LTC Pharmacy News
July 2018
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.
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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.

MedPAC Calls it a Wrap!
Elise reports on the January meeting and finalizes its recommendations to Congress for payment policy in 2019. This is the annual ritual where the Commission assembles its mountain of data and tells Congress which providers, in its estimation, are being overpaid, underpaid and how payments could be improved.

As usual, MedPAC thinks nursing homes get paid too much under Medicare and has some recommendations. I won't spoil the story, so if you want to know what they think, read more.

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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The President's Plan To Reorganize Government
President Trump believes the federal executive branch is in need of a makeover and has proposed a plan to remake the federal superstructure to be more coherent and effective. 

Among the more interesting proposals is the plan to move food regulation from the FDA to the Dept. of Agriculture and rename the FDA as the Federal Drug Administration, focused primarily on drug evaluation and approval. Also proposed is a re-naming of HHS to the Dept. of Health and Public Welfare.

Given the polarization in the nation's capital, this proposal appears to be aspirational rather than practical. 

Is Congress Done for the Year?
While the House of Representatives moves ahead on efforts to combat the opioid crisis, The Senate seems less interested in passing legislation before the current Congress adjourns. 

Senate Majority Leader Mitch McConnell has called for a shortened August recess in order to force consideration of President Trump's appointees, including a new Associate Justice of the Supreme Court. Other than that, most observers don't see much chance for enough agreement between parties to pass any substantive legislation as the mid-term elections get closer.
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Federal Agency News
Centers for Medicaid Releases LTSS Report
The Center for Medicaid and CHIP released a report on Medicaid coverage of Long Term Services and Supports for fiscal year 2016. The report shows that expenditures for institutional care fell 2 percent, while payments for Home and Community-Based Services and Managed Care increased.

New Bulletin Released on Model Practices for State Oversight of Group Homes
The Administration for Community Living (ACL) and the HHS Inspector General and Office of Civil Rights released a report in January on health and safety issues in group homes. The ACL reports on a new bulletin released by Center for Medicaid and CHIP Services to encourage states to implement compliance oversight programs. 

CMS Publishes Proposed Home Health Payment Rule
CMS has released its annual proposed rate-setting rule for FY 2019. The proposal includes a payment rate increase of 2.1 percent ($400 million) as well as a remote monitoring reimbursement. Comment period ends August 31.

AHRQ: Non-Invasive Nonpharmacological Treatment for Chronic Pain: A Systematic Review
The Agency for Healthcare Research and Quality published a review of treatments for pain that did not require pharmaceuticals. See report here

NIH: Aging Brains Still Good at Some Things
The National Institutes of Health posts a report on how our brains function as we age. The news is not all bad, with researchers showing that older brains are still capable of learning, creating new memories and improving language skills.

HHS Inspector General Posts Semi-annual Report
The Inspector General released its semi-annual report on its efforts to identify and curb waste and abuse in the programs run by the federal government's largest department. 
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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
NIC Reports on SNF Occupancy and Revenue Trends
The National Investment Center for Seniors Housing & Care (NIC) has posted its latest analysis of occupancy and revenue trends through March 2018. The data continue to be somewhat discouraging on occupancy, which fell to 81.6 percent nationally. Medicare patient days enjoyed an uptick, but managed Medicare continues to garner an increasing percentage of Medicare stays. See NIC Blog for more insights.

More SNF Days Not Associated with Better Outcomes
McKnight's Long Term Care News reports on a Brown University study comparing length of stay for 300,000 Medicare hip replacement patients that researchers claim demonstrates that Medicare Advantage patients spent fewer days in SNFs but had slightly better outcomes.

Manufacturers Raise Drug Prices. Ignore President's Warning
The Washington Examiner reports that major pharmaceutical manufacturers are raising drug prices mid-year, following a recent announcement by the President that they would soon be lowering prices. Pfizer reportedly will raise the price on more than 40 of its drugs and other companies plan to follow suit.

Will the Latest Healthcare Mergers Shakeup Skilled Nursing?
Skilled Nursing News reports on how the CVS-Aetna merger and the cooperation between Berkshire Hathaway, Amazon and JP Morgan Chase may have ripple effects that eventually extend to the skilled nursing industry.

AHIP New CEO to Focus on Drug Pricing
Matt Eyles, newly-minted CEO of America's Health Insurance Plans, the major trade group for health insurers, vows to make drug pricing the highest priority for the association under his leadership. Eyles, a former executive with major pharmaceutical manufacturers, succeeds Marilyn Tavenner, former CMS Administrator, who retired from the leadership of AHIP on June 1. See Fierce Healthcare

PillPack Bought by Amazon
Regular readers will recall that we have featured PillPack in previous letters, noting that the company seems have capitalized on helping people with complex medication regimens better manage their prescription drugs. Amazon has taken notice and has reached an agreement to buy the company at an estimated price of just under $1 billion, a handy premium over its last valuation of $330 million. See Tech Crunch

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