Healthcare Industry Trends  *  ABL Member News  *  January 9, 2018


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HEALTHCARE & GOVERNMENT - IN BRIEF


HEALTHCARE TRENDS - IN BRIEF

UPCOMING ABL HEALTHCARE ROUND TABLES & EVENTS
  • 1/09  -  Silicon Valley Round Table

  • 1/10  -  San Francisco Round Table

  • 1/11  -  East Bay Round Table

  • 1/18  -  Sacramento Round Table

  • 1/19  -  Los Angeles Round Table

  • 2/07  -  Orange County Round Table
     

  • 1/24  -  "THE NEW INDUSTRIAL REVOLUTION: THE FIRES OF CHANGE"
                 ABL's 15th Top Tech Trends, featuring Dave Berkus, Chairman of Multiple Portfolio
                 Companies, Long Beach
     


MIMI GRANT'S BLOG:

An Ode to the JP Morgan Healthcare Conference 

'Twas the second week of Jan'ry, when all through the City
Not a room could be found for the usual kitty.
Luring VCs, and PEs, and I-Bankers, too
JP Morgan's Health Conf'rence is quite the to-do.

Armani and Gucci's the dress code for four days,
Plus, red ties and pinstripes give attendees away.
While the Event's hub, at the Westin is found
Receptions and meetings take place all around.

Non-profits and for-profits all make their play:
"No margin, no mission's" the phrase of the day.
With 3.3 Trillion at stake in the health game
No wonder for thousands, San Francisco's their aim.

So on Uber, on Lyft, and a few Yellow Cabs
And trollies and Munis, and walking – so fab
In a town known for Tech and Unicorns rare:
Herald Healthcare's week-long Financial affair!

 

MEMBER NEWS - IN BRIEF
ARTICLES

HEALTHCARE & GOVERNMENT

Proposal Would Allow Insurance Coverage that Doesn't Include ACA's Mandatory Benefits


The Trump administration is proposing changes that would let millions of small businesses and the self-employed buy health-insurance plans that don't comply with all ACA requirements. The proposal would allow businesses that share geography or an industry in common to form an association and sell members health policies that are exempt from some of the health law's requirements, according to a senior Labor Department official. They would no longer have to comply with an ACA rule that they offer a mandatory array of benefits. The senior official said there are nondiscrimination provisions in the rule, a draft of which was released last week, that would prevent an association from cherry-picking employers with healthy workforces or charging higher premiums to less-healthy people. An association couldn't charge different premiums to different small employers based on health factors, the official said. The regulation wouldn't preempt state law, the Labor Department official said, adding that states still have a critical role to play. Because every state regulates insurance, an association that sold plans in two states, for example, could be subject to two different sets of rules. (wsj.com, 1/4/18)
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Judge Dismisses Hospital Industry Suit that Attempted to Stop Medicare Subsidy Cuts


A federal judge in Washington recently ruled the Trump administration can make sharp cuts to subsidies Medicare pays some hospitals for pharmaceuticals, a blow to the American Hospital Association and others fighting in court and Congress to halt the reductions. The hospital association and two other healthcare trade groups had filed a lawsuit against the Department of Health and Human Services in an attempt to stop the cuts. But U.S. District Judge Rudolph Contreras in late December dismissed the case, saying the plaintiffs cannot sue before exhausting other avenues to challenge the cuts, as required by law. Judge Contreras's ruling means Medicare was able to proceed with the cuts, scheduled to start January 1. The administration estimates the cuts will reduce annual drug spending by Medicare and beneficiaries - who pick up some of the cost of certain drugs - by about $1.6 billion.
     The subsidy, called 340B, was first created more than two decades ago and was expanded under the ACA. The program requires pharmaceutical companies to sell some drugs at a steep discount to hospitals and clinics that care for large numbers of low-income or uninsured patients. Medicare has paid hospitals slightly more than the average sales price for the drugs. Hospitals have argued the difference helps pay for expanded services for patients. Medicare will now slash what it pays hospitals eligible for the program, under a new rule the administration released in November. Lower Medicare subsidies would reduce hospitals' profit under the program, but not eliminate it, the administration said as it issued a final rule on the cuts. It also exempted some hospitals in the program from the cut, allowing the more generous payments to continue for some rural, children's and cancer hospitals, the administration said. (wsj.com, 12/29/18)
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California Bills Aim to Tackle Opioid Addiction by Curbing Excessive Prescriptions


Looking to combat the opioid abuse epidemic, a Silicon Valley legislator has introduced a slate of bills meant to clamp down on access to highly addictive prescription drugs. Assemblyman Evan Low (D-Campbell) authored three measures meant to provide a better understanding of patients' access to these medications, building on an existing state database tracking prescriptions in California. One proposal would enable California's database, called CURES, to link up with those in other states in order to trace "doctor shopping" for multiple opioid prescriptions in multiple states. Another would require pharmacies to report dispensed prescriptions to the database within 24 hours, instead of the current time frame of seven days. The third bill would add more regulations to the printing of prescription pads in order to cut down on fraudulent prescriptions. (latimes.com, 1/4/18)
     Meanwhile, Bay Area public health officials have begun receiving shipments of naloxone - the drug that reverses the effects of an opioid overdose - in the first state-funded effort to get the emergency antidote to local health departments across California. The distribution of the drug, funded by a one-time $3 million grant approved by state legislators in 2016, marks a ramp-up in the state's response to deadly overdoses of prescription painkillers, heroin, and the synthetic opioid fentanyl. All nine Bay Area counties, as well as the city of Berkeley, are slated to receive thousands of doses of Narcan (naloxone's brand name), collectively, by the end of the year. The California Department of Public Health and the Harm Reduction Coalition plan to train local law enforcement agencies and treatment centers over the next six months on how to recognize overdoses and administer naloxone, said a spokeswoman for the state public health agency. (sfchronicle.com, 1/3/18)
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Draft Trusted Exchange Framework Released by HHS


The Department of Health and Human Services has released the draft Trusted Exchange Framework, a significant step towards achieving interoperability, as required by the 21st Century Cures Act of 2016. The draft Trusted Exchange Framework, issued by HHS' Office of the National Coordinator for Health Information Technology (ONC), advances Congress' intent that building and maintaining trust is an important core element in ensuring that health information is available where and when it is needed to manage patient health and care. The Trusted Exchange Framework proposes policies, procedures, and technical standards necessary to advance the single on-ramp to interoperability requested by Congress. It will be facilitated through ONC in collaboration with a single Recognized Coordinating Entity (RCE) to be selected through a competitive process. The RCE will use the Trust Exchange Framework policies, procedures, technical standards, principles, and goals to develop a single Common Agreement that Qualified Health Information Networks (Qualified HINs) and their participants will voluntarily agree to adopt. Following a 45-day public comment period and refinements to the draft document, a final draft of the combined Trusted Exchange Framework and Common Agreement will be released. The Trusted Exchange Framework and Common Agreement (TEFCA) will be published in the Federal Register in 2018.
     The proposed Trusted Exchange Framework supports ONC's goals of achieving nationwide interoperability:  1.) Patient Access - Patients must be able to access their health information electronically without any special effort; 2.) Population-level Data Exchange - Providers and payer organizations accountable for managing benefits can receive population level health information allowing them to analyze population health trends, outcomes, and costs; identify at-risk populations; and track progress on quality improvement initiatives; and 3.) Open and Accessible APIs - The health IT community should have open and accessible application programming interfaces to encourage entrepreneurial, user-focused innovation to make health information more accessible and to improve EHR usability. The period to comment on the draft Trusted Exchange Framework closes on February 18, 2018. Comments can be submitted at exchangeframework@hhs.gov. (HHS.gov release, 1/5/18)
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HEALTHCARE TRENDS

Severe Flu Brings Medicine Shortages, Packed ERs, and Rising Death Toll in California


Health officials said last Friday that 27 people younger than 65 have died of influenza in California since October, compared with three at the same time last year. Nationwide and in California, flu activity spiked sharply in late December and continues to grow. The emergency room at UCLA Medical Center in Santa Monica typically treats about 140 patients a day, but at least one day this week 200+ patients - mostly because of the flu, said the ER's medical director, Dr. Wally Ghurabi, who added, "The Northridge earthquake was the last time we saw over 200 patients." Experts say it's possible that this year's flu season is outpacing the last simply because it's peaking earlier. The flu season is typically worst around February, but can reach its height anytime from October to April. Though flu had only killed three Californians at this time last year, it had taken 68 lives by the end of February, according to state data.
     Many California doctors, however, contend that the recent surge has been unusually severe. State health officials said Friday that there was no region of the state where people were being spared from the flu. In Riverside and San Bernardino counties, ambulance services have been severely strained because of the number of flu calls coming in, local health officials said. Plus, ERs are so crowded that ambulances arriving at hospitals can't immediately unload their patients, so they're unable to leave for incoming 911 calls, said Jose Arballo Jr., spokesman for the Riverside County Department of Public Health. Most people in California and nationwide are catching a strain of influenza known as H3N2, which the flu vaccine typically doesn't work as well against. National health officials say the vaccine might only be about 32% effective this year, which could be contributing to the high number of people falling ill. H3N2 is also a particularly dangerous strain of the flu, experts say, tending to cause more deaths and more hospitalizations than the other strains, said Dr. Jeffrey Gunzenhauser, L.A. County's interim health officer. Of extra concern this year are large numbers of older patients who are showing up at hospitals with the flu and pneumonia, a potentially fatal combination.
     Doctors often prescribe the flu medication oseltamivir, known by the brand name Tamiflu, to patients with the flu; it doesn't eliminate the flu but lessens the severity of symptoms and how long they last. It works best if taken within 48 hours of when patients start to feel sick. But doctors and patients said last week that the drug was hard to find. Meanwhile, health officials say it's not too late to get the flu shot. The vaccine is recommended for everyone older than 6 months. (latimes.com, 1/6/18)
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Hospitals Wrestle with Shortage of IV Bags, Linked to Hurricane


The U.S. is facing a nationwide shortage of intravenous bags just as flu cases accelerate, forcing many hospitals to use more time-consuming ways to administer drugs and to weigh a halt on elective procedures and clinical trials. Some hospital officials said they have only a day or two of supplies and worry whether they would be able to handle an influx of patients as the influenza virus ramps up. Forty-six states are seeing widespread flu activity, according to the CDC, putting this year on par with 2014-15, which was the most severe flu season in recent years. The availability of saline IV bags has plummeted because a major manufacturer in Puerto Rico, Baxter International Inc., was affected by the hurricane that slammed its plants on the island, while production problems hit another key manufacturer of the bags this year. The FDA said last Thursday that production at Puerto Rico plants remains fragile. A large hospital can go through hundreds or thousands of IV bags a day, depending on patient volume. Officials at Catholic Health Initiatives, which offers care in 100 hospitals across 17 states, said it is possible they would have to delay elective procedures until the shortage abates. (wsj.com, 1/7/18)
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Anthem to Cut Pay for Some Same-Day Services by 25%


Anthem Blue Cross Blue Shield plans to reduce payment by 25% for some separate services administered on the same day, such as a wellness exam or another procedure. Becker's Hospital Review has provided "four things to know" about the proposed policy.  1.) The insurer lowered the planned payment cut for some same-day services from 50% to 25% following pushback from the American Medical Association. Anthem also postponed the rollout of the cuts - initially slated for January 1 - to March 1, 2018. 2.) One example the Kentucky Medical Association provided of a same-day service that may face payment reduction is the instance of a patient coming in for a nosebleed. After the physician packs a patient's nose to stop the bleeding, the physician may evaluate the patient for moderate hypertension and adjust their medication. In this instance, KMA argued, the hypertension service was medically necessary, though separate from packing the nose.  3.) The policy begins March across the following states: California, Colorado, Connecticut, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, New York, Ohio, and Wisconsin. The policy will also take effect in Georgia and Virginia after network contract renewal.  4.) Jack Resneck Jr., MD, chair-elect of the AMA board of trustees, said, "Anthem's decision to reduce the magnitude of the proposed payment cuts in response to evidence supplied by AMA is a positive step. However, the AMA continues to challenge Anthem's rationale for the unjustified 25% reduction proposed in the revised policy." (beckershospitalreview.com, 12/28/17)
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Epic to Release New EHR Version, 'Sonnet,' in March 2018


Epic plans to release a new EHR version, called Sonnet, in March 2018, a company spokesperson said. Earlier last year, Epic announced its work to develop two new EHR versions, slated to be released by the end of 2017. The additions bring the number of Epic EHR versions to three: the full Epic EHR, called "All-Terrain"; a mid-range Epic EHR with fewer modules, called "Utility"; and "Sonnet," a slimmed-down Epic EHR with fewer modules and advanced features. The target market for the products is physician practices and smaller hospitals, such as critical access hospitals, which may benefit from the lower price points and shorter implementation times. Another target market is medium-sized community hospitals, which may want a lower starting price point with the option for a more advanced EHR version later on. The Sonnet software - which is designed for small hospitals, physician groups, and post-acute care facilities - leverages the company's "compact method" for installations, which only takes a few months, according to Epic. Sonnet will be interoperable with the Epic All-Terrain EHR, Adam Whitlatch, a lead developer at Epic, said. (beckershospitalreview.com, 12/18/18)
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Price Tag on Gene Therapy for Rare Form of Blindness: $850K


A first-of-its kind genetic treatment for blindness will cost $850,000 per patient, making it one of the most expensive medicines in the world and raising questions about the affordability of a coming wave of similar gene-targeting therapies. The injectable treatment from Spark Therapeutics can improve the eyesight of patients with a rare genetic mutation that affects just a few thousand people in the U.S. Previously there has been no treatment for the condition, which eventually causes complete blindness by adulthood. Pricing questions have swirled around the treatment due to a number of unusual factors - it is intended to be a one-time treatment, it treats a very small number of patients and represents a medical breakthrough. Previously, Spark suggested its therapy, Luxturna, could be worth more than $1 million. But the company said last week it decided on the lower price after hearing concerns from health insurers about the affordability of the treatment.
     Luxturna is still significantly more expensive than nearly every other medicine on the global market, including two other gene therapies approved earlier last year in the U.S. The treatment is part of an emerging field of medicine that could produce dozens of new gene-targeting medications in the next few years. Like Luxturna, these therapies are generally intended to be taken once, a fact which drug developers argue sets them apart from traditional drugs taken for months or years. Even compared to other one-time gene therapies Luxturna is still an outlier. Two customized gene therapies for blood cancer approved last year are priced at $373,000 and $475,000.
     Like most prescription medicines in the U.S., most of the immediate costs of Luxturna will be borne by insurers - not patients - including private plans and government programs. For patients, Spark said it will cover all out-of-pocket expenses needed to obtain the medication, including transportation to hospitals trained to administer the injections. Given Luxturna's federal approval and strong study results, experts say U.S. insurers will likely cover the drug. Spark will try to deflect some pricing concerns by offering unconventional payment plans to insurers. Under one arrangement with the non-profit insurer Harvard Pilgrim, Spark will refund some costs if patients don't experience the expected improvements in vision. Spark said it is also discussing a proposal in which insurers would pay for the drug in installments over several years. That idea would apply to government programs like Medicare and Medicaid, which provide health coverage to the poor and elderly. (nytimes.com, 1/3/18)
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Tenet Healthcare Increases Job Cuts


One of the nation's largest hospital companies, under pressure from activist shareholders, isn't waiting to replace its chief executive to revamp its business. Since October, when longtime Tenet Healthcare CEO Trevor Fetter exited the company and its board, Tenet has unveiled plans to cut jobs and squeeze $250 million from its costs, and announced the possible sale of one of its three business segments. In a presentation to investors on Monday, the company announced its cost-cutting efforts would increase the number of job cuts to 2,000, or about 2% of its workforce, from 1,300 it had previously announced. (wsj.com, 1/8/18)
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MEMBER NEWS

24Hr HomeCare CEO Wins Outstanding Leadership Award


24Hr HomeCare recently won five Decision Health Private Duty Platinum Awards, which recognize the top professionals and organizations who demonstrate success in the private duty home care market. Among the honors received, 24Hr HomeCare won for "Best Private Duty Home Care Agency;" CEO David Allerby won the "Outstanding Leadership in the Organization" Award; and CMO Ryan Iwamoto was presented with the "Outstanding Marketing and Sales Leadership" Award. (David Allerby, Los Angeles)
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Choice in Aging to Present Annual Crab Feed Fundraiser on February 10


On the evening of February 10, in Pleasant Hill, Choice in Aging will hold its 43rd Annual Crab Feed fundraiser to support adult day healthcare services. The popular event will feature "all you can eat" fresh Dungeness crab, live music, cocktails, and silent and live auctions. (Debbie Toth, Bay Area)
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Dignity Health & Select Medical Get Antitrust Clearance for Concentra + US HealthWorks


Select Medical Holdings and Dignity Health have announced that the FTC granted early termination of the waiting period under the Hart-Scott-Rodino Antitrust Improvements Act of 1976, as amended, applicable to the proposed combination of Concentra Group Holdings, an occupational medicine and urgent care service provider, with U.S. HealthWorks, a subsidiary of Dignity Health Holdings, also a service provider in this sector. Following the closing of the transaction, which is expected to occur in the first quarter of 2018, Dignity Health will own a 20% equity interest in the combined entity. (Marvin O'Quinn)
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ElderConsult Geriatric Medicine's CEO to Discuss Pain's Impact on Seniors


On the evening of February 1, Elizabeth Landsverk MD, of ElderConsult Geriatric Medicine, will lead a presentation, entitled Elders and Pain: Making Life Worth Living, as part of the Medical Doctor Lecture Series, in Foster City. (Elizabeth Landsverk MD, Bay Area)
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Kaiser's Anaheim Facility Named a 5-Star Hospital by CMS


CMS recently updated the methodology used in its Overall Hospital Quality Star Rating program, and Kaiser Foundation Hospital Orange County-Anaheim received 5 stars, the highest possible rating. The rating program is part of CMS' Hospital Compare website, which reports on quality measures for 4,000+ hospitals from around the country. This time, 337 hospitals achieved 5 stars. (Walt Meyers, Bay Area)
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King & Spalding's Upcoming Webinar & Conference to Address Health Law Issues


On January 29, 10-11:15 a.m. Pacific, King & Spalding (K&S) will hold a webinar - Insurance Coverage for False Claims Act Investigations and Healthcare Regulatory Matters, which will dispel coverage-related myths that exist in this area, highlight the events during a healthcare regulatory proceeding or FCA investigation that would likely be significant from a coverage standpoint, and arm attorneys involved in representing providers with information to help them spot coverage issues.  And, on March 19, in Atlanta, K&S will present its 27th Annual King & Spalding Health Law & Policy Forum, a one-day conference focusing on the latest legal and political developments impacting the healthcare industry.  Meanwhile, the recent issue of K&S Health Headlines includes "OIG Issues Favorable Gainsharing Advisory Opinion," reinterpreting the application of the gainsharing civil monetary penalty provision and the Anti-Kickback Statute in connection with a proposed arrangement whereby a hospital will share with certain neurosurgeons a percentage of the hospital's cost savings attributable to cost-saving measures implemented by the neurosurgeons for spinal surgeries performed at the hospital. (Marcia Augsburger, Sacramento, & Travis Jackson, Los Angeles)
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Mission Hospice to Commemorate 39th Anniversary with Gala


Mission Hospice will celebrate its 39 years of service to the community with a gala on January 28, from 4-7 p.m., at Sharon Heights Golf & Country Club in Menlo Park. The evening will also honor Mission's Special Recognition Award winner Peninsula Health Care District and its 2018 Lotus Award winner Mary Chigos, RN, NP. (Dwight Wilson, Bay Area)
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Nelson Hardiman Talks About ACA Individual Mandate Repeal on KTLA5 News


Harry Nelson, Managing Partner of Nelson Hardiman, was recently interviewed on KTLA5 Morning News, where he discussed the likely impact of the repeal of the ACA individual mandate, as well as current healthcare insurance options in California, and some possible scenarios going forward. (Harry Nelson, Los Angeles)
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OneLegacy CEO Quoted in LA Times Regarding "Turf Battle for Organs"


The recent Los Angeles Times article - In a turf battle for organs, a policy review rattles the national transplant system - delves into a lawsuit brought by a 21-year-old woman who needs a lung transplant to survive. But her odds of finding a suitable organ were especially low in New York, where she lives, because waiting times there are among the longest in the country. In nearby New Jersey, patients in far better condition routinely receive lungs much more quickly. The disparities stem from a principle that has always guided the national transplant system: local first. Most organs stay in the areas where they are donated, even if sicker patients are waiting elsewhere. Now, a federal judge's recent emergency order in the lawsuit by Holman is threatening to upend decades of organ transplant policy and force places with a relative abundance of organs to start sharing more of them. The article spotlights Tom Mone, CEO of OneLegacy, the nonprofit contracted to coordinate allocation in the donation service area that includes Los Angeles, who says he has fought for years to bring more organs to Southern California but has been rebuffed by "the parochial self-interest of transplant centers" seeking to preserve short waiting times for their patients. (Tom Mone, Los Angeles)
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Select Data Webinar to Help Clinicians Understand the HH CAHPS Survey


On February 21, from 10:30 to 11 a.m., Select Data will present a webinar - Understanding the HH CAHPS Survey and How it Impacts Your Home Health Agency - part of its "Select Connects With Clinicians" program that offers training free of charge to clinicians and support staff working in home health. The program is an effort to support OASIS accuracy and compliance and to promote better outcomes for patients. (Ed Buckley, Orange County, & Ted Schulte, Los Angeles)
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The Health Trust Addressing Chronic Condition Management in Workshops


The Health Trust will present its Better Choices, Better Health Program every Wednesday, from January 24 to February 28, from 2-5 p.m., at the Center for Independence in San Mateo. The interactive workshops are suitable for anyone dealing with the challenges of living with an ongoing health condition, like diabetes, asthma, heart disease, high cholesterol, and more, and are designed to enhance regular treatment and condition-specific education. Participants will learn about stress management, dealing with pain and fatigue, weight management, decision making, and more. (Todd Hansen, Silicon Valley)
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