LTC Pharmacy News
December 2017
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.
Digital Marketing for LTC Pharmacy Professionals
Whether you are manage or own a long-term care pharmacy or are a consultant pharmacist in your own practice (or aspire to either) you compete in a crowded and competitive industry. 

Attracting and retaining new customers is a top-of-the-list priority. Let us help with a new guide to Digital Marketing for LTC Pharmacy Professionals

While you're at it, please sign up for the new LTCPharmacy Marketing Newsletter.
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CMS Final Rule: Knee Replacement No Longer Inpatient Only
Elise reported earlier on the CMS proposed rule to remove total knee replacement from the list of "inpatient only" procedures under the Medicare Outpatient Payment System. The agency has finalized the rule, which means that recipients undergoing outpatient knee replacement will not have a 72-hour hospital stay in order to qualify for Medicare Part A rehabilitation in a SNF.  See more here.

Recent MedPAC actions on Nursing Home Quality
Elise reviews recent MedPAC research on why Medicare beneficiaries continue to choose lower quality nursing facilities. MedPAC staff point to statutory prohibitions against allowing hospitals to recommend SNFs for patients being discharged. How could changes affect nursing home quality initiatives and how can LTC pharmacies engage? See more here

Proposed Changes to the Inpatient Only Rule Could Impact SNFs
CMS recently published a proposed rule on Hospital Outpatient Payment System updates and asked for comments on allowing hip and knee replacements to be performed in outpatient settings. Elise discusses the implications on nursing facilities if Medicare beneficiaries stop using SNFs for rehabilitation. See more here.

Getting to a Unified Post-Acute Care Payment System
Various Federal agencies have been working for years to come up with a unified payment system for post-acute care (PAC). In this paper, Elise gives us a much-needed history of the policy and its development, featuring the star players CMS and MedPAC. 

Why should you care? Your PAC customers have a lot riding on how the drama finally resolves. They care about this, and so should we. See more here.

CMS Reverses Its 2016 Position on Pre-Dispute Arbitration
On June 8, 2017, CMS issued a proposed rule that reversed its position prohibiting pre-dispute arbitration agreements in long term care facilities. This was the culmination of policy making and unmaking that, with respect to the latest clash on Skilled Nursing Facility/ Nursing Facility arbitration practice, started on October 4, 2016. See more here

CMS Releases Proposed Case-Mix Payment Proposal
While you have been frolicking over these past several years, CMS has been steadily preparing an assault on the status quo as it relates to Medicare payment policy for SNFs under Part A.

According to another insightful analysis by Elise, CMS suspects SNFs have been gaming the RUGs system and proposes a new payment methodology based on more "objective" standards than the number of rehabilitation hours a resident will require.

Read this and your confusion over the new proposal will vanish like your paycheck in Las Vegas.

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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Legislative Highlights

Congress Focused on Tax Reform
Having failed to repeal and replace the Affordable Care Act, Congress has now turned its attention to tax reform. With a budget resolution in hand they are now able to move legislation without any Democratic support through a process known as reconciliation

As noted in the last issue of LTC Pharmacy News, the budget resolution called for reductions in Medicaid and Medicare spending to make room for tax reduction, but no one expects any serious cost-cutting in these popular programs.

As most observers watch the process of achieving some kind of tax reform and/or reduction, some of us are watching for movement on Congressional action on the extension of several Medicare programs due to expire by the end of the year, as well as expiring authorization for programs like Area Agencies on Aging. We are also watching whether Congress will provide funding for transitional payments for home infusion services. 

President Nominates new HHS Secretary
The President announced that he will nominate Alex Azar to be the next Secretary of Health and Human Services, following the sudden resignation of Tom Price over his use of private jets on official business. 

Azar is a former Deputy Secretary of HHS in the George W. Bush Administration and served as president of Eli Lilly, the Pharma giant. See Politico story

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Federal Agency News
CMS Proposes Medicare Rule for 2019
CMS issued a proposed rule on November 16 containing implementation standards for the Comprehensive Addiction and Recovery Act (CARA). The proposal also asks for comment on potential rules to require plans to offer discounts at point of sale, which could positively impact DIR fees for pharmacies. 

CMS also proposes to tighten rules to require plans to make their networks more accessible to any willing pharmacy enrollment, would reduce transitional drug supplies for LTC residents to one-month's supply from the current three-month allowance, and would impose new formulary tiering rules to lower drug costs for Medicare enrollees. 

CMS Delays Implementation of Some Phase-2 F-Tags
You may recall the provisions of last year's SNF Mega Rule. The new administration has had a few thoughts about some of the substance and has issued a notice to State Survey Directors that it will delay enforcement of certain requirements, including those relating to psychotropic medications and antibiotic stewardship, for 18 months. 

President's Opioid Commission Reports
The President's Commission on Combating Drug Addiction and the Opioid Crisis has published its final report, which calls for greater interagency cooperation, more prescription drug monitoring programs, greater access to treatment and increased federal funding. 

AHRQ Releases TeamSTEPPS 2.0 to Improve Patient Safety in Long-Term Care
The Agency for Healthcare Research and Quality’s (AHRQ) TeamSTEPPS 2.0 for Long-Term Care curriculum reflects updates to the original TeamSTEPPS in Long-Term Care curriculum, which was released to the public in 2012. Since then, AHRQ released TeamSTEPPS 2.0, an update to the original curriculum that focuses on hospital-based teams. As a result, AHRQ has sponsored the development of an updated curriculum for use in the long-term care setting.

FDA Approves Drug with Tracking Device
The FDA has approved a version of aripiprazole (Abilify) with a tracking device to measure compliance. The brand name is Abilify MyCite. The system works by sending a message from the pill’s sensor to a wearable patch. The patch transmits the information to a mobile application so that patients can track the ingestion of the medication on their smart phone. Patients can also permit their caregivers and physician to access the information through a web-based portal.

CMS Chief Outlines New Vision for Medicaid
CMS Administrator Seema Verna, in a speech to the National Association of Medicaid Directors, outlined a new vision for Medicaid, one which will allow states more flexibility in program design and implementation, but will also ask for more accountability. 
The CMS outline of her comments also includes updates to how CMS will manage Section 1100 waivers and plans to create Medicaid and CHIP scorecards.

DEA Moves to Emergency Schedule all Fentanyls
The Drug Enforcement Administration announced its intent to schedule illicit Fentanyl products and analogs. The DEA will make an emergency declaration, after which possession and distribution of these products will be a criminal offense. 

AHRQ Updates National Healthcare Disparities Site
The Agency for Healthcare Research and Quality (AHRQ) announced an update to its health disparities website. The interactive resource evaluates states based on more than 250 measures of health care quality and access.

DEA's Latest Drug Takeback a Big Success
The DEA's latest national drug takeback was held on October 28th in cooperation with more than 4,200 local and tribal authorities. DEA reports that the latest effort resulted in the return of more than 463 tons of expired, unused and unwanted drugs. 

AHRQ Rehospitalization Data
Medicare experiences the highest rate of hospital readmission among all payers for healthcare, and the leading diagnoses resulting in readmission is schizophrenia and other psychotic disorders. All this and more here.
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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
ASCP:  Grosso Stepping Down
McKnight's  reports that the American Society of Consultant Pharmacists Executive Director and CEO, Frank Grosso, will step down from his position once a new leader can be recruited and transitioned into the role. Grosso has been at the helm of ASCP since 2014.

CVS to Offer Next Day Delivery
The New York Times reports that CVS will begin offering next-day delivery in some urban areas beginning in 2018. Analysts believe CVS, concerned that Amazon may attempt to enter the space, has preemptively moved to add to its offerings. 

NACDS Generally Positive on CMS Proposed Rule
The National Association of Chain Drug Stores issued a statement noting the positive aspects of the latest CMS proposed rule on Medicare, citing the agency's position on pharmacy lock-ins, request for information on DIR fees and proposed implementation of the NCPDP standard for electronic prescribing.

Drug Channels Discusses CMS Proposed Rule and DIR
Dr. Adam Fein, in Drug Channels dissects the CMS discussion in the Medicare proposed rule and the impact it could have in rationalizing the drug price and cost debate. Well worth reading.

Seniors Adopting Smartphone Use Fastest of All Groups
Marketing Charts reports that seniors (55-74 years old) are adopting smartphones at a faster rate than the next tier of adults (age 45-54). More than two-thirds of seniors have smart phones and are likely to use them every day. 

How Employers See Drug Benefit Management
The National Pharmaceutical Council has published a report on its survey of employer benefits management decision makers and how they view their experience with the management of the employee drug benefit and what they would propose to improve the process.

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