LTC Pharmacy News
October 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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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

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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 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 Passes CHRONIC Care Act
Late last month the Senate unanimously passed the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017. The rare display of bipartisanship reflects the consensus that the management of chronic conditions of Medicare beneficiaries is a critical element in making the program sustainable.

Main features of the bill include extension of the Independence at Home demonstration, allowing telehealth expansion in Medicare Advantage programs, and allowing Accountable Care Organizations to accept fee-for-service assignments and to allow them to offer beneficiary incentives. 

The legislation also directs the Government Accountability Office to issue reports on the extent to which Medicare prescription drug plans and private payors use programs that synchronize pharmacy dispensing to facilitate comprehensive counseling and promote medication adherence.

The bill is now in the House and has been assigned to the Committee on Ways and Means and to the Energy and Commerce Committee. 

President Appoints Hargan as Acting HHS Secretary
President Trump appointed Eric Hargan as Acting HHS Secretary, replacing the previous Acting Secretary Don Wright, following the resignation of Secretary Tom Price, who resigned over White House concerns about his travel on private aircraft. See Bloomberg

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Federal Agency News
CMS Releases 2018 Landscape Files
The Centers for Medicare and Medicaid Services published the 2018 PDP, SNP and MA Landscape Source Files. These publications give plan premium information by state and can help pharmacies understand which plans will available for dual-eligible auto-enrollment. CMS expects MA plan enrollment to increase by more than 9 percent in 2018

CMS Unveils Star Ratings for Health and Drug Plans
The agency announced the Star Ratings for 2018 Medicare health and drug plans in advance of the annual open enrollment. See announcement, along with fact sheets and other links.

AHRQ Releases New Interactive Map Depicting Trends in Opioid-Related Hospitalizations
The Agency for Healthcare Research and Quality (AHRQ) has released a new interactive map that presents State-specific results for opioid-related hospitalizations based on information presented in HCUP Fast Stats.
After selecting a State of interest, users can obtain information on the change in the rate of hospitalization over a 5-year time frame as well as the patient age, sex, community-level income, and location groups with the highest rates in 2014.

CMS Withdraws Controversial Part B Proposed Rule
You may recall that in early 2016 CMS issued a proposed rule that would change Medicare Part B drug reimbursement from the current ASP +6% to ASP+2.5% with a $16.80 dispensing fee. The rule was intended to reduce any incentives physicians might have had to choose high-cost drugs over lower cost alternatives. The rule has been withdrawn by the Trump Administration, citing protests from the physician community.

AHRQ Stats: Medication Errors Among Seniors
The percentage of adults age 65 and older who received potentially inappropriate prescription medications declined from 19 percent in 2003 to 12 percent in 2014. (Source: AHRQ, 2016 National Healthcare Quality and Disparities Report, Chartbook on Patient Safety.)

ACL: Supporting People with Dementia and Their Caregivers in the Community
The Administration on Aging (AoA) within the Administration for Community Living (ACL) commissioned a supplemental issue of Generations through its National Alzheimer’s and Dementia Resource Center (NADRC) in an effort to advance the establishment and enhancement of dementia-capable home and community-based systems.

MedPAC September Meeting Highlights
The Medicare Payment Advisory Commission (MedPAC) held its September meeting on September 7th and 8th. Among other topics, staff provided a backgrounder on PBMs and Specialty Pharmacies, as well as a report on Encouraging Medicare beneficiaries to use higher-quality post-acute care providers.

Medicare Current Beneficiary Survey: Diabetes
The Medicare Current Beneficiary Survey posted a new report: “Diabetes Occurrence, Costs, and Access to Care among Medicare Beneficiaries Aged 65 Years and Over”. Using data from the 2013 Medicare Current Beneficiary Survey (MCBS), this report presents prevalence and access to care patterns of persons with type 1 and type 2 diabetes among Medicare beneficiaries aged 65 years and over.

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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
California Governor Signs Drug Pricing Legislation
Governor Jerry Brown has signed Senate Bill 17, which requires pharmaceutical manufacturers to disclose price increases to health plans and the state government when price increases exceed 16 percent over a two-year period. The law also mandates that health plans report the 25 most commonly prescribed drugs, the 25 costliest drugs and 25 drugs with the highest year-over-year increase in total annual plan spending. Pharmaceutical companies spent millions to defeat the legislation, but the public concern over ever-rising drug costs appeared to carry the day. 

Check Your Meds Day Coming October 21
It's no secret that Americans take a lot of prescription drugs. Many of us may not even know what we're taking or why. On October 21st we will observe Check Your Meds Day, where Consumer Reports is encouraging Americans to consult with their pharmacist on their medication regimen to determine whether some medications can be discontinued, changed or adjusted. 

Patients Want Media-Savvy Pharmacists
Drug Topics reports on the results of a national survey suggesting that patients want their pharmacies to be accessible and communicate more on social media sites, such as Facebook and Twitter. See Business Wire

Google Parent Jumps Into Healthcare
Alphabet, the parent company of Google, has hatched a healthcare startup called City Block. Unlike many innovations in the healthcare universe, City Blocks is focused on lower-income populations and the medically underserved. The company is positioned as an add-on to other insurance offerings at no additional cost to the patient. See CNBC Report.

Long Term Care Costs Up over 3 percent
McKnight's reports on a Genworth Cost of Care survey indicating assisted living costs have increased 3.36 percent from 2016 to 2017, while nursing home costs jumped 4.44 percent over the same period for a semi-private room. 

Low Value Healthcare Services Adds to Health Costs
Healthcare Dive reports on a study published in Health Affairs demonstrating that low-value, low-cost healthcare services in Virginia contributed to nearly $600 million in excess healthcare costs. Low-value services included baseline lab and imaging tests for low-risk patients. 

Nursing Homes Complaints up
The HHS Inspector General found that nursing home complaints increased by a third between 2011 and 2015, reports McKnight's. Although the increase was significant, the report suggests some of the increase may have been the result of improved reporting. 

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