LTC Pharmacy News
June 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.
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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 Publishes Draft SNF PPS Updates for 2018
Ah Spring! The flowers in bloom, pollen in the air and CMS busy delivering fresh assaults in advance of the next fiscal year.

If thoughts of wading through another proposal rule fills your heart with dread, fear not! Our intrepid Elise Smith proves herself equal to the challenge of deciphering the most obtuse policy jargon and delivering prose simple enough for an online news editor to understand. See it 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

Senate Takes Up Health Reform
Following House passage of its "repeal and replace" legislation of the Affordable Care Act, the Senate is preparing to tackle its version. 

The process is more complicated in the Senate where, unlike the House, most legislation requires 60 votes to overcome procedural rules allowing the minority party to delay consideration of a bill. The exception is when the legislation is considered under a process known as reconciliation, where the legislative text needs to have some relationship to federal spending. 

Trouble is, not all 52 Republicans can seem to agree on what to do, with several members objecting to the House provisions that scale back Medicaid expansion. 

Pundits put the likelihood of Senate success at somewhat less than 50 percent, unless the restive GOP members can come together. 

Senate Finance Committee Passes Chronic Care Legislation
In a rare moment of bipartisanship, the Senate Finance Committee agreed unanimously to forward the (CHRONIC) Care Act of 2017 to the full Senate for consideration. 

The legislation expands provisions of the Independence at Home demonstration and increases the availability of telehealth options for Medicare beneficiaries. 

House Health Reform Bill Reportedly Increases Uninsured
The Congressional Budget Office released its analysis of the House-passed American Health Care Act and predicts that the provisions of the legislation will result in 23 million Americans to lose insurance coverage by 2026. The report also reduce the federal deficit by $119 billion over ten years. See story in Fierce Healthcare

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Federal Agency News
CMS Asks for Your Input on Regulatory Burden of the ACA
The Centers for Medicare and Medicaid published a request for information asking for public input on how to streamline regulation in the individual and small group markets under the Affordable Care Act.

“We are looking for valuable feedback on how to change existing regulations in ways that put patients first, promote greater consumer choice, enhance affordability and return more control over healthcare to the States,” said CMS Administrator Seema Verma.

The comment period will be open for 30 days following publication.

CMS Extends Comment Period on Case-Mix Proposal
CMS has extended the comment period for its recent proposal to modify the case-mix for SNF PPS. The original deadline for comment was June 26, and had now been extended to August 25, 2017.

New Health Workforce Projections
The National Center for Health Workforce Analysis (NCHWA) released a new report and four fact sheets on the national supply of and demand for:
  • Geriatricians
  • General Pediatricians
  • Neurology Physicians and Physician Assistants
  • Physical Medicine and Rehabilitation Physicians and Physician Assistants
  • Physicians and Physician Assistants in Emergency Medicine
What Is ACL's Interest in HCBS Quality?
A transcript (PDF), recording, and slides (PDF) from the first webinar in this series are now available. The webinar included and overview of ACL's work on HCBS quality measures, why this work is important, and an update on HCBS quality measures progress, including findings and impact.

Request for Public Comment on Proposed Revisions for the Older Americans Act Annual State Program Performance Report
On June 1, 2017, Administration for Community Living released the proposed revisions for the Older Americans Act Title III and VII, Chapters 3 and 4 Annual State Program Performance Report (SPR) for public comment. The Notice of Comment Request is now on display in the Federal Register (Vol. 82, No. 104, page 25293 -25294) and will be open for public comment until July 31, 2017.

Community Pharmacists Not Trained in Hand-offs (AHRQ)
This cross-sectional survey of community pharmacies found that virtually none of the pharmacists had received training in how to hand off information. A significant proportion of responses indicated that pharmacy information technology systems do not support handoff communication. Respondents reported that handoffs are frequently inadequate or inaccurate.

Upcoming IMPACT Act Special Open Door Forum- June 20th
Tuesday, June 20, 2016 2:00-3:00 pm ET
This Special Open Door Forum (SODF) will provide information and solicit feedback pertaining to the Improving Medicare Post-Acute Care Transformation Act of 2014 (commonly referred to as the IMPACT Act). This SODF will focus on the goals of the IMPACT Act, update attendees on the RAND contract activities for item development, including the upcoming national testing, and identify opportunities for providers, consumers, stakeholders, researchers, and advocates to become involved over the next year.
Visit the IMPACT Act SODF Announcement- 6-20-17 for more information.

AHRQ Highlights Errors in Electronic Pre-populated Med Rec
The Agency for Healthcare Research and Quality featured a report citing the prevalence of clinically relevant medication errors in electronically generated medication reconciliation reports upon entry into acute care hospitals. 

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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
Seniors Becoming More Tech Savvy
The common perception of the over-65 set is a general reluctance to experiment with new technology. According to new information from the Pew Research Center, that information may be outdated. Pew reports that more than two-thirds of seniors regularly go online and over 40 percent own smart phones. While still lagging their millenial juniors, the number of seniors going digital has never been higher.

National Investment Center for Senior Housing and Care Q1 Report Available
The NIC SNF Q1 report is now available for download. The report shows the continuing decline in nursing home admissions, despite a seasonal uptick. Medicare Managed Care admissions at a five-year high. 

State Regs on Telepharmacy
TelePharm posted a useful guide to the current state of regulation of telepharmacy by state. Check it out to see if your state allows telepharmacy. 

Pharmacist Salaries up, but Growth Lags
Drug Channels reports on survey data showing average pharmacist salaries at around $120,000 per year, but annual growth is not keeping pace with other healthcare professionals. 

Improving Pharmacy Through Technology 
Technology has played an important role in improving access, compliance and safety, according to a recent article in Managed Healthcare Executive. The robotics revolution that has swept other industries is slowly ramping up in the world of retail pharmacy.

Elder Troubles with Med Management Increasing
A study cited in Drug Topics suggests that difficulty managing medications is not confined to the "very old", but may include significant numbers of seniors below age 80. The aging of America will demand more attention be paid to helping seniors better manage medications. 

Nurse Practitioners in High Demand
Forbes reports that, due to changes in practice standards, nurse practitioners are now in higher demand than many physician specialties. More states now allow direct access to nurse practitioners and more consumers prefer the convenience of consulting with a nurse instead of waiting for an appointment with physicians.

Nursing Home Statistics
Ever wonder what the average nursing home costs are in the US? How about the average age of admission to a nursing home, or the number of licensed beds in the US? Well, wonder no more. Statistic Brain has a handy statistical list of all things nursing home at the click of a mouse.

Do Nurse Phone Calls Reduce Hospital Readmissions?
Seems to make sense that having a nurse make follow-up calls to seniors follow hospital discharge would result in fewer readmissions. Well, we now have some data that suggests that this may not be true. Reporting on the evidence, Fierce Healthcare quotes an observer who suggests that personal visits may be more effective.

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