LTC Pharmacy News
May 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 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.

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

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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Energy and Commerce Advances Opioid Bills
The Health Subcommittee of the House Energy and Commerce Committee approved 57 bills to respond to the opioid crisis and animal drug user fee act reauthorization. 
Most of these are variants of existing laws, extending drug monitoring programs and requiring federal health programs to pay more attention to the recognition and treatment of opioid dependence. 

These bills now go to the full committee for approval before being referred to the full House of Representatives for action. When in doubt, legislate.
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Federal Agency News
CMS Issues 2019 SNF Payment Rule with New System
The Centers for Medicare and Medicaid Services issued the highly-anticipated proposed SNF payment rule for 2019. Along with a $850 million payment increase, CMS issued a proposal that would Shelve its proposed RCS-1 payment formula and replace it with a Patient Driven Payment Model (PDPM). CMS will accept comments on the proposed rule through June 26.

CMS Delivers Medicare Advantage Encounter Data
The CMS Administrator announced the availability of 2015 Medicare Advantage encounter data to researchers. Files covering all six settings (inpatient, skilled nursing facility, home health, outpatient, carrier/provider and durable medical equipment) will be available.

ACL Kicks Off Older Americans Month
The Administration for Community Living has published resources for the observance of Older Americans Month, including resources for organizations to celebrate this year's theme Engage at Every Age.

CBO Sees Big Deficits in Future
The Congressional Budget Office has published its Economic Forecast for the 2018–2028 Period. The picture is not a pretty one. The aging of America produces pressure on Social Security and Medicare and interest payments on the country's already massive debt will crowd out discretionary spending. The nation's debt as a percentage of GDP will approach levels not seen since World War II.

What do you Know About the National Institute on Aging?
The NIA is the nation's premier research agency on issues related to healthy aging. While many of us are vaguely aware of this organization, how many of us really understand what activities NIA is involved in. To help, the NIA has produced a short video that highlights the agency's mission and purpose. It is well worth the five minutes you spend getting to know the NIA.

Center for Innovation Gets New Leader
The Center for Medicare and Medicaid Innovation has a new director. CMS Administrator Verma announced that Adam Boehler, healthcare entrepreneur, will lead the agency. The Hill
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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
Health Affairs Blog: The Never-Ending Misuse of Antipsychotics In Nursing Homes
The journal Health Affairs features a commentary on what the author views as the intractable problem of misuse of antipsychotics in nursing homes, speculating that more than 15,000 residents die each year from the inappropriate use of these drugs in nursing homes.

ManorCare Operations Sold for $1.35 billion
Nonprofit Promedica has agreed to purchase the healthcare operations of ManorCare and will operate the company as a joint venture with Welltower, which has purchased ManorCare's landlord QCP, which is a real estate investment trust. The deal will make 
Promedica a major player in the post-acute care market. See story in Home Healthcare News.

How Amazon Could Disrupt Healthcare
Healthcare providers and suppliers have been worried that if Amazon takes aim at healthcare as a business opportunity, they could find themselves disrupted right out of business. Sure, Amazon has relentlessly exploited its competitors margins and inefficiencies to carve out a major section in the retail landscape, but what risk does the online behemoth pose for the healthcare world? Healthcare Finance News

Does Walmart and Humana Pose a Greater Threat?
The recent report that Walmart and Humana are exploring a merger has created more anxiety among America's healthcare industry. Unlike Amazon, Walmart, through its in-store clinics and pharmacies, is already a healthcare player. Combine Walmart's experience with the skills and experience of Humana, and maybe this becomes the more credible threat to the status quo. Mercer

Can Adding a Pharmacist to Home Health Reduce Readmissions?
Hospitals face serious financial and reputational risk when Medicare patients are readmitted following a hospital stay. Here's an example of how the use of a pharmacist on the Home Health team can reduce readmissions and improve medical outcomes. Pharmacy Practice News.

Technology Helps Seniors Stay at Home
More seniors are able to stay at home, rather than in institutions, thanks to advances in technology. Kaiser Health News reports on products and services that can monitor the frail elderly at home and improve safety and add some peace of mind, not only for the senior, but also for their loved ones. Bonus: the cost of this technology doesn't need to break the bank!

Medicine Use and Spending in 2017
IQVIA Reports on drug spending, with all the facts, for the year 2017. This is a good and comprehensive review drug product spending, patient cost sharing and the full story on manufacturer price increases, as well as a forecast of what's to come.

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