What’s New in Health Care Reform: July 5

The Week in Review provides an overview of the past week’s top health care content, including industry news and trends, Mayo Clinic and Mayo Medical Laboratories news, and upcoming events.


Should GOP Health Bill Prevail, Say Bye-Bye to Insurance Rebates

If Senate GOP leaders have their way, the check may not be in the mail. Many consumers collected unexpected rebates after the Affordable Care Act became law, possibly with a note explaining why: Their insurer spent more of their revenue from premiums on administration and profits than the law allowed, so it was payback time. More than $2.4 billion has been returned to customers since the provision went into effect in 2011, averaging about $138 per family in 2015. Via Kaiser Health News.

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$45 Billion to Fight Opioid Abuse? That’s Much Too Little, Experts Say

The Senate leadership’s efforts to salvage the Republican health care bill have focused in part on adding $45 billion for states to spend on opioid addiction treatment. That is a big pot of money. But addiction specialists said it was drastically short of what would be needed to make up for the legislation’s deep cuts to Medicaid, which has provided treatment for hundreds of thousands of people caught up in a national epidemic of opioid abuse. Via NY Times.

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How the GOP Medicaid Overhaul Could Become the Next Fiscal Cliff

Even some Senate Republicans acknowledge the changes in their repeal bill might never see the light of day. The Senate health care bill, if it becomes law, would set in motion a massive rollback of Medicaid funding beginning in three years. But even some Republican supporters acknowledge the full cuts might never happen. Instead, they say it could become another Washington fiscal cliff, where lawmakers go to the brink of radical spending changes only to pull back—or have their successors pull back—just before the point of inflicting real pain in the face of intense pressure. Via Politico.

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FDA Announces Plan to Eliminate Backlog of Rare Disease Drugs

The Food and Drug Administration unveiled a plan to speed the agency’s response to orphan drug requests, which doubled from 2012 to 2016. The plan is a top priority of FDA Commissioner Scott Gottlieb, who has vowed to eliminate the current backlog of designation requests for orphan drugs, which treat rare diseases, and to streamline the agency’s review process so all new requests receive a response within three months. Via Morning Consult.

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America’s Failed Response to the Opioid Epidemic, in One Statistic

A new report by the Blue Cross Blue Shield Association, an insurance organization, bears that out. Analyzing data from millions of its own customers, Blue Cross and Blue Shield (BCBS) recorded a 493 percent increase in people diagnosed with opioid use disorders from 2010 through 2016. At the same time, there was only a 65 percent increase in the number of people using medication-assisted treatment—where medications like methadone, buprenorphine, and naltrexone are used to ease opioid cravings, which addiction experts consider the gold standard for opioid addiction care. Via Vox.

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Doctors Prescribed Fewer Meds after Payments from Pharma Were Disclosed

A decade ago, a big push began to force drug makers to disclose payments to doctors for speaking, consulting, travel, and research. The campaign was controversial, but reflected concerns that medical practice and research may be unduly influenced by financial ties, and it ultimately led to the creation of a federal database that collects industry payments. Via STAT.

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Seniors Miss out on Clinical Trials

More than 60% of cancer patients are older adults—and that will rise to 70% by 2040. Yet, seniors continue to be underrepresented in clinical trials, making it difficult to assess how treatments are likely to help or harm them. The newest evidence of the problem comes from a Food and Drug Administration analysis, which found that only 25% of patients participating in cancer clinical trials were 65 or older. The analysis, which has not yet been published, was presented at the American Society of Clinical Oncology’s annual meeting in June. Via Kaiser Health News.

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Six Months into MACRA Rollout, Docs Are Still Unprepared

More than halfway through the first year of the rollout of the Medicare Access and CHIP Reauthorization Act, the majority of medical practice leaders still are not ready to comply with the law, according to a survey by American Medical Association and consulting firm KPMG. The revelation, outlined in a report, is based on the responses from 1,000 physicians who have been involved in practice decision-making related to MACRA. The survey found that fewer than 1 in 4 physicians interviewed were prepared to meet statutory requirements this year. The revelation could mean that many will face a financial penalty in 2019, which is when 2017 compliance will be measured. Via Modern Healthcare.

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Insurance Claim Denials Cost Hospitals $262 Billion Annually

Hospitals across the country lose approximately $262 billion per year on denied claims from insurers, sparking huge cash-flow issues and recovery costs, according to new data. Payers initially deny about 9% of hospital claims, putting about $5 million in payments per hospital at risk, said Jason Williams, vice president of analytics for Change Healthcare, which collected the data. Although hospitals ultimately will secure payment for 63% of initially denied claims, it costs $118 per claim on average to recoup the money, not to mention the cost to hospitals of foregoing the payments while they claw back the funds, Williams said. Via Modern Healthcare.

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Hospitals Ramp up Hyperbaric Therapy For Diabetics, Despite Concerns

Enticed by healthy Medicare payments—about $450 for a two-hour session—and for-profit management companies that do much of the work, nearly 1,300 U.S. hospitals have installed hyperbaric facilities. That’s triple the number that an industry group says offered the service in 2002, when Medicare first decided to pay for the therapy for certain diabetic wounds. Medicare—the largest payer of hyperbaric services—has flagged evidence of overuse in at least some parts of the country. Medicare officials declined to comment for this story, but they have retained coverage for more than 15 years, even as studies have questioned the therapy’s effectiveness. Via Kaiser Health News.

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Andy Tofilon

Andy Tofilon is a Marketing Segment Manager at Mayo Medical Laboratories. He leads strategies for corporate communications, public relations, and new media innovations. Andy has worked at Mayo Clinic since 2003. Outside of work, Andy can be found running, hiking, snapping photos, and most importantly, spending time with his family.