LTC Pharmacy News
December 2016
The healthcare industry is in the beginning of massive change and the long term care pharmacy industry will be affected by this change. 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.
See Video Overview of Final LTC Facility Rule
The long-awaited CMS final rule on long term care facilities has been published. Take a tour of the pharmacy-related provisions here.

We also have a video overview of the CMS SNF PPS Final Rule for FY 2017

Elise Smith Joins LTC Pharmacy News
If you've been in the long term care industry for any length of time you are probably familiar with Elise Smith, long time Senior Vice President of Finance Policy and Legal Affairs at the American Health Care Association until her recent retirement.

She has a longstanding interest in the Medicare and Medicaid programs and became an expert on the pharmacy side of the industry during the implementation of the Medicare Modernization Act, which created the prescription drug benefit.

We are honored to have Elise working with us. She brings a depth of knowledge that is unequaled in the industry.

See McKnight's Profile

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CMS Announces ACO for Duals

CMS announced that it will begin testing a new payment and delivery system for dual eligibles under the ACO model it calls Medicare-Medicaid Accountable Care Organization (ACO) Model.

The Medicare-Medicaid ACO Model is open to all states and the District of Columbia that have a sufficient number of Medicare-Medicaid enrollees in fee-for-service Medicaid. CMS will enter into participation agreements with up to six states, with preference given to states with low Medicare ACO saturation.

CMS encourages interested states to submit a Letter of Intent as early as possible to begin the development of the state-specific aspects of the Model and the Model application process.

See CMS release

MedPAC December Meeting
The Medicare Payment Advisory Commission (MedPAC) met on December 8 and 9 to begin development of the March Report on provider Medicare payment rates for FY 2018. Based on its payment adequacy framework , MedPAC discussed recommendations with respect to post-acute care that would eliminate increases in or reduce Medicare payment rates in 2018 for home health agencies (HHAs), skilled nursing facilities (SNFs), inpatient rehabilitation facilities (IRFs) and long-term care hospitals (LTCHs). The final vote will come in January.

Building a System that Works: Thoughts of HHS Secretary Silvia Matthews Burwell
The tenure of Sylvia Matthew Burwell as Secretary of Health and Human Services is nearing its end. In a Blog published by Health Affairs, Secretary Burwell laid out the accomplishments of the Obama Administration and “the path forward,” her vision for the future of health care. She discusses the complex and sometimes daunting array of initiatives that the Administration has provided many through the Center for Medicare and Medicaid Innovation (CMMI).
CMS Posts Video on IMPACT Act Quality Reporting Requirements 
CMS held a webcast on September 14th on the Skilled Nursing Facility (SNF) Quality Reporting Program (QRP). Learn about the reporting requirements for the new SNF QRP, effective October 1, 2016. See video

AHRQ Reviews Medication Errors in Nursing Homes
The Agency for Healthcare Research and Quality reports on a review of medication errors in nursing homes and found a relatively high rate of errors, although less than one percent of these errors was considered potentially serious. See Abstract

AHRQ Role in Improving Care in Chronic Conditions
In a recent Blog Post, AHRQ Director Andy Bindman, MD, discusses the work the agency is now doing to respond to the challenge of better managing the vast number of Americans living with multiple chronic medical conditions. 

HCUP Fast Stats: Hospital Costs
The The Healthcare Cost and Utilization Project (HCUP) announces new reports on national hospital utilization and costs, including most common diagnoses and most common operations

National Vital Statistics Reports
This report presents complete period life tables for the United States by race, Hispanic origin, and sex, based on age-specific death rates in 2012.
Congress Passes 21st Century Cures Act
The House and Senate have passed the 21st Century Cures Act and the president is expected to sign it into law. The legislation was championed by outgoing Chairman Fred Upton (R-MI) of the House Energy and Commerce Committee and revamps the process by which the FDA approves new treatments. The bill also provides additional resources for the National Institutes of Health. The massive bill was supported by a large industry coalition, but was criticized by public interest groups, led most vocally by Senators Bernie Sanders (I-VT) and Elizabeth Warren (D-MA) as giveaways to the drug lobby.

One provision which merits attention was the addition of language to create a Medicare Home Infusion payment, however that progress was muted by delaying implementation of the provision until 2021, while reducing payments for home infusion drugs, which begins in January of 2017. This sets off a scramble by home infusion companies to get current patients moved out of home infusion services before the payment reductions take effect. Advocates will need to remedy this when Congress reconvenes in January.

See Energy and Commerce Committee Summary of the bill.

Ways and Means Releases 2016 Green Book
Washington insiders know that the Ways and Means Green Book is a trove of useful information on the programs overseen by the House Ways and Means Committee, including Medicare and Social Security. The publication is prepared by the Congressional Research Service and is available electronically.

Rep. Tom Price Nominated to Head HHS
Rep. Tom Price (R-GA), current chairman of the House Budget Committee will be President-elect Donald Trump's nominee to be Secretary of Health and Human Services. Price is a long-time foe of the Affordable Care Act. He is also a orthopedic surgeon.

Price generally favors replacing direct federal subsidies for health insurance coverage with focused tax credits and allowing consumers to shop for health insurance across state lines. The incoming Trump Administration has noted that it is not interested in overhauling Medicare, but is willing to consider Republican initiatives on Medicaid, including devolving control to states through block grants. 

Trump Selects New CMS Adminstrator
The Trump transition team announced that the president-elect will nominate health policy consultant Seema Verma to become the next Administrator of the Centers for Medicare and Medicaid Services. The nominee has worked as a consultant to Republican governors, including the current Indiana governor and vice president-elect Tom Price. See Politico

Next Energy and Commerce Committee Chairman Named
The US House of Representatives has elected Rep. Greg Walden (R-OR) as chairman of the House Energy and Commerce Committee, which oversees Medicaid, as well as the Medicare Part D benefit.
Federal Agency News
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
Truven Health Analytics Posts Paper on Bundled Pricing
Truven, an IBM affiliate, published a paper on bundled pricing in commercial plans for joint replacement, highlighting the cost differentials in the marketplace for joint replacement and noting the roles of hospitals, post-acute care facilities and re-hospitalizations in the variation of costs for joint replacement. 

The paper notes that facility costs of hospitals, not professional services, was the largest contributor to cost differentiation. 

Clover Health; An Insurance Startup to Reduce Costs
Once of the most-watched experiments in healthcare cost control is now taking place in New Jersey, where the two-year-old startup is focusing its operations, not just on paying claims, but using sophisticated data analytics to predict and control costs in the senior population; the most expensive healthcare users in the US. See Bloomberg

P&T Reports on LTC Pharmacy Rules
The December issue of Pharmacy & Therapeutics reports on LTC pharmacy provisions in the CMS final rule on long term care facilities.

McKinsey: How tech-enabled consumers are reordering the healthcare landscape We accept as a matter of course that technology affects every facet of our lives, but perhaps we haven't thought deeply about how technology will change healthcare. McKinsey and Co. presents a thoughtful piece on how this evolution may play out in ways we are not yet ready for.

2015 Healthcare Cost and Utilization Report
The Health Care Cost Institute issued a cost and utilization report covering the period 2012-2015 and is taken from claims data from four major health insurers. 

Physicians Rate Electronic Health Records
Medical Economics is out with its 2016 EHR Report. As useful as these tools can be to help physicians manage their patients' medical care, it seems that no one product quite measures up to what doctors are hoping for. 

Pharmacist vs Physician in Medicare Annual Wellness Visits
The Journal of Managed Care and Specialty Pharmacy features a study comparing interventions recommended by pharmacists and physicians for Medicare enrollees under the Medicare Annual Wellness Visit program. Pharmacists provided more recommendations than physicians, on average, and received marginally higher reimbursement ($105 per visit, vs $99) than physicians. The authors suggest that participation in this model can be a source of revenue for pharmacists.

Illinois Pharmacists Make House Calls
In a partnership with the Illinois Dept of Aging, pharmacists affiliated with APC, LLC are making visits to seniors to provide medication reconciliation services and adherence advice. The state hopes to see reduced hospitalizations and readmissions as a result. See Drug Topics article
Assisted Living Staff to Administer Meds in New York
McKnights reports on a new law in New York that allows some advanced home health aids in New York to administer medications to residents of assisted living facilities. This was a high priority for Argentum of New York. The association predicts this will save Medicaid millions of dollars in preventing higher-cost interventions.

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