February 6, 2020 | Too much transparency?

Live Event Today!

Get the Medications Right: Innovations in Team-Based Care

February 6, 2020 | 8:30-10:30 am

The Bipartisan Policy Center and the GTMRx Institute will co-host, “Get the Medications Right: Innovations in Team-Based Care.” This event will feature keynote presentations and a panel discussion with leaders—including Katherine H. Capps, Carolyn Clancy, M.D., Susan Dentzer, M.P.H., Gregory Downing, DO, PhD, Elizabeth Fowler, J.D., Ph.D., Jerry Greskovic, RPh, CACP, CDE, Anand Parekh, M.D., and Dan Rehrauer, Pharm.D.—who have been at the forefront of advancing the appropriate and personalized use of medication and gene therapies. As an organization that actively fosters bipartisanship by combining the best ideas from both parties to promote health, security and opportunity for all Americans and that prioritizes “getting things done” above all else, the Bipartisan Policy Center offers an ideal venue for this important event.

Register now for the live-stream of the event. You can find more information here.

INDUSTRY NEWS

Verma: Privacy a “vile” pretext for opposing access

CMS Administrator Seema Verma added her voice to the chorus of administration officials who are criticizing opponents of the ONC’s proposed rule to improve patient access to their medical records. “We have made it clear to providers that they don’t own a patient’s data and they must give it to their patients.” She emphasized that patient privacy is a priority and called out “the disingenuous efforts by certain private actors to use privacy—as vile as it is—as a pretext for holding patient data hostage is an embarrassment to the industry.” (Health Data Management)

NYT: Chaotic retail pharmacies put patients at risk

Retail pharmacists—working at such places as CVS, Rite Aid and Walgreens—tell the New York Times about chaotic workplaces that make it difficult to perform their jobs safely, putting the public at risk of medication errors. The article points out that the presence of industry reps on the state boards creates a conflict of interest and stifles complaints. “We are afraid to speak up and lose our jobs,” one pharmacist wrote anonymously last year in response to a survey by the Missouri Board of Pharmacy. “PLEASE HELP.” (New York Times)

INNOVATION & TRANSFORMATION

Manual prior authorizations costs skyrocket

The cost of prior authorization requirements has continued to increase—up 60% in 2019 to manually generate a request to insurers, according to the recent CAQH 2019 Index. Overall, it concluded, the health care industry can save $13.3 billion on administrative waste through automation of eight transactions including prior authorizations. In particular, transitioning to electronic prior authorizations could save $454 million annually. MGMA noted that the CAQH report confirms its own concern about the burden prior authorizations place on physician practices. (Fierce Healthcare; CAQH 2019 Index)

CONSUMERS & PROVIDERS

Providers aren’t using Z codes

In the first two years they were available, providers used diagnostic codes specific to social determinants of health (Z codes) for only 1.4% of the total beneficiary population, according to a new CMS report. The reason: “Participants noted a general lack of awareness of the Z codes, and confusion as to who could document social needs.” The report looked at Medicare fee-for-service claims. (Healthcare Dive; CMS)

Living in a healthy state won’t save you from CVD

Middle-aged people are increasingly dying from heart disease across the country—including “healthy” places (e.g., Colorado) where those rates have been historically low, according to a Wall Street Journal analysis of mortality statistics. The findings suggest the underlying causes of cardiovascular disease are universal and difficult to address. (Wall Street Journal)

Insurance often doesn’t cover needed drugs

Health plans may cover prescription drugs, but many patients report that their insurance sometimes doesn’t cover a drug they need. That’s a take-away from an NPR, Robert Wood Johnson Foundation and Harvard T.H. Chan School of Public Health poll. Despite insurance coverage, more than a third of adults across all income groups say that in the past year, they or someone in their household learned their insurance would not cover a drug prescribed by their doctor. It was most common among lower-income adults: 49% of them reported this, compared with 41% of the highest-income adults and 32% of middle-income adults. (NPR)

NEW & NOTED

Too much transparency? Hospitals and insurers say they support price transparency, but claim the Trump administration has gone too far. At issue: A proposed rule to force employer health plans and insurance companies to post in-network and out-of-network rates they negotiate with providers. In comments published last week insurer and hospital groups said the rule would, among other things, confuse patients and increase costs. (Modern Healthcare)

Subsidies under scrutiny: Last week, CMS proposed changes to health plans sold in the ACA marketplace. Several focus on ensuring CMS doesn’t provide subsidies to those not eligible. It’s also considering cutting automatic re-enrollment for low-income consumers. (Modern Healthcare)

Block grant proposal explained: The Trump administration unveiled a Medicaid overhaul plan that would allow states to opt out of part of the current federal funding program and instead seek a fixed payment each year in exchange for greater flexibility. Kaiser Health News breaks it down. (KHN)

MULTI-MEDIA

Consolidation impact on rural hospitals

Corporate health systems have been purchasing community hospitals, and that can have both positive and negative implications for patients in rural areas. KHN Editor-in-Chief Elisabeth Rosenthal appeared on the public radio show 1A to discuss “The Hidden Cost Of Health Systems Gobbling Up Rural Hospitals,” and what that means for communities around the country. (1A)

MARKETVOICES...QUOTES WORTH READING

“The amount of busywork we must do while verifying prescriptions is absolutely dangerous. Mistakes are going to be made and the patients are going to be the ones suffering.”—A pharmacist, writing to the Pennsylvania Pharmacy Board last year, quoted in the New York Times