble to appeal a Dec. 14 ruling that essentially struck down the Affordable Care Act, a reprieve keeping the law intact could come by the end of the year.
The ACA remains in effect until Dec. 31 after Judge Reed O’Connor of the U.S. District Court for the Northern District of Texas ruled that the 2017 tax law that zeroed out penalties beginning in 2019 for not carrying health insurance effectively rendered the entire ACA unconstitutional.
On Dec. 17, a group of Democratic attorneys general “asked Judge O’Connor to clarify that his ruling does not presently affect any rights or responsibilities under the ACA until appellate review is complete, or alternatively to stay his ruling,” Timothy S. Jost, emeritus professor at the Washington and Lee School of Law, in Lexington, Va., said during a Dec. 18 press teleconference hosted by the Commonwealth Fund. “They also asked him to certify the case for an immediate appeal and to do so by the end of this week.”
Mr. Jost noted that Judge O’Connor asked the plaintiffs and the U.S. Department of Health & Human Services to respond to this request by Dec. 21.
“I expect him to rule, probably, on New Year’s Eve on what happens next,” Mr. Jost said.
If Judge O’Connor refuses to stay his order, the group of Democratic attorneys general is expected to appeal to the Fifth Circuit Court of Appeals for such a stay, Mr. Jost said. He noted that the Fifth Circuit is one of the more conservative courts – with five Trump administration appointees and five judges appointed by previous Democratic administrations.
In general, Mr. Jost said that he does not expect Judge O’Connor’s ruling to stand.
“The decision is so clearly wrong, however, that I believe there is a good chance that it will be reversed,” he said. “If the Fifth Circuit does, I think it is very unlikely the Supreme Court take the case.” He added that if the Fifth Circuit upholds Judge O’Connor’s ruling, the court would take the case and “very likely reverse at least 5-4 and quite possibly 6-3 on at least the issue of severability.”
Mr. Jost added that he expects the case to drag into 2020 and possibly 2021.
Democrats – with their new majority in the House of Representatives – are likely to intervene legislatively in early in 2019 but are unlikely to be successful at getting the Republican-led Senate to pass “feel-good” legislation that would protect those with preexisting conditions, something Mr. Jost said “cannot be re-created” short of reenacting the entire ACA given the complex processes and subsidies that make coverage of preexisting conditions possible.
Both chambers of Congress could work together on something as simple as reinstating the penalty – even if it were set at just $1 – to coming up with something more comprehensive, but that would be extremely challenging to make happen and to get President Trump to sign off on, he said.
As Democratic governors scramble to appeal a Dec. 14 ruling that essentially struck down the Affordable Care Act, a reprieve keeping the law intact could come by the end of the year.
The ACA remains in effect until Dec. 31 after Judge Reed O’Connor of the U.S. District Court for the Northern District of Texas ruled that the 2017 tax law that zeroed out penalties beginning in 2019 for not carrying health insurance effectively rendered the entire ACA unconstitutional.
On Dec. 17, a group of Democratic attorneys general “asked Judge O’Connor to clarify that his ruling does not presently affect any rights or responsibilities under the ACA until appellate review is complete, or alternatively to stay his ruling,” Timothy S. Jost, emeritus professor at the Washington and Lee School of Law, in Lexington, Va., said during a Dec. 18 press teleconference hosted by the Commonwealth Fund. “They also asked him to certify the case for an immediate appeal and to do so by the end of this week.”
Mr. Jost noted that Judge O’Connor asked the plaintiffs and the U.S. Department of Health & Human Services to respond to this request by Dec. 21.
“I expect him to rule, probably, on New Year’s Eve on what happens next,” Mr. Jost said.
If Judge O’Connor refuses to stay his order, the group of Democratic attorneys general is expected to appeal to the Fifth Circuit Court of Appeals for such a stay, Mr. Jost said. He noted that the Fifth Circuit is one of the more conservative courts – with five Trump administration appointees and five judges appointed by previous Democratic administrations.
In general, Mr. Jost said that he does not expect Judge O’Connor’s ruling to stand.
“The decision is so clearly wrong, however, that I believe there is a good chance that it will be reversed,” he said. “If the Fifth Circuit does, I think it is very unlikely the Supreme Court take the case.” He added that if the Fifth Circuit upholds Judge O’Connor’s ruling, the court would take the case and “very likely reverse at least 5-4 and quite possibly 6-3 on at least the issue of severability.”
Mr. Jost added that he expects the case to drag into 2020 and possibly 2021.
Democrats – with their new majority in the House of Representatives – are likely to intervene legislatively in early in 2019 but are unlikely to be successful at getting the Republican-led Senate to pass “feel-good” legislation that would protect those with preexisting conditions, something Mr. Jost said “cannot be re-created” short of reenacting the entire ACA given the complex processes and subsidies that make coverage of preexisting conditions possible.
Both chambers of Congress could work together on something as simple as reinstating the penalty – even if it were set at just $1 – to coming up with something more comprehensive, but that would be extremely challenging to make happen and to get President Trump to sign off on, he said.
As Democratic governors scramble to appeal a Dec. 14 ruling that essentially struck down the Affordable Care Act, a reprieve keeping the law intact could come by the end of the year.
The ACA remains in effect until Dec. 31 after Judge Reed O’Connor of the U.S. District Court for the Northern District of Texas ruled that the 2017 tax law that zeroed out penalties beginning in 2019 for not carrying health insurance effectively rendered the entire ACA unconstitutional.
On Dec. 17, a group of Democratic attorneys general “asked Judge O’Connor to clarify that his ruling does not presently affect any rights or responsibilities under the ACA until appellate review is complete, or alternatively to stay his ruling,” Timothy S. Jost, emeritus professor at the Washington and Lee School of Law, in Lexington, Va., said during a Dec. 18 press teleconference hosted by the Commonwealth Fund. “They also asked him to certify the case for an immediate appeal and to do so by the end of this week.”
Mr. Jost noted that Judge O’Connor asked the plaintiffs and the U.S. Department of Health & Human Services to respond to this request by Dec. 21.
“I expect him to rule, probably, on New Year’s Eve on what happens next,” Mr. Jost said.
If Judge O’Connor refuses to stay his order, the group of Democratic attorneys general is expected to appeal to the Fifth Circuit Court of Appeals for such a stay, Mr. Jost said. He noted that the Fifth Circuit is one of the more conservative courts – with five Trump administration appointees and five judges appointed by previous Democratic administrations.
In general, Mr. Jost said that he does not expect Judge O’Connor’s ruling to stand.
“The decision is so clearly wrong, however, that I believe there is a good chance that it will be reversed,” he said. “If the Fifth Circuit does, I think it is very unlikely the Supreme Court take the case.” He added that if the Fifth Circuit upholds Judge O’Connor’s ruling, the court would take the case and “very likely reverse at least 5-4 and quite possibly 6-3 on at least the issue of severability.”
Mr. Jost added that he expects the case to drag into 2020 and possibly 2021.
Democrats – with their new majority in the House of Representatives – are likely to intervene legislatively in early in 2019 but are unlikely to be successful at getting the Republican-led Senate to pass “feel-good” legislation that would protect those with preexisting conditions, something Mr. Jost said “cannot be re-created” short of reenacting the entire ACA given the complex processes and subsidies that make coverage of preexisting conditions possible.
Both chambers of Congress could work together on something as simple as reinstating the penalty – even if it were set at just $1 – to coming up with something more comprehensive, but that would be extremely challenging to make happen and to get President Trump to sign off on, he said.
More rheumatology slots available, filled on Specialty Match Day, but numbers well below need
Although more fellowships slots in rheumatology were available and filled during the Specialty Match Day for the 2019 appointment year, the numbers are still well below what will be needed to fill the physician shortfall in this area.
For the 2019 appointment year, there were 236 fellowship positions available, with 233 of them filled, up from 221 positions available and 218 filled on the previous year’s Specialty Match Day, according to results released by the National Resident Matching Program.
Adding 10 or even 20 a year “is still not going to make a dent” in the expected rheumatologist shortfall, Beth Jonas, MD, director of the Rheumatology Fellowship Training Program at the University of North Carolina, Chapel Hill, said in an interview.
That being said, there are still positive messages to be taken away from the Specialty Match Day results.
“The rheumatology match was great this year,” Dr. Jonas said. “From the perspective of the quality of the applicant pool, it was very strong. The interest in rheumatology is very high. From the perspective of program directors, we had a lot of excellent applicants to interview and to choose from.”
She noted that in total there were 358 applicants who listed rheumatology as their preference for the 2019 appointment year, up from 313. Dr. Jonas also serves as chair of the American College of Rheumatology’s Committee on Rheumatology Training and Workforce Issues.
“The message here is that there are a lot more people who want to become rheumatologists than there are slots to train them,” she stated.
And the key reason more people aren’t being trained is money.
“There is capacity to train more people, but the challenge is funding those slots,” Dr. Jonas said, noting that the ACR is doing what it can to help fund fellowship slots, and the Arthritis Foundation has a new grant mechanism that has helped to fund new slots.
“But I think there needs to be other ways.”
She suggested that there should be more involvement from the federal government, perhaps through Medicare, and more involvement from local institutions.
Mona Singer, president and CEO of the National Resident Matching Program, highlighted rheumatology as a standout among the overall specialty matching programs for the 2019 program year.
“The specialty that has become more popular over the years is rheumatology, which I find interesting,” Ms. Singer said. “This isn’t the first year it has done well, but it has been on an upward trend.”
Overall, the programs that have been doing well, matching at a rate of 95% or better, have continued to see those high fill rates: allergy/immunology, cardiology, gastroenterology, hematology, oncology, pulmonary and critical care medicine, and endocrinology.
For the 2019 appointment year, there were a total of 5,881 applicants for 5,215 program slots, with 4,579 positions filled. The fill rate of 87.8% is unchanged from the previous year, when 5,491 applicants competed for 4,831 positions, with 4,242 slots filled.
Although more fellowships slots in rheumatology were available and filled during the Specialty Match Day for the 2019 appointment year, the numbers are still well below what will be needed to fill the physician shortfall in this area.
For the 2019 appointment year, there were 236 fellowship positions available, with 233 of them filled, up from 221 positions available and 218 filled on the previous year’s Specialty Match Day, according to results released by the National Resident Matching Program.
Adding 10 or even 20 a year “is still not going to make a dent” in the expected rheumatologist shortfall, Beth Jonas, MD, director of the Rheumatology Fellowship Training Program at the University of North Carolina, Chapel Hill, said in an interview.
That being said, there are still positive messages to be taken away from the Specialty Match Day results.
“The rheumatology match was great this year,” Dr. Jonas said. “From the perspective of the quality of the applicant pool, it was very strong. The interest in rheumatology is very high. From the perspective of program directors, we had a lot of excellent applicants to interview and to choose from.”
She noted that in total there were 358 applicants who listed rheumatology as their preference for the 2019 appointment year, up from 313. Dr. Jonas also serves as chair of the American College of Rheumatology’s Committee on Rheumatology Training and Workforce Issues.
“The message here is that there are a lot more people who want to become rheumatologists than there are slots to train them,” she stated.
And the key reason more people aren’t being trained is money.
“There is capacity to train more people, but the challenge is funding those slots,” Dr. Jonas said, noting that the ACR is doing what it can to help fund fellowship slots, and the Arthritis Foundation has a new grant mechanism that has helped to fund new slots.
“But I think there needs to be other ways.”
She suggested that there should be more involvement from the federal government, perhaps through Medicare, and more involvement from local institutions.
Mona Singer, president and CEO of the National Resident Matching Program, highlighted rheumatology as a standout among the overall specialty matching programs for the 2019 program year.
“The specialty that has become more popular over the years is rheumatology, which I find interesting,” Ms. Singer said. “This isn’t the first year it has done well, but it has been on an upward trend.”
Overall, the programs that have been doing well, matching at a rate of 95% or better, have continued to see those high fill rates: allergy/immunology, cardiology, gastroenterology, hematology, oncology, pulmonary and critical care medicine, and endocrinology.
For the 2019 appointment year, there were a total of 5,881 applicants for 5,215 program slots, with 4,579 positions filled. The fill rate of 87.8% is unchanged from the previous year, when 5,491 applicants competed for 4,831 positions, with 4,242 slots filled.
Although more fellowships slots in rheumatology were available and filled during the Specialty Match Day for the 2019 appointment year, the numbers are still well below what will be needed to fill the physician shortfall in this area.
For the 2019 appointment year, there were 236 fellowship positions available, with 233 of them filled, up from 221 positions available and 218 filled on the previous year’s Specialty Match Day, according to results released by the National Resident Matching Program.
Adding 10 or even 20 a year “is still not going to make a dent” in the expected rheumatologist shortfall, Beth Jonas, MD, director of the Rheumatology Fellowship Training Program at the University of North Carolina, Chapel Hill, said in an interview.
That being said, there are still positive messages to be taken away from the Specialty Match Day results.
“The rheumatology match was great this year,” Dr. Jonas said. “From the perspective of the quality of the applicant pool, it was very strong. The interest in rheumatology is very high. From the perspective of program directors, we had a lot of excellent applicants to interview and to choose from.”
She noted that in total there were 358 applicants who listed rheumatology as their preference for the 2019 appointment year, up from 313. Dr. Jonas also serves as chair of the American College of Rheumatology’s Committee on Rheumatology Training and Workforce Issues.
“The message here is that there are a lot more people who want to become rheumatologists than there are slots to train them,” she stated.
And the key reason more people aren’t being trained is money.
“There is capacity to train more people, but the challenge is funding those slots,” Dr. Jonas said, noting that the ACR is doing what it can to help fund fellowship slots, and the Arthritis Foundation has a new grant mechanism that has helped to fund new slots.
“But I think there needs to be other ways.”
She suggested that there should be more involvement from the federal government, perhaps through Medicare, and more involvement from local institutions.
Mona Singer, president and CEO of the National Resident Matching Program, highlighted rheumatology as a standout among the overall specialty matching programs for the 2019 program year.
“The specialty that has become more popular over the years is rheumatology, which I find interesting,” Ms. Singer said. “This isn’t the first year it has done well, but it has been on an upward trend.”
Overall, the programs that have been doing well, matching at a rate of 95% or better, have continued to see those high fill rates: allergy/immunology, cardiology, gastroenterology, hematology, oncology, pulmonary and critical care medicine, and endocrinology.
For the 2019 appointment year, there were a total of 5,881 applicants for 5,215 program slots, with 4,579 positions filled. The fill rate of 87.8% is unchanged from the previous year, when 5,491 applicants competed for 4,831 positions, with 4,242 slots filled.
Part D proposal includes prior authorization, step therapy
Rules governing the six protected medication classes covered by Medicare Part D could change under a proposal that would allow for utilization management or potential formulary exclusion of a drug for price increases.
Currently, Medicare Part D prescription drug benefit plans must cover “all or substantially all” approved drugs in six classes (antidepressants, antipsychotics, anticonvulsants, antiretrovirals, and antineoplastics). The proposed rule would allow three exceptions aimed at giving plans more negotiating leverage to help lower prices.
Plans would be allowed to implement prior authorization and step therapy for protected-class drugs, “including to determine use for a protected class indication,” according to a fact sheet. They also could exclude a protected-class drug from their formulary “if the drug represents only a new formulation of an existing single-source drug or biological product, regardless of whether the older formulation remains on the market.”
This does not change requirements that at least two drugs per class be covered, Seema Verma, administrator of the Centers for Medicare & Medicaid Services, said at a briefing. “In some classes, there are lots of competitors. For example, for antidepressants, there are lots of new generics available, so we see plans being in a very strengthened negotiating position. But in other classes, where there may not be as many drugs that are available, you might not see the same type of step therapy and prior authorization because there are just not that many options. It is really going to depend on the class of drugs and what’s available and the plans’ ability to negotiate discounts with manufacturers.”
Plans could exclude a protected-class drug if its price had increased greater than inflation, Ms. Verma said, but they could not use this to not cover any drugs in a class if available options are limited to one or two drugs.
“Foremost in our minds was the impact on patients and ensuring affordability and access to prescription drugs,” Ms. Verma said.
Oncologists don’t seem to agree.
“For the first time ever, Medicare patients with cancer and other serious diseases [who] rely on drugs in these protected therapeutic categories, will no longer have guaranteed access to potentially life-saving drugs. Instead, they will be subjected to ‘fail first’ step therapy and formulary restrictions that potentially restrict them from receiving the evidence-based therapies that their trained physicians prescribe as first-line cancer treatment,” Jeff Vacirca, MD, president of the Community Oncology Alliance, said in a statement. “Step therapy requirements are driven by financial interests to save money and not by what is in the best medical interest of patients. Treatment decisions are made by nameless and faceless corporate bureaucrats who are often not board certified in the diseases they are making coverage decisions over.”
AGA is concerned that these proposed changes will limit access for current and future beneficiaries and will add to the growing regulatory burden that physicians already face.
The proposal also would codify a policy implemented for 2019 that allows Medicare Advantage to implement step therapy tools for Part B drugs. And like the 2019 policy, the proposal would apply to new medication starts only, must be reviewed by a plan’s pharmacy and therapeutics committee, and must have an expedited exceptions process.
The proposal also specifically allows pharmacists to advise Part D beneficiaries on lower-cost options – something current regulations prohibit – and would require Part D explanation of benefits forms to include drug pricing information and lower-cost therapeutic alternatives.
The proposal is part of a broader update for Medicare Parts C and D in 2020 issued by CMS. It was published online Nov. 26 and is scheduled for publication in the Federal Register on Nov. 30. Comments can be made at www.regulations.gov through Jan. 25, 2019.
Rules governing the six protected medication classes covered by Medicare Part D could change under a proposal that would allow for utilization management or potential formulary exclusion of a drug for price increases.
Currently, Medicare Part D prescription drug benefit plans must cover “all or substantially all” approved drugs in six classes (antidepressants, antipsychotics, anticonvulsants, antiretrovirals, and antineoplastics). The proposed rule would allow three exceptions aimed at giving plans more negotiating leverage to help lower prices.
Plans would be allowed to implement prior authorization and step therapy for protected-class drugs, “including to determine use for a protected class indication,” according to a fact sheet. They also could exclude a protected-class drug from their formulary “if the drug represents only a new formulation of an existing single-source drug or biological product, regardless of whether the older formulation remains on the market.”
This does not change requirements that at least two drugs per class be covered, Seema Verma, administrator of the Centers for Medicare & Medicaid Services, said at a briefing. “In some classes, there are lots of competitors. For example, for antidepressants, there are lots of new generics available, so we see plans being in a very strengthened negotiating position. But in other classes, where there may not be as many drugs that are available, you might not see the same type of step therapy and prior authorization because there are just not that many options. It is really going to depend on the class of drugs and what’s available and the plans’ ability to negotiate discounts with manufacturers.”
Plans could exclude a protected-class drug if its price had increased greater than inflation, Ms. Verma said, but they could not use this to not cover any drugs in a class if available options are limited to one or two drugs.
“Foremost in our minds was the impact on patients and ensuring affordability and access to prescription drugs,” Ms. Verma said.
Oncologists don’t seem to agree.
“For the first time ever, Medicare patients with cancer and other serious diseases [who] rely on drugs in these protected therapeutic categories, will no longer have guaranteed access to potentially life-saving drugs. Instead, they will be subjected to ‘fail first’ step therapy and formulary restrictions that potentially restrict them from receiving the evidence-based therapies that their trained physicians prescribe as first-line cancer treatment,” Jeff Vacirca, MD, president of the Community Oncology Alliance, said in a statement. “Step therapy requirements are driven by financial interests to save money and not by what is in the best medical interest of patients. Treatment decisions are made by nameless and faceless corporate bureaucrats who are often not board certified in the diseases they are making coverage decisions over.”
AGA is concerned that these proposed changes will limit access for current and future beneficiaries and will add to the growing regulatory burden that physicians already face.
The proposal also would codify a policy implemented for 2019 that allows Medicare Advantage to implement step therapy tools for Part B drugs. And like the 2019 policy, the proposal would apply to new medication starts only, must be reviewed by a plan’s pharmacy and therapeutics committee, and must have an expedited exceptions process.
The proposal also specifically allows pharmacists to advise Part D beneficiaries on lower-cost options – something current regulations prohibit – and would require Part D explanation of benefits forms to include drug pricing information and lower-cost therapeutic alternatives.
The proposal is part of a broader update for Medicare Parts C and D in 2020 issued by CMS. It was published online Nov. 26 and is scheduled for publication in the Federal Register on Nov. 30. Comments can be made at www.regulations.gov through Jan. 25, 2019.
Rules governing the six protected medication classes covered by Medicare Part D could change under a proposal that would allow for utilization management or potential formulary exclusion of a drug for price increases.
Currently, Medicare Part D prescription drug benefit plans must cover “all or substantially all” approved drugs in six classes (antidepressants, antipsychotics, anticonvulsants, antiretrovirals, and antineoplastics). The proposed rule would allow three exceptions aimed at giving plans more negotiating leverage to help lower prices.
Plans would be allowed to implement prior authorization and step therapy for protected-class drugs, “including to determine use for a protected class indication,” according to a fact sheet. They also could exclude a protected-class drug from their formulary “if the drug represents only a new formulation of an existing single-source drug or biological product, regardless of whether the older formulation remains on the market.”
This does not change requirements that at least two drugs per class be covered, Seema Verma, administrator of the Centers for Medicare & Medicaid Services, said at a briefing. “In some classes, there are lots of competitors. For example, for antidepressants, there are lots of new generics available, so we see plans being in a very strengthened negotiating position. But in other classes, where there may not be as many drugs that are available, you might not see the same type of step therapy and prior authorization because there are just not that many options. It is really going to depend on the class of drugs and what’s available and the plans’ ability to negotiate discounts with manufacturers.”
Plans could exclude a protected-class drug if its price had increased greater than inflation, Ms. Verma said, but they could not use this to not cover any drugs in a class if available options are limited to one or two drugs.
“Foremost in our minds was the impact on patients and ensuring affordability and access to prescription drugs,” Ms. Verma said.
Oncologists don’t seem to agree.
“For the first time ever, Medicare patients with cancer and other serious diseases [who] rely on drugs in these protected therapeutic categories, will no longer have guaranteed access to potentially life-saving drugs. Instead, they will be subjected to ‘fail first’ step therapy and formulary restrictions that potentially restrict them from receiving the evidence-based therapies that their trained physicians prescribe as first-line cancer treatment,” Jeff Vacirca, MD, president of the Community Oncology Alliance, said in a statement. “Step therapy requirements are driven by financial interests to save money and not by what is in the best medical interest of patients. Treatment decisions are made by nameless and faceless corporate bureaucrats who are often not board certified in the diseases they are making coverage decisions over.”
AGA is concerned that these proposed changes will limit access for current and future beneficiaries and will add to the growing regulatory burden that physicians already face.
The proposal also would codify a policy implemented for 2019 that allows Medicare Advantage to implement step therapy tools for Part B drugs. And like the 2019 policy, the proposal would apply to new medication starts only, must be reviewed by a plan’s pharmacy and therapeutics committee, and must have an expedited exceptions process.
The proposal also specifically allows pharmacists to advise Part D beneficiaries on lower-cost options – something current regulations prohibit – and would require Part D explanation of benefits forms to include drug pricing information and lower-cost therapeutic alternatives.
The proposal is part of a broader update for Medicare Parts C and D in 2020 issued by CMS. It was published online Nov. 26 and is scheduled for publication in the Federal Register on Nov. 30. Comments can be made at www.regulations.gov through Jan. 25, 2019.
Fewer insured may have helped slow health spending growth in 2017
Health care spending as a percentage of gross domestic product remained relatively stable in 2017, despite a slowdown in the growth of spending.
Total health care spending in the United States was $3.5 trillion in 2017, an increase of 3.9% from 2016, according to data released Dec. 6 by the Centers for Medicare & Medicaid Services.
The growth rate was down from that of 2016 (4.8%) but similar to growth rates experienced during 2008-2013, according to the research article in Health Affairs.
“The slower growth in health care spending in 2017 resulted primarily from slower growth in hospital care, physician and clinical services, and retail prescription drugs, with residual use and intensity of these goods and services contributing substantially to the trend,” Anne B. Martin, an economist in the CMS Office of the Actuary’s National Health Statistics Group, and her colleagues wrote.
The report notes that slower growth in the use and intensity of health care goods and services in 2017 “may have been affected by slower growth in overall health insurance enrollment, as the insured share of the population fell from 91.1% in 2016 to 90.9% in 2017.”
Spending on hospital care increased 4.6% to $1.1 trillion in 2017 and accounted for 33% of total health care spending; however, growth was slower than in the previous year (5.6%). Ms. Martin and her colleagues noted that growth in outpatient visits slowed while growth in inpatient days increased at about the same rate and prices in hospital care grew in 2017 to 1.7% from 1.2% in the previous year.
Spending on physician and clinical services grew 4.2% in 2017 to $694.3 billion and accounted for 20% of total health care spending. The growth rate is down from the previous year (5.6%) and a recent peak of 6% in 2015.
“Although spending growth for both physician services and clinical services slowed in 2017, the growth rate for the latter (5.0%) continued to out pace the rate for the former (3.9%), as spending for most types of outpatient care centers contributed to the stronger growth in spending for clinical services,” Ms. Martin and her colleagues reported.
They attributed the slowdown to non-price factors, such as slower growth in the use and intensity of physician and clinical services, although price growth for physician and clinical services increased 0.4% in 2017, up from 0.2% in 2016.
Spending on retail prescription drugs grew 0.4% in 2017 to $333.4 billion and accounted for 10% of total national health spending. It is the slowest growth rate increase since 2012, a year that saw a number of blockbuster drugs lose patent protection. This was down from a growth rate of 2.3% in 2016 and down from recent rates of 12.4% in 2014 and 8.9% in 2015.
“Slower growth in non-price factors, such as the use and mix of retail prescription drugs – and, to a lesser extent, in retail prescription drug prices – contributed to the slower overall growth in retail prescription drug spending in 2017,” according to the authors. Key factors included slower growth in the number of prescriptions dispensed, the continued shift to lower-cost generics, and slower growth in the volume of high-cost drugs, particularly those used to treat hepatitis C. Price decreases in generics and lower increases for existing brand-name drugs also contributed to the lower spending growth in 2017.
Ms. Martin and her colleagues highlighted the slower growth rate in the number of prescriptions (1.8% in 2017, down from 2.3% in 2016) “resulted in large part from a decline in the number of prescriptions dispensed for drugs used to treat pain.”
Medicare spending, which represents 20% of all national health care spending in 2017 ($705.9 billion), grew 4.2%, a slight decline from the 4.3% growth in 2016. Enrollment growth slowed slightly to 2.5% in 2017 from 2.7% in the previous year, while in the same time frame, per-enrollee expenditures increased slightly to 1.7% from 1.6%. Slower growth in fee-for-service Medicare spending was offset by faster growth in spending by Medicare private health plans.
Medicaid spending reached $581.9 billion (17% of national health care spending), and the growth rate slowed for the third straight year, increasing 2.9% in 2017 versus 4.2% in 2016. The slower growth “was influenced by a deceleration in enrollment growth and a reduction in the Medicaid net cost of health insurance as the federal government recovered payments from managed care organizations based on their favorable prior-period experience,” the authors stated. Enrollment growth has been decelerating following a peak of growth of 11.9% in 2014 because of states that elected to expand Medicaid eligibility, which was followed by 3 years of slower growth rates of 4.9%, 3.0% and 2.0% in 2015, 2016, and 2017, respectively. Per-enrollee spending also slowed to 0.9% growth in 2017 from a rate of 1.2% in 2016, attributed to “the decline in government administration and the net cost of insurance.”
SOURCE: Martin A et al. Health Aff. 2018. doi: 10.1377/hlthaff.2018.05085.
Health care spending as a percentage of gross domestic product remained relatively stable in 2017, despite a slowdown in the growth of spending.
Total health care spending in the United States was $3.5 trillion in 2017, an increase of 3.9% from 2016, according to data released Dec. 6 by the Centers for Medicare & Medicaid Services.
The growth rate was down from that of 2016 (4.8%) but similar to growth rates experienced during 2008-2013, according to the research article in Health Affairs.
“The slower growth in health care spending in 2017 resulted primarily from slower growth in hospital care, physician and clinical services, and retail prescription drugs, with residual use and intensity of these goods and services contributing substantially to the trend,” Anne B. Martin, an economist in the CMS Office of the Actuary’s National Health Statistics Group, and her colleagues wrote.
The report notes that slower growth in the use and intensity of health care goods and services in 2017 “may have been affected by slower growth in overall health insurance enrollment, as the insured share of the population fell from 91.1% in 2016 to 90.9% in 2017.”
Spending on hospital care increased 4.6% to $1.1 trillion in 2017 and accounted for 33% of total health care spending; however, growth was slower than in the previous year (5.6%). Ms. Martin and her colleagues noted that growth in outpatient visits slowed while growth in inpatient days increased at about the same rate and prices in hospital care grew in 2017 to 1.7% from 1.2% in the previous year.
Spending on physician and clinical services grew 4.2% in 2017 to $694.3 billion and accounted for 20% of total health care spending. The growth rate is down from the previous year (5.6%) and a recent peak of 6% in 2015.
“Although spending growth for both physician services and clinical services slowed in 2017, the growth rate for the latter (5.0%) continued to out pace the rate for the former (3.9%), as spending for most types of outpatient care centers contributed to the stronger growth in spending for clinical services,” Ms. Martin and her colleagues reported.
They attributed the slowdown to non-price factors, such as slower growth in the use and intensity of physician and clinical services, although price growth for physician and clinical services increased 0.4% in 2017, up from 0.2% in 2016.
Spending on retail prescription drugs grew 0.4% in 2017 to $333.4 billion and accounted for 10% of total national health spending. It is the slowest growth rate increase since 2012, a year that saw a number of blockbuster drugs lose patent protection. This was down from a growth rate of 2.3% in 2016 and down from recent rates of 12.4% in 2014 and 8.9% in 2015.
“Slower growth in non-price factors, such as the use and mix of retail prescription drugs – and, to a lesser extent, in retail prescription drug prices – contributed to the slower overall growth in retail prescription drug spending in 2017,” according to the authors. Key factors included slower growth in the number of prescriptions dispensed, the continued shift to lower-cost generics, and slower growth in the volume of high-cost drugs, particularly those used to treat hepatitis C. Price decreases in generics and lower increases for existing brand-name drugs also contributed to the lower spending growth in 2017.
Ms. Martin and her colleagues highlighted the slower growth rate in the number of prescriptions (1.8% in 2017, down from 2.3% in 2016) “resulted in large part from a decline in the number of prescriptions dispensed for drugs used to treat pain.”
Medicare spending, which represents 20% of all national health care spending in 2017 ($705.9 billion), grew 4.2%, a slight decline from the 4.3% growth in 2016. Enrollment growth slowed slightly to 2.5% in 2017 from 2.7% in the previous year, while in the same time frame, per-enrollee expenditures increased slightly to 1.7% from 1.6%. Slower growth in fee-for-service Medicare spending was offset by faster growth in spending by Medicare private health plans.
Medicaid spending reached $581.9 billion (17% of national health care spending), and the growth rate slowed for the third straight year, increasing 2.9% in 2017 versus 4.2% in 2016. The slower growth “was influenced by a deceleration in enrollment growth and a reduction in the Medicaid net cost of health insurance as the federal government recovered payments from managed care organizations based on their favorable prior-period experience,” the authors stated. Enrollment growth has been decelerating following a peak of growth of 11.9% in 2014 because of states that elected to expand Medicaid eligibility, which was followed by 3 years of slower growth rates of 4.9%, 3.0% and 2.0% in 2015, 2016, and 2017, respectively. Per-enrollee spending also slowed to 0.9% growth in 2017 from a rate of 1.2% in 2016, attributed to “the decline in government administration and the net cost of insurance.”
SOURCE: Martin A et al. Health Aff. 2018. doi: 10.1377/hlthaff.2018.05085.
Health care spending as a percentage of gross domestic product remained relatively stable in 2017, despite a slowdown in the growth of spending.
Total health care spending in the United States was $3.5 trillion in 2017, an increase of 3.9% from 2016, according to data released Dec. 6 by the Centers for Medicare & Medicaid Services.
The growth rate was down from that of 2016 (4.8%) but similar to growth rates experienced during 2008-2013, according to the research article in Health Affairs.
“The slower growth in health care spending in 2017 resulted primarily from slower growth in hospital care, physician and clinical services, and retail prescription drugs, with residual use and intensity of these goods and services contributing substantially to the trend,” Anne B. Martin, an economist in the CMS Office of the Actuary’s National Health Statistics Group, and her colleagues wrote.
The report notes that slower growth in the use and intensity of health care goods and services in 2017 “may have been affected by slower growth in overall health insurance enrollment, as the insured share of the population fell from 91.1% in 2016 to 90.9% in 2017.”
Spending on hospital care increased 4.6% to $1.1 trillion in 2017 and accounted for 33% of total health care spending; however, growth was slower than in the previous year (5.6%). Ms. Martin and her colleagues noted that growth in outpatient visits slowed while growth in inpatient days increased at about the same rate and prices in hospital care grew in 2017 to 1.7% from 1.2% in the previous year.
Spending on physician and clinical services grew 4.2% in 2017 to $694.3 billion and accounted for 20% of total health care spending. The growth rate is down from the previous year (5.6%) and a recent peak of 6% in 2015.
“Although spending growth for both physician services and clinical services slowed in 2017, the growth rate for the latter (5.0%) continued to out pace the rate for the former (3.9%), as spending for most types of outpatient care centers contributed to the stronger growth in spending for clinical services,” Ms. Martin and her colleagues reported.
They attributed the slowdown to non-price factors, such as slower growth in the use and intensity of physician and clinical services, although price growth for physician and clinical services increased 0.4% in 2017, up from 0.2% in 2016.
Spending on retail prescription drugs grew 0.4% in 2017 to $333.4 billion and accounted for 10% of total national health spending. It is the slowest growth rate increase since 2012, a year that saw a number of blockbuster drugs lose patent protection. This was down from a growth rate of 2.3% in 2016 and down from recent rates of 12.4% in 2014 and 8.9% in 2015.
“Slower growth in non-price factors, such as the use and mix of retail prescription drugs – and, to a lesser extent, in retail prescription drug prices – contributed to the slower overall growth in retail prescription drug spending in 2017,” according to the authors. Key factors included slower growth in the number of prescriptions dispensed, the continued shift to lower-cost generics, and slower growth in the volume of high-cost drugs, particularly those used to treat hepatitis C. Price decreases in generics and lower increases for existing brand-name drugs also contributed to the lower spending growth in 2017.
Ms. Martin and her colleagues highlighted the slower growth rate in the number of prescriptions (1.8% in 2017, down from 2.3% in 2016) “resulted in large part from a decline in the number of prescriptions dispensed for drugs used to treat pain.”
Medicare spending, which represents 20% of all national health care spending in 2017 ($705.9 billion), grew 4.2%, a slight decline from the 4.3% growth in 2016. Enrollment growth slowed slightly to 2.5% in 2017 from 2.7% in the previous year, while in the same time frame, per-enrollee expenditures increased slightly to 1.7% from 1.6%. Slower growth in fee-for-service Medicare spending was offset by faster growth in spending by Medicare private health plans.
Medicaid spending reached $581.9 billion (17% of national health care spending), and the growth rate slowed for the third straight year, increasing 2.9% in 2017 versus 4.2% in 2016. The slower growth “was influenced by a deceleration in enrollment growth and a reduction in the Medicaid net cost of health insurance as the federal government recovered payments from managed care organizations based on their favorable prior-period experience,” the authors stated. Enrollment growth has been decelerating following a peak of growth of 11.9% in 2014 because of states that elected to expand Medicaid eligibility, which was followed by 3 years of slower growth rates of 4.9%, 3.0% and 2.0% in 2015, 2016, and 2017, respectively. Per-enrollee spending also slowed to 0.9% growth in 2017 from a rate of 1.2% in 2016, attributed to “the decline in government administration and the net cost of insurance.”
SOURCE: Martin A et al. Health Aff. 2018. doi: 10.1377/hlthaff.2018.05085.
FROM HEALTH AFFAIRS
Key clinical point: National health care spending growth slowed to 3.9% in 2017.
Major finding: The $3.5 trillion in national health care spending represents 17.9% of GDP.
Study details: Annual analysis of national health expenditures conducted by federal actuaries.
Disclosures: Analysis conducted by the Centers for Medicaid & Medicare Services Office of the Actuary; the authors have no relevant financial conflicts of interest.
Source: Martin A et al. Health Affairs. 2018. doi: 10.1377/hlthaff.2018.05085.
ONC releases draft strategy on reducing EHR burden
A new federal proposal aims to move you away from the keyboard and back face-to-face with your patients.
The draft strategy from the Office of the National Coordinator for Health IT has three aims: to reduce the time and effort to record information in EHRs; to reduce the time and effort required to meet regulatory requirements; and to improve the functionality and ease of use of EHRs.
“This draft strategy includes recommendations that will allow physicians and other clinicians to provide effective care to their patients with a renewed sense of satisfaction for them and their patients,” Andrew Gettinger, MD, chief clinical officer at ONC, and Kate Goodrich, MD, chief medical officer at the Centers for Medicare & Medicaid Services, wrote in a recent blog post. “We are taking one more step toward improving the interoperability and usability of health information by establishing a goal, strategy, and recommendations to reduce regulatory and administrative burdens relating to the use of EHRs.”
To ease documentation burdens, the proposal seeks to “mitigate the EHR-related burden associated with a variety of administrative processes,” the draft strategy notes. “We are considering how reforming certain administrative requirements or optimizing out-of-date requirements for health IT–enabled health care provider work flows can reduce the burden of clinical documentation.”
Specifically, ONC proposes to reduce the overall regulatory burden, leverage data present in the electronic record to reduce the redocumentation, waive certain documentation requirements for participants in advanced alternative payment models (APMs), and promote standardized documentation for ordering and prior authorization.
To improve health IT usability, the draft strategy aims to “address how improvements in the design and use of health IT systems” can reduce burden and calls on clinicians, software developers, and other vendors to collaborate.
To do so, ONC recommends better alignment between EHR design and clinical work flow and making improvements to clinical decision support, as well as improving the presentation of clinical data within EHRs and clinical documentation functionality.
ONC also recommends standardizing basic clinical operations across all EHRs, designing EHR interfaces that are standard to health care delivery, and better integration of the EHR with the exam room.
The draft strategy also includes recommendations to help doctors better understand the financial requirements for successful implementation and optimize the log-in procedures to help reduce burden.
EHR reporting strategies “are designed to address many of the programmatic, technical, and operational challenges raised by stakeholders to reduce EHR-related burden associated with program reporting.”
ONC wants to simplify scoring for the “promoting interoperability” performance category in the Merit-based Incentive Payment System (MIPS) track of the Quality Payment Program and improving other measures of health IT usage; applying additional data standards to make data access, extraction, and integration across multiple systems easier and less costly; and exploring alternate, less burdensome approaches to electronic quality measurement through pilot programs and reporting program incentives.
Finally, public health reporting strategies “look at a set of topics linked to federal, state, local, territorial, and tribal government policies and public health programs, with a specific focus on EPCS [electronic prescribing for controlled substances] and PDMPs [prescription drug monitoring programs]. Where EHR-related burden remains a key barrier to progress in these areas, there are several recommendations for how stakeholders can advance these burden reduction goals related to public health.”
In this area, ONC is recommending increasing adoption of e-prescribing of controlled substances with access to medication history to better inform prescribing of controlled substances, harmonizing reporting requirements across federally funded programs to streamline reporting requirements, and providing better guidance about HIPPA and federal confidentially requirements governing substance abuse disorder to better facilitate the electronic exchange of health information for patient care.
Comments on the report may be submitted electronically through Jan. 28, 2019.
A new federal proposal aims to move you away from the keyboard and back face-to-face with your patients.
The draft strategy from the Office of the National Coordinator for Health IT has three aims: to reduce the time and effort to record information in EHRs; to reduce the time and effort required to meet regulatory requirements; and to improve the functionality and ease of use of EHRs.
“This draft strategy includes recommendations that will allow physicians and other clinicians to provide effective care to their patients with a renewed sense of satisfaction for them and their patients,” Andrew Gettinger, MD, chief clinical officer at ONC, and Kate Goodrich, MD, chief medical officer at the Centers for Medicare & Medicaid Services, wrote in a recent blog post. “We are taking one more step toward improving the interoperability and usability of health information by establishing a goal, strategy, and recommendations to reduce regulatory and administrative burdens relating to the use of EHRs.”
To ease documentation burdens, the proposal seeks to “mitigate the EHR-related burden associated with a variety of administrative processes,” the draft strategy notes. “We are considering how reforming certain administrative requirements or optimizing out-of-date requirements for health IT–enabled health care provider work flows can reduce the burden of clinical documentation.”
Specifically, ONC proposes to reduce the overall regulatory burden, leverage data present in the electronic record to reduce the redocumentation, waive certain documentation requirements for participants in advanced alternative payment models (APMs), and promote standardized documentation for ordering and prior authorization.
To improve health IT usability, the draft strategy aims to “address how improvements in the design and use of health IT systems” can reduce burden and calls on clinicians, software developers, and other vendors to collaborate.
To do so, ONC recommends better alignment between EHR design and clinical work flow and making improvements to clinical decision support, as well as improving the presentation of clinical data within EHRs and clinical documentation functionality.
ONC also recommends standardizing basic clinical operations across all EHRs, designing EHR interfaces that are standard to health care delivery, and better integration of the EHR with the exam room.
The draft strategy also includes recommendations to help doctors better understand the financial requirements for successful implementation and optimize the log-in procedures to help reduce burden.
EHR reporting strategies “are designed to address many of the programmatic, technical, and operational challenges raised by stakeholders to reduce EHR-related burden associated with program reporting.”
ONC wants to simplify scoring for the “promoting interoperability” performance category in the Merit-based Incentive Payment System (MIPS) track of the Quality Payment Program and improving other measures of health IT usage; applying additional data standards to make data access, extraction, and integration across multiple systems easier and less costly; and exploring alternate, less burdensome approaches to electronic quality measurement through pilot programs and reporting program incentives.
Finally, public health reporting strategies “look at a set of topics linked to federal, state, local, territorial, and tribal government policies and public health programs, with a specific focus on EPCS [electronic prescribing for controlled substances] and PDMPs [prescription drug monitoring programs]. Where EHR-related burden remains a key barrier to progress in these areas, there are several recommendations for how stakeholders can advance these burden reduction goals related to public health.”
In this area, ONC is recommending increasing adoption of e-prescribing of controlled substances with access to medication history to better inform prescribing of controlled substances, harmonizing reporting requirements across federally funded programs to streamline reporting requirements, and providing better guidance about HIPPA and federal confidentially requirements governing substance abuse disorder to better facilitate the electronic exchange of health information for patient care.
Comments on the report may be submitted electronically through Jan. 28, 2019.
A new federal proposal aims to move you away from the keyboard and back face-to-face with your patients.
The draft strategy from the Office of the National Coordinator for Health IT has three aims: to reduce the time and effort to record information in EHRs; to reduce the time and effort required to meet regulatory requirements; and to improve the functionality and ease of use of EHRs.
“This draft strategy includes recommendations that will allow physicians and other clinicians to provide effective care to their patients with a renewed sense of satisfaction for them and their patients,” Andrew Gettinger, MD, chief clinical officer at ONC, and Kate Goodrich, MD, chief medical officer at the Centers for Medicare & Medicaid Services, wrote in a recent blog post. “We are taking one more step toward improving the interoperability and usability of health information by establishing a goal, strategy, and recommendations to reduce regulatory and administrative burdens relating to the use of EHRs.”
To ease documentation burdens, the proposal seeks to “mitigate the EHR-related burden associated with a variety of administrative processes,” the draft strategy notes. “We are considering how reforming certain administrative requirements or optimizing out-of-date requirements for health IT–enabled health care provider work flows can reduce the burden of clinical documentation.”
Specifically, ONC proposes to reduce the overall regulatory burden, leverage data present in the electronic record to reduce the redocumentation, waive certain documentation requirements for participants in advanced alternative payment models (APMs), and promote standardized documentation for ordering and prior authorization.
To improve health IT usability, the draft strategy aims to “address how improvements in the design and use of health IT systems” can reduce burden and calls on clinicians, software developers, and other vendors to collaborate.
To do so, ONC recommends better alignment between EHR design and clinical work flow and making improvements to clinical decision support, as well as improving the presentation of clinical data within EHRs and clinical documentation functionality.
ONC also recommends standardizing basic clinical operations across all EHRs, designing EHR interfaces that are standard to health care delivery, and better integration of the EHR with the exam room.
The draft strategy also includes recommendations to help doctors better understand the financial requirements for successful implementation and optimize the log-in procedures to help reduce burden.
EHR reporting strategies “are designed to address many of the programmatic, technical, and operational challenges raised by stakeholders to reduce EHR-related burden associated with program reporting.”
ONC wants to simplify scoring for the “promoting interoperability” performance category in the Merit-based Incentive Payment System (MIPS) track of the Quality Payment Program and improving other measures of health IT usage; applying additional data standards to make data access, extraction, and integration across multiple systems easier and less costly; and exploring alternate, less burdensome approaches to electronic quality measurement through pilot programs and reporting program incentives.
Finally, public health reporting strategies “look at a set of topics linked to federal, state, local, territorial, and tribal government policies and public health programs, with a specific focus on EPCS [electronic prescribing for controlled substances] and PDMPs [prescription drug monitoring programs]. Where EHR-related burden remains a key barrier to progress in these areas, there are several recommendations for how stakeholders can advance these burden reduction goals related to public health.”
In this area, ONC is recommending increasing adoption of e-prescribing of controlled substances with access to medication history to better inform prescribing of controlled substances, harmonizing reporting requirements across federally funded programs to streamline reporting requirements, and providing better guidance about HIPPA and federal confidentially requirements governing substance abuse disorder to better facilitate the electronic exchange of health information for patient care.
Comments on the report may be submitted electronically through Jan. 28, 2019.
Trump scheme for Part B drugs raises red flags
A proposed Trump administration plan for paying for drugs under Medicare Part B has raised red flags for doctors.
The Centers for Medicare & Medicaid Services announced Oct. 25 that it will test paying for Part B drugs by more closely aligning those payments with international rates.
The so-called International Price Index (IPI) model “would test whether increasing competition for private-sector vendors to negotiate drug prices, and aligning Medicare payments for drugs with prices that are paid in foreign countries, improves beneficiary access and quality of care while reducing expenditures,” according to a government fact sheet.
Under the test, private vendors would “procure drugs, distribute them to physicians and hospitals, and take on the responsibility of billing Medicare. Vendors would aggregate purchasing, seek volume-based discounts, and compete for providers’ business, thereby creating competition where none exists today.”
Health care professionals and hospitals in certain geographic areas would receive their Part B drugs under this program, while the rest of the country would continue under the current buy-and-bill system. Eventually, over the 5-year phase-in period, half of the geographic regions would fall under this IPI model.
CMS officials note that the IPI model “would maintain beneficiaries’ choice of provider and treatments and would have meaningful beneficiary protections such as enhanced monitoring and Medicare Beneficiary Ombudsman supports.”
Initially, only single-source drugs and biologics with available international pricing data would be provided under the IPI model, which could be expanded over time to include drugs available via multiple sources.
Currently, Medicare typically pays average sales price (ASP) plus a 6% add-on for drugs under Part B. Under IPI, if the international price is determined to be lower than the ASP, the CMS would reimburse based on a target price derived from an international price index, with the hope that manufacturers would match the international price. The target price would be phased in over a 5-year period.
The plan also calls for an add-on price similar to the current buy-and-bill system; however, the CMS aims to bring the add-on back to 6% rather than the actual 4.3% under the budget sequestration.
Other add-ons are also under consideration, such as paying a fixed amount per encounter or per month as well as a unique payment based on drug class, physician specialty, or physician practice.
The American Gastroenterological Association also has concerns, noting that the proposed changes in policy are complex and certain details are lacking, which makes it difficult to assess fully the impact of the proposal.
While it’s true that the high cost of biologics, such as those used to treat inflammatory bowel disease, create barriers to patient access, efforts to address costs may create other patient access issues and penalize gastroenterologists for providing high-quality care to some of the most complex patients. The Competitive Acquisition Program previously abandoned created patient access issues. Moreover, utilization management strategies such as step therapy or “fail first” protocols have no place in the Medicare Part B program. Policy makers should be careful to not penalize Medicare patients who depend on timely access to needed therapies.
“The administration’s proposal for an International Pricing Index Model for Part B drugs raises a number of questions, and we need to have a greater understanding of the potential impact of the proposal on patients, physicians, and the health care system,” American Medical Association President Barbara McAneny, MD, said in a statement. “We look forward to working constructively with the Administration as it seeks feedback.”
Comments are due Dec. 24. The CMS plans to issue the proposed rule related to this model in the spring of 2019.
A proposed Trump administration plan for paying for drugs under Medicare Part B has raised red flags for doctors.
The Centers for Medicare & Medicaid Services announced Oct. 25 that it will test paying for Part B drugs by more closely aligning those payments with international rates.
The so-called International Price Index (IPI) model “would test whether increasing competition for private-sector vendors to negotiate drug prices, and aligning Medicare payments for drugs with prices that are paid in foreign countries, improves beneficiary access and quality of care while reducing expenditures,” according to a government fact sheet.
Under the test, private vendors would “procure drugs, distribute them to physicians and hospitals, and take on the responsibility of billing Medicare. Vendors would aggregate purchasing, seek volume-based discounts, and compete for providers’ business, thereby creating competition where none exists today.”
Health care professionals and hospitals in certain geographic areas would receive their Part B drugs under this program, while the rest of the country would continue under the current buy-and-bill system. Eventually, over the 5-year phase-in period, half of the geographic regions would fall under this IPI model.
CMS officials note that the IPI model “would maintain beneficiaries’ choice of provider and treatments and would have meaningful beneficiary protections such as enhanced monitoring and Medicare Beneficiary Ombudsman supports.”
Initially, only single-source drugs and biologics with available international pricing data would be provided under the IPI model, which could be expanded over time to include drugs available via multiple sources.
Currently, Medicare typically pays average sales price (ASP) plus a 6% add-on for drugs under Part B. Under IPI, if the international price is determined to be lower than the ASP, the CMS would reimburse based on a target price derived from an international price index, with the hope that manufacturers would match the international price. The target price would be phased in over a 5-year period.
The plan also calls for an add-on price similar to the current buy-and-bill system; however, the CMS aims to bring the add-on back to 6% rather than the actual 4.3% under the budget sequestration.
Other add-ons are also under consideration, such as paying a fixed amount per encounter or per month as well as a unique payment based on drug class, physician specialty, or physician practice.
The American Gastroenterological Association also has concerns, noting that the proposed changes in policy are complex and certain details are lacking, which makes it difficult to assess fully the impact of the proposal.
While it’s true that the high cost of biologics, such as those used to treat inflammatory bowel disease, create barriers to patient access, efforts to address costs may create other patient access issues and penalize gastroenterologists for providing high-quality care to some of the most complex patients. The Competitive Acquisition Program previously abandoned created patient access issues. Moreover, utilization management strategies such as step therapy or “fail first” protocols have no place in the Medicare Part B program. Policy makers should be careful to not penalize Medicare patients who depend on timely access to needed therapies.
“The administration’s proposal for an International Pricing Index Model for Part B drugs raises a number of questions, and we need to have a greater understanding of the potential impact of the proposal on patients, physicians, and the health care system,” American Medical Association President Barbara McAneny, MD, said in a statement. “We look forward to working constructively with the Administration as it seeks feedback.”
Comments are due Dec. 24. The CMS plans to issue the proposed rule related to this model in the spring of 2019.
A proposed Trump administration plan for paying for drugs under Medicare Part B has raised red flags for doctors.
The Centers for Medicare & Medicaid Services announced Oct. 25 that it will test paying for Part B drugs by more closely aligning those payments with international rates.
The so-called International Price Index (IPI) model “would test whether increasing competition for private-sector vendors to negotiate drug prices, and aligning Medicare payments for drugs with prices that are paid in foreign countries, improves beneficiary access and quality of care while reducing expenditures,” according to a government fact sheet.
Under the test, private vendors would “procure drugs, distribute them to physicians and hospitals, and take on the responsibility of billing Medicare. Vendors would aggregate purchasing, seek volume-based discounts, and compete for providers’ business, thereby creating competition where none exists today.”
Health care professionals and hospitals in certain geographic areas would receive their Part B drugs under this program, while the rest of the country would continue under the current buy-and-bill system. Eventually, over the 5-year phase-in period, half of the geographic regions would fall under this IPI model.
CMS officials note that the IPI model “would maintain beneficiaries’ choice of provider and treatments and would have meaningful beneficiary protections such as enhanced monitoring and Medicare Beneficiary Ombudsman supports.”
Initially, only single-source drugs and biologics with available international pricing data would be provided under the IPI model, which could be expanded over time to include drugs available via multiple sources.
Currently, Medicare typically pays average sales price (ASP) plus a 6% add-on for drugs under Part B. Under IPI, if the international price is determined to be lower than the ASP, the CMS would reimburse based on a target price derived from an international price index, with the hope that manufacturers would match the international price. The target price would be phased in over a 5-year period.
The plan also calls for an add-on price similar to the current buy-and-bill system; however, the CMS aims to bring the add-on back to 6% rather than the actual 4.3% under the budget sequestration.
Other add-ons are also under consideration, such as paying a fixed amount per encounter or per month as well as a unique payment based on drug class, physician specialty, or physician practice.
The American Gastroenterological Association also has concerns, noting that the proposed changes in policy are complex and certain details are lacking, which makes it difficult to assess fully the impact of the proposal.
While it’s true that the high cost of biologics, such as those used to treat inflammatory bowel disease, create barriers to patient access, efforts to address costs may create other patient access issues and penalize gastroenterologists for providing high-quality care to some of the most complex patients. The Competitive Acquisition Program previously abandoned created patient access issues. Moreover, utilization management strategies such as step therapy or “fail first” protocols have no place in the Medicare Part B program. Policy makers should be careful to not penalize Medicare patients who depend on timely access to needed therapies.
“The administration’s proposal for an International Pricing Index Model for Part B drugs raises a number of questions, and we need to have a greater understanding of the potential impact of the proposal on patients, physicians, and the health care system,” American Medical Association President Barbara McAneny, MD, said in a statement. “We look forward to working constructively with the Administration as it seeks feedback.”
Comments are due Dec. 24. The CMS plans to issue the proposed rule related to this model in the spring of 2019.
Feds call for EHR interoperability. Again.
WASHINGTON – In what feels like a tradition, the need to solve interoperability issues was front and center once again as the key goal presented by Health and Human Services officials at the annual meeting of the Office of the National Coordinator.
“It is actually impossible to move to a future health system, the one that we need ... without a truly interoperable system,” HHS Deputy Secretary Eric Hargan said Nov. 29 during a keynote address.
“Patients need to be able to access their own records. Period,” he added.
Mr. Hargan emphasized that the HHS will define what it wants to see regarding interoperability, but leave it up to vendors and developers to come up with solutions on how this will be accomplished.
One example that he mentioned is Blue Button 2.0, a part of the MyHealthEData initiative, which allows Medicare patients to connect their claims data to apps to help them make informed decisions about their care.
“The use of apps here reflects to potential, we believe, for patient-centered technology to improve health,” Mr. Hargan said.
He also noted that the agency is looking at how existing law and regulation – such as the antikickback statute, the Stark law, HIPAA, and federal privacy regulations – might be hindering the transition to value-based care.
This analysis is “specifically focused on understanding as quickly as we can ... how current interpretations of these laws may be impeding value-based transformation and coordinated care,” Mr. Hargan said.
ONC is also taking a look at reducing provider burden, issuing a draft strategy for comment that specifically targets provider burden related to the use of EHRs and offer up a series of recommendations to help address it.
WASHINGTON – In what feels like a tradition, the need to solve interoperability issues was front and center once again as the key goal presented by Health and Human Services officials at the annual meeting of the Office of the National Coordinator.
“It is actually impossible to move to a future health system, the one that we need ... without a truly interoperable system,” HHS Deputy Secretary Eric Hargan said Nov. 29 during a keynote address.
“Patients need to be able to access their own records. Period,” he added.
Mr. Hargan emphasized that the HHS will define what it wants to see regarding interoperability, but leave it up to vendors and developers to come up with solutions on how this will be accomplished.
One example that he mentioned is Blue Button 2.0, a part of the MyHealthEData initiative, which allows Medicare patients to connect their claims data to apps to help them make informed decisions about their care.
“The use of apps here reflects to potential, we believe, for patient-centered technology to improve health,” Mr. Hargan said.
He also noted that the agency is looking at how existing law and regulation – such as the antikickback statute, the Stark law, HIPAA, and federal privacy regulations – might be hindering the transition to value-based care.
This analysis is “specifically focused on understanding as quickly as we can ... how current interpretations of these laws may be impeding value-based transformation and coordinated care,” Mr. Hargan said.
ONC is also taking a look at reducing provider burden, issuing a draft strategy for comment that specifically targets provider burden related to the use of EHRs and offer up a series of recommendations to help address it.
WASHINGTON – In what feels like a tradition, the need to solve interoperability issues was front and center once again as the key goal presented by Health and Human Services officials at the annual meeting of the Office of the National Coordinator.
“It is actually impossible to move to a future health system, the one that we need ... without a truly interoperable system,” HHS Deputy Secretary Eric Hargan said Nov. 29 during a keynote address.
“Patients need to be able to access their own records. Period,” he added.
Mr. Hargan emphasized that the HHS will define what it wants to see regarding interoperability, but leave it up to vendors and developers to come up with solutions on how this will be accomplished.
One example that he mentioned is Blue Button 2.0, a part of the MyHealthEData initiative, which allows Medicare patients to connect their claims data to apps to help them make informed decisions about their care.
“The use of apps here reflects to potential, we believe, for patient-centered technology to improve health,” Mr. Hargan said.
He also noted that the agency is looking at how existing law and regulation – such as the antikickback statute, the Stark law, HIPAA, and federal privacy regulations – might be hindering the transition to value-based care.
This analysis is “specifically focused on understanding as quickly as we can ... how current interpretations of these laws may be impeding value-based transformation and coordinated care,” Mr. Hargan said.
ONC is also taking a look at reducing provider burden, issuing a draft strategy for comment that specifically targets provider burden related to the use of EHRs and offer up a series of recommendations to help address it.
REPORTING FROM ONC 2018