LTC Pharmacy News
August 2018
The healthcare industry is in the beginning of massive change and the long term care pharmacy industry will be affected by this change. LTCPharmacynews.com is your guide to understanding this process, the legislation and regulation that will implement this change and the key to adjusting your approach to succeeding in this new environment. We will try to not just tell you the "what" of this change, but the "how" as well.
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CMS Publishes Final SNF PPS Rule for 2019: PDPM Approved
The long-awaited final PPS rule has been published. Elise has been through it with her usual attention to detail and reports on the changes that will take place beginning in October of 2019. This rule represents a major shift in incentives for SNFs; away from a focus on therapy to a new emphasis on the objective medical needs of the residents.
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MedPAC Supports PDPM and Releases June Report
The comment period for CMS proposed rule on SNF PPS for 2019 has passed. Elise reports on MedPAC's support of the proposed new payment model and also gives us her expert analysis of the issues covered in the Commission's June report to Congress
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Elise Covers CMS Proposed Patient Driven Payment Model
CMS recently proposed a major change in the way SNFs are paid under Medicare Part A. Elise takes us through the proposal and explains how CMS arrived at this approach and what it's likely to mean for LTC Pharmacy. 
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MedPAC Addresses A Key Element in the Uniform PAC PPS
As you know from Elise's previous updates, the Medicare Payment Advisory Commission has been studying the process of moving toward a unified post-acute care prospective payment system. Sound simple? Not so fast. Elise explains the issues MedPAC is considering in this latest update.
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Medicare Bundled Payments and SNFs
CMS' Bundled Payments for Care Improvement seems to have left nursing homes out of the driver's seat on managing care for Medicare patients. In this comprehensive overview of the latest policy moves by CMS on bundled payments, Elise 
patiently takes us through the history of bundled payments in Medicare and how SNFs have been positioned and why, as well as how the industry has responded.


The Policy Issues Ahead for SNFs in 2018
Nursing homes are faced with a dizzying mix of pending and likely regulatory activity that could cause us to throw our hands in the air in defeat. Unless, of course, you have Elise Smith to guide you through the quagmire.

Read what Elise sees as the major public policy issues facing the industry we serve and what we can do to lend a hand.


More Elise Smith Insights
The list of Elise's publications was getting too lengthy to continue listing on the newsletter, so we have created her own page on the LTC Pharmacy News site. See it all now.

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Congress Faces Discontented Voters
The House of Representatives has gone home for August, but the Senate remains in the Washington swamps. Senate Majority Leader Mitch McConnell (R-KY) is keeping senators in town to work on spending bills and confirmation of presidential appointees.

Being back home allows members to campaign, catch up with constituents and take a breather from committee meetings and voting schedules, but many are learning that being home is no picnic. 

Pollsters are nearly unanimous in their predictions that the House will fall to a new Democratic majority in the November election, while previous bets that the Senate will remain under Republican control are no longer certain. 

Democrats are energized by President Trump's actions and appear determined to show up at the polls to usher in a new majority to oppose every action taken by the Administration. 

Still, given the surprise the voters delivered to the pollsters on the last election, who knows what will happen two months from now when citizens line up to choose their election officials.

RUSH Act Introduced to Allow Telehealth in SNFs
Rep. Adrian Smith (R-NE) and a bipartisan group of co-sponsors, introduced the Reducing Unnecessary Senior Hospitalizations (RUSH) Act to allow qualified physician practices to use telehealth to help reduce unnecessary visits to the emergency room and to hospitals. See Rep. Smith's statement

MedPAC Releases Data Book
A happy time for data-hungry health policy nerds has arrived with the publication of the Medicare Payment Advisory Commission (MedPAC) annual treasure trove of health spending data in the publication Health Care Spending and the Medicare Program. Maybe not exactly bedside reading, but think how smart you'll look when you can rattle off relevant post-acute care statistics. 

Rep. Buddy Carter on Pharmacist Empowerment to Combat Opioids
The House Energy and Commerce Committee released a video presentation featuring Rep. Buddy Carter (R-GA), the only pharmacist serving in Congress, on features in the House-passed legislation to combat the opioid crisis that focus on empowering pharmacists.

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Federal Agency News
SNF PPS 2019 Rule Goes Final
The SNF PPS annual rule for FY 2019 is final, as published in the Federal Register. The rule represents a major shift from a therapy-based payment model to one that relies more on an objective assessment of the medical needs of the resident. There were no significant changes from the proposed rule released earlier this year. Nursing home trade associations were muted in their praise of the rule, complaining that CMS' tone in the rule was unnecessarily critical of their behavior. 

CMS Allows MA Organizations to Implement Step Therapy in Part B 
The Trump Administration announced a new option for Medicare Advantage Organizations that would allow them to implement step therapy for physician-administered drugs. The new option provides beneficiary protections, but signals the Administration's intent to use whatever levers they have to reduce drug costs.

HHS Secretary Establishes Drug Importation Task Force
Secretary Alex Azar announced that he had asked FDA Commissioner Scott Gottlieb to assemble a task force to examine how the federal government could safely facilitate a process to allow for the importation of lower-cost drugs from other countries in the event of egregious price spikes by manufacturers in the US.

CMS Proposes Changes to ACO Program
In a proposed rule, CMS has outlined its plan to change the ways Accountable Care Organizations (ACOs) handle risk. Currently, ACOs are allowed to opt for shared savings for three years from the time they begin operations. They must then move to shared risk for both savings and losses. The proposed rule looks to change that model to require shared losses after the first year of operation. See Health Affairs

HRSA Promotes Telehealth
The Health Resources and Services Administration (HRSA) celebrates efforts to promote telehealth, through the Federal Office of Rural Health Policy and the Office for the Advancement of Telehealth. The use of telehealth to reduce costs is only part of the story. The ability for remote citizens to gain access to medical care is equally important.

ASPE Points to Missed Savings from Drug Substitution
The Office of the Assistant Secretary for Policy and Evaluation (ASPE) issued a Data Point document, noting that Medicare Part D spent $9 billion in 2016 on brand-name drugs that had therapeutically-equivalent generic versions. If generics were used exclusively in these cases, the Part D program would have saved $3 billion, according to agency estimate.

CMS Requires Hospitals to Post Prices Online
Even if you're not in the hospital business, you should take a look at CMS' latest effort to give consumers tools to evaluate the cost of care. CMS issued a final rule that requires hospitals to post prices for common procedures online, not just to make them available on request. Many policy experts believe consumers will make better choices if they have price and quality information readily available. This is unlikely to stop at hospital prices. See The Hill

CMS Proposes Site-Neutral Payments in Outpatient Hospital Proposed Rule
CMS issued a proposed rule intended to pay for services at a similar rate regardless of where the service takes place. The rule is intended to combat hospital practice of providing services in venues that come with higher reimbursement. If approved, the change would result in $760 million in savings to Medicare in 2019 and lower beneficiary cost sharing. See story in HealthPayer Intelligence. See CMS Release

National Institute on Aging News
The National Institute on Aging posted new items on its website, including research related to Alzheimer's disease and opioid dependence.
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Go to the LTC Pharmacy website for regular updates on what's coming from CMS, including proposed and final rules, new programs, news from Medicare and Medicaid and updated Medicare Learning resources. Go there now.

The FDA often updates its website with drug safety information, news about drug approvals and implementation information on laws, such as the Drug Quality and Security Act. Keep checking our site for the latest news from FDA.

THE HHS Office of Inspector General publishes audit reports and results of investigations on federal health programs, such as Medicare and Medicaid. Congress frequently looks at these reports when deciding where to focus on oversight and legislation. Keep in touch here.

The Government Accountability Office is the official investigative arm of Congress and publishes important reports that often guide the national conversation. We keep track of announcements coming out of GAO, so you don't have to. All you need to do is click here.
News Items of Interest
Pharmacists Prepare for Drug Shortages
Modern Healthcare reports on the efforts of pharmacists and other professionals at the Cleveland Clinic to manage through the increasingly-common announcements of drug shortages throughout the pharmaceutical supply chain. In addition to working all their contacts to obtain drugs that are in short supply over the normal course of events, a major natural disaster that wipes out vital supplies adds to the complexity of their work.

Nursing Homes Lose Star Ratings on Staffing Issues
McKnight's Long Term Care News reports that nearly 1400 nursing homes across the country have lost a star in their CMS rating, largely due to issues related to staffing. The rating downgrade doesn't automatically denote an unsafe condition, as some facilities did not report data, resulting in the downgrade. Nursing homes note the difficulty of hiring registered nurses in a full-employment economy. 

New Startups Focus on Serving the Elderly
Technology companies have come to realize the opportunity of helping seniors age successfully. TechCrunch reports on enterprises that are leveraging technology to give seniors a more useful home health experience. 

What's the Status of Consumer-Directed Health?
The idea that consumers are poised to take charge of their healthcare with access to more pricing and quality transparency, ready to tear down the systems that make care inaccessible and expensive has been all the rage. If you were wondering how all that was working out, take a look at McKinsey and Company's update on healthcare consumerism in 2018.

Will PDPM Drive Smaller SNFs Out of Business?
Skilled Nursing News reports that major real estate investment trusts believe implementation of the new CMS payment model will cause many smaller SNFs to throw in the towel and either sell out to larger players or just go out of business. Citing historical precedent, they note that every time there has been a major disruption in the regulatory climate, many of the smaller facilities decide to get out of the business.


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