Mid-week Update

David Ermer–Uncategorized–

The Centers for Medicare and Medicaid Services and the Health and Human Services Inspector General issued related proposed rules today intended to modernize the Stark self-referral proscription law and the federal health programs anti-kickback act’s safe harbor provisions. The actions stem from the HHS Patients over Paperwork Initiative. Healthcare Dive explains that

  • The long-awaited proposals from the Trump Administration seek to alter physician self-referral and anti-kickback laws to account for the healthcare system’s shift from fee-for-service to value-based arrangements. Backers of the revamp say current regulations discourage providers from entering into partnerships aimed at improving quality outcomes due to fear of harsh criminal penalties.
  • A number of new safe harbors are being proposed to encourage value-based care, allow patient engagement through furnishing of certain tools and supports and permit certain remuneration when provided in connection with some CMS-sponsored models to cut down on the need for fraud and abuse waivers. They also provide guidance aimed at clarifying when compensation provided to a doctor by another provider must be paid for at fair market value.
The public comment deadline on these proposed rules is December 31, 2019. 
Speaking of CMS, the agency has posted 2018 reporting year medical loss ratio refund reports. Such ACA MLR refunds owed on FEHB business are paid into the plan’s contingency reserve under OPM rules. 
Health Payer Intelligence offers health plans three strategies to improve member adherence to taking prescription drugs. On a related note, Healthcare Dive reports 

Pharmaceutical companies often preach value. Yet, for seven top-selling drugs, prices went up in 2017 and 2018 despite limited new evidence showing patients receiving treatment experienced greater benefit, according to a new report.

Taken together, the price hikes added more than $5 billion to U.S. spending on those drugs over the two-year period, a study published Tuesday by the Institute for Clinical and Economic Review said.  * * *

Unsurprisingly, PhRMA, the industry’s principal lobby, took issue with ICER’s findings, as did drugmakers flagged for taking unsupported price increases. 

The bipartisan Senate Health Education Labor and Pensions bill (S. 1895) to lower prescription drug costs and address surprise billing currently appears stalled. While visiting Arizona, the FEHBlog saw a political ad favoring arbitration over S. 1895’s out of network price setting approach which by the way the ACA already uses to a limited extent. As Forbes consultant Avik Roy commented the arbitration approach would raise costs. That’s common sense.