Weekly Spotlight
The SHP Digest will be on hiatus next week. Keep an eye out for a double edition the following week.
Although Ranking Rizzler Rosa (DeLauro) was serving, Congress failed to pass appropriations bills funding the government next year. Since pumpkin spice season means the Holidays are right around the corner, Congress decided to start the decorating early and left a lump of coal, in the form of an expiring continuing resolution, on the agenda for the lame duck Congress in December.
… another reason for take vacation now. See you on the flip.
Other Regulatory News
Centers for Medicare and Medicaid Services (CMS)
CMS to seek health industry accountability for data breaches
The Centers for Medicare and Medicaid Services has developed a five-pronged plan geared toward reducing data breaches and ensuring accountability among healthcare organizations.
The strategy, which will expand on policies CMS Principal Deputy Administrator Jonathan Blum shared Sept. 12 at Modern Healthcare’s Leadership Symposium, will be introduced and implemented in the coming months, according to federal agency leaders.
#All
Medicare will continue its cautious approach to paying for Alzheimer’s drugs
Tamara Syrek Jensen, the director of the group at CMS that’s responsible for writing national coverage determination policies, doesn’t speak publicly often, but she did a brief fireside chat at an event hosted by the USC Leonard D. Schaeffer Center for Health Policy & Economics on Wednesday. She said the current patient registry in place to collect data on Alzheimer’s drugs takes clinicians less than five minutes to complete. The next step will be collecting data from the registry and medical claims to start evaluating the drugs’ performance. “We hope to do that over the next…it’s not gonna take us months, so over the next few years,” Jensen said.
#Drug
13 drugs expected to be included in CMS negotiations: Study
CMS is expected to announce in early 2025 the list of up to 15 Medicare Part D drugs that will be subject to price negotiations in 2025, with negotiated prices expected to be implemented in 2027.
Researchers have aimed to predict which drugs would be selected by analyzing Part D spending from 2020 to 2022 and applying selection criteria from the Inflation Reduction Act and CMS guidelines.
#Drug
Biden administration axes proposal to mandate more drug price transparency in Medicaid
Biden administration officials have abandoned their own proposal to require drug companies to disclose the prices and research costs of drugs that are driving up spending in state Medicaid programs
#Drug
Hospital readmission penalties stabilized in fiscal 2025: CMS
About 70% of hospitals will receive penalties of less than 1% as a result of their pandemic-era performance on readmission rates.
#Hospital
As Medicare spending on remote patient monitoring jumps, HHS watchdog warns of fraud, misuse
Experts worry that the remote monitoring costs could outstrip benefit seen by patients.
Read the OIG report here as well as reporting by
#Patient, #Device, #Provider
Why aren’t alternative payment models working?
Out of more than 50 alternative payment models (APM) that CMS has implemented only six have shown statistically significant cost savings and only four of these met the requirements to be expanded in duration and scope. That is not my opinion, CMS itself states this. We all want higher quality at lower cost; so the question is, why aren’t APMs delivering what was promised?
#Payer, #Patient, #Provider
Cardiology groups cheer new bill that would improve access to Medicare claims data
The Society of Thoracic Surgeons (STS) and American College of Cardiology (ACC) have joined dozens of other U.S. medical societies to praise new bipartisan legislation that, if passed, would give clinician-led clinical registries access to Medicare claims data for research purposes.
#Provider
Medicare Advantage
Medicare Advantage insurer Zing Health raises $140M for expansion
The Medicare Advantage insurer co-founded by Dr. Eric Whitaker will try to find patients in underserved parts of other markets.
#Payer
Humana, Aetna, EmblemHealth overpaid by Medicare: HHS OIG
Three Medicare Advantage insurers deny allegations they manipulated billing codes to generate higher federal payments.
#Payer
How Sutter is revising its relationship to Medicare Advantage
In an interview, Warner Thomas, CEO of Sacramento, California-based Sutter said Sutter is trying to better align with Medicare Advantage carriers, along with expanding its outpatient network and boosting inpatient capacity. The interview has been edited for length and clarity.
#Payer, #Hospital
Cigna scaling back Medicare Advantage footprint in 8 states next year
The reductions will affect roughly 5,400 members, mostly in Florida, according to a notice to marketing agents.
#Payer, #Patient
Comparing MA Payments to FFS Spending during Risk-Model Transitions
This paper describes how MedPAC’s MA:FFS spending ratio is calculated, identifies potential drawbacks to focusing on this ratio during a risk-adjustment-model transition, and offers an alternate analysis that models FFS spending based on projected growth
#Provider
Food and Drug Administration (FDA)
FDA’s new head of device safety held senior role at company troubled by safety warnings
The Food and Drug Administration has tapped Ross Segan, a former device industry exec and Army veteran, to lead its division charged with ensuring medical device safety. Segan was chief medical officer at Olympus from 2020 to 2023. Olympus is a leading distributor of endoscopes and the recipient of FDA warning letters claiming the company did not adequately address product defects — including instances where endoscope caps fell into patients’ bodies.
#Device
Hill Happenings
Hassan indicates she’s open to tweaks on site-neutral payment reforms
Hassan is the lead Democrat in the Senate pushing to equalize payments between hospitals and outpatient facilities. During a STAT event on Thursday, she indicated that there might be room for negotiating a deal with her GOP colleagues on site-neutral legislation.
#All
House Passes Bill Putting AEDs in Schools
The House passed the HEARTS Act, which would support CPR and automated external defibrillator training in schools. Now the bipartisan bill is headed to the Senate.
#All
Changes in store for CBO
Lawmakers haven’t moved much significant legislation during this Congress, but reforms to the nonpartisan Congressional Budget Office impacting health care have gained momentum. To do its work as a cost scorekeeper, the CBO often leans on data from federal agencies like HHS, some of which isn’t public, requiring the agency to lean on formal and informal agreements to get information from agencies while maintaining confidentiality. On Monday, the House passed Senate-approved legislation by voice vote that would expand the CBO’s authority to speed up data-sharing. The broader push: The move comes as a different bill to help expedite information sharing with the CBO awaits President Joe Biden’s signature after passing the Senate earlier this month. The House also passed legislation in March that would require the CBO to weigh whether a bill would save money over a 30-year budget window instead of 10 if Congress requests such an estimate.
#All
GOP doctors fume over Medicare pay cuts but see only partial fix
The best that physicians can hope for to repair the latest proposed cuts to the Medicare fee schedule is a short-term fix, said members of the House Republican Doctors Caucus Friday as they fumed that their private sector colleagues have been left out in the cold by the federal government.
#Provider
Notable Notes
Electronic health records giant Epic Systems sued over alleged monopolistic practices
The health data company Particle Health has filed an antitrust lawsuit against Epic Systems, alleging that the electronic health record vendor has used its control of patient data to thwart competition and undermine its business. Epic Systems has been challenged in court before, but it’s different this time
#All
Heart Failure Society of America to livestream late-breaking studies after meeting cancellation
The show will go on. After HFSA was forced to cancel its annual meeting due to Hurricane Helene, the group will now be livestreaming a series of late-breaking clinical sessions for anyone who had previously registered.
#Patient, #Provider
