LTC Pharmacy News
November 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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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

Budget Resolution Hits Health Programs
Even though the 2018 fiscal year began on October 1, Congress, eager to create a vehicle for tax reform, has passed the budget resolution. The resolution outlines policy that dictate how much spending authority appropriators will have, establishes program philosophies and provides a way for the Senate to pass relevant (i.e., tax reform) legislation on a simple majority vote in the event the resolution contains reconciliation instructions. [See Brookings Institution Explanation].

Critics have jumped on the current resolution because the outline suggests significant cuts in Medicare and Medicaid, which Republicans frame as common sense efforts to streamline the program, return more control to the states, and create a more competitive market.

See Coverage from CNBC

Energy and Commerce Committee on Repeal of Therapy Caps
The House Energy and Commerce Committee announced that they had come to a bipartisan policy agreement on a framework to repeal Medicare therapy caps. The policy would continue to allow therapy above the per capita caps as long as a claims modifier was included. There would continue to be targeted medical review of claims. 

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Federal Agency News
President Declares Opioids Public Health Emergency
The President has declared opioid addiction to be a public health emergency. The impact of the declaration has yet to be determined and falls short of what advocates hoped would be a declaration of national emergency that would allow states to tap federal disaster funding. The President will provide more specific actions once he reviews the recommendations of the Commission on Combating Drug Addiction and the Opioid Crisis. See Fierce Healthcare

ACL Posts Grants for HCBS for the Disabled
The Administration for Community Living (ACL) awarded three grants totaling $1.35 million a year for five years to help develop and test model approaches for enhancing the quality, effectiveness, and monitoring of home and community-based services (HCBS) for people with developmental disabilities. The projects funded by the new grants began on October 1.

New Report: LTSS Data for 2013
Truven Health Analytics, under a grant from CMS, has published a report on Medicaid Long-Term Services and Supports Beneficiaries in 2013. Key highlights include 5.2 million people covered by LTSS services in 2013; most LTSS services provided home and community-based care. The report includes charts and graphs illustrating the multiple options available for states to provide services to Medicaid recipients in need of assistance. 

Medicaid 1915(c) Waiver Data
Medicaid 1915(c) waivers provide funding for states to, among other things, provide home and community-based services for Medicaid recipients. This report, authored by Truven Health Analytics, under contract to CMS, provides data on expenditures, enrollment and services for 2014 based on state-submitted reports. 

Screening for Cognitive Impairment in Older Adults
The US Preventive Services Task Force posted a final research plan on screening for cognitive impairment in older adults. The draft research plan for this topic was posted for public comment from June 29, 2017 through July 26, 2017. The Task Force reviewed all of the comments that were submitted and took them into consideration as it finalized the research plan. 

DEA Posts National Drug Threat Assessment
The Drug Enforcement Administration announced the results of the 2017 National Drug Threat Assessment. While the current opioid crisis has received significant attention, other drugs of abuse remain prevalent. These include methamphetamine, cocaine, new psychoactive substances (NPS), and marijuana. In addition, drug poisoning deaths are the leading cause of injury death in the United States; they are currently at their highest ever recorded level and, every year since 2011, have outnumbered deaths by firearms, motor vehicle crashes, suicide, and homicide.

MedPAC Updates Payment Basics Series
If you've ever wished for an understandable primer on how Medicare pays for various services, look no further. MedPAC's Payment Basics series has been updated and covers all the bases, from hospice to hospitals, this is a great place to start to begin to understand the convoluted processes that frequently govern Medicare.

AHRQ: Statistical Brief on Readmissions
The latest Health Care Cost and Utilization Project statistical brief reviews the top causes of 7-day and 30-day readmissions. See brief here.

CMS Publishes SNF Public Use Files for 2015
CMS has released the Skilled Nursing Facility Public Use File for 2015, which provides information on services provided to Medicare beneficiaries residing in skilled nursing facilities. The Skilled Nursing Facility PUF contains information on utilization, payment (allowed amount, Medicare payment and standard payment), submitted charges and beneficiary demographic and chronic condition indicators organized by CMS Certification Number (6-digit provider identification number), Resource Utilization Group (RUG), and state of service.

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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
Kaiser: Hospitals Buying Nursing Homes
Kaiser Health News reports on Indiana's publicly-owned nursing homes buying or leasing nursing facilities around the state in order to draw down additional Medicaid dollars ( See NCSL Provider Taxes). The state claims that the practice is necessary in order to cover increasing costs of nursing care, while critics claim it's a loophole that shifts the burden to federal taxpayers.

Prison Healthcare Services
The Pew Charitable Trusts has published a unique look at America's prison health systems. Partnering with the Vera Institute of Justice, Pew reports on variations in per capita spending on health, by state, and discusses disparities in healthcare quality. Total prison healthcare spending in 2015 totaled $8.1 billion, or about 20 percent of total prison expenditures. 

The Future of Independent Pharmacy
Drug Topics reports on a Q&A with NCPA CEO B. Douglas Hoey concerning the future of independent pharmacy. The association executive believes independents continue to be a vital part of American healthcare, but continues to warn about the impact of DIR fees. He also offers insight into the pharmacy's role in the opioid epidemic. 

Amazon Obtains Wholesale Drug Licenses in 12 States
The St. Louis Post Dispatch reports that Amazon has applied for wholesale drug licences in 12 states, including Nevada, Arizona, North Dakota, Louisiana, Alabama, New Jersey, Michigan, Connecticut, Idaho, New Hampshire, Oregon and Tennessee. This fuels speculation as to the extent of Amazon's ambition to enter the drug distribution business, but it seems the company is beginning to set the stage for its next steps. 

Thrive Innovation Center Opens in Louisville
McKnight's reports on the debut of Thrive, a center for innovation in aging. Supported by local companies such as PharMerica and Kindred Healthcare, the center invites entrepreneurs and technology companies to collaborate on innovations that allow seniors to thrive through the aging process.

Hope to See You at ASCP Annual Meeting
If you're attending the ASCP Annual Meeting in Kissimmee, FL from November 2-5, I hope we will have the chance to meet. Looks like a great agenda and a wonderful location. 

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