10 Essential Facts About Medicare and Prescription Drug Spending
Prescription drugs play an important role in medical care for 59 million seniors and people with disabilities, and account for $1 out of every $6 in Medicare spending. The majority of Medicare prescription drug spending is for drugs covered under the Part D prescription drug benefit, administered by private stand-alone drug plans and Medicare Advantage drug plans. Medicare Part B also covers drugs that are administered to patients in physician offices and other outpatient settings.
The Centers for Medicare & Medicaid Services today announced it will update the hospital outpatient prospective payment system rates by 1.35% in calendar year 2018 compared to CY 2017. The rule also finalizes CMS’s proposal to drastically cut Medicare payment for drugs that are acquired under the 340B Drug Pricing Program. Specifically, CMS will pay separately payable, non pass-through drugs (other than vaccines) purchased through the 340B program at a rate of the average sales price minus 22.5%, rather than ASP plus 6%. Sole community hospitals in rural areas, PPS-exempt cancer hospitals and children’s hospitals will be excepted from this policy for CY 2018.
For the first time, rates of drug overdose deaths are rising in rural areas, surpassing rates in metropolitan (urban) areas, according to a new report in the by the Centers for Disease Control and Prevention (CDC).
Drug overdoses are the leading cause of injury death in the United States, resulting in approximately 52,000 deaths in 2015. This report analyzed trends in illicit drug use and disorders from 2003-2014 and drug overdose deaths from 1999-2015 in urban and rural areas. In 1999, drug overdose death rates for urban areas were higher than in rural areas (6.4 per 100,000 population versus 4.0 per 100,000). The rates converged in 2004, and by 2015 the rural rate (17.0 per 100,000) was slightly higher than the urban rate (16.2 per 100,000).
The Next Chapter In Transparency: Maryland’s Wear The Cost
by Robert Moffit, Marilyn Moon, François de Brantes, and Suzanne Delbanco
Historically, the State of Maryland’s per capita health spending has been substantially higher than the national average. In an attempt to control health care costs, the state has been administering an all-payer rate setting system for Maryland hospitals—fixing the rates for Medicare and private payers—for more than 40 years. Regardless of one’s view of the desirability of these regulatory interventions, the Maryland system has been unable to address the wide disparity among providers in terms of both price and quality.
Firearm-Related Injury and Death: A US Health Care Crisis in Need of Health Care Professionals
by Darren B. Taichman, MD, PhD; Howard Bauchner, MD; Jeffrey M. Drazen, MD; et al
What would happen if on one day more than 50 people died and over 10 times that many were harmed by an infectious disease in the United States? Likely, our nation’s esteemed and highly capable public health infrastructure would gear up to care for those harmed and study the problem. There would be a rush to identify the cause, develop interventions, and refine them continually until the threat is eliminated or at least contained. In light of the risks to public health (after all, over 500 people have been harmed already!), health care professionals would sound the alarm. We would demand funding. We would go to conferences to learn what is known and what we should do. We would form committees at our institutions to plan local responses to protect our communities. The United States would spend millions or more in short order to ensure public safety, and no elected officials would conceive of getting in the way. Rather, they would compete to be calling the loudest for the funds and focus required to protect our people. Americans should be proud of our prowess at and commitment to addressing public health crises.
Vital Signs: Trends in Incidence of Cancers Associated with Overweight and Obesity — United States, 2005–2014
by C. Brooke Steele, DO; Cheryll C. Thomas, MSPH; S. Jane Henley, MSPH; Greta M. Massetti, PhD; Deborah A. Galuska, PhD; Tanya Agurs-Collins, PhD; Mary Puckett, PhD; Lisa C. Richardson, MD
Data from the United States Cancer Statistics for 2014 were used to assess incidence rates, and data from 2005 to 2014 were used to assess trends for cancers associated with overweight and obesity (adenocarcinoma of the esophagus; cancers of the breast [in postmenopausal women], colon and rectum, endometrium, gallbladder, gastric cardia, kidney, liver, ovary, pancreas, and thyroid; meningioma; and multiple myeloma) by sex, age, race/ethnicity, state, geographic region, and cancer site. Because screening for colorectal cancer can reduce colorectal cancer incidence through detection of precancerous polyps before they become cancerous, trends with and without colorectal cancer were analyzed.
In 2016, there were 11.8 million people aged 12 or older who misused opioids in the past year, according to a new Substance Abuse and Mental Health Services Administration’s (SAMHSA) latest National Survey on Drug Use and Health (NSDUH) report.
The study found the majority of people who misused opioids were misusing pain relievers rather than heroin use—there were 11.5 million pain reliever misusers and 948,000 heroin users.
Nationally, nearly a quarter (21 percent) of persons 12 years or older with an opioid use disorder received treatment for their illicit drug use at a specialty facility in the past year. Receipt of treatment for illicit drug use at a specialty facility was higher among people with a heroin use disorder (38 percent) than among those with a prescription pain reliever use disorder (17.5 percent).
The report also reveals that adolescents’ and adults’ (age 18-25) initiation of marijuana has remained steady. In contrast, adults aged 26 and older have higher rates of marijuana initiation than prior years. In 2016, an estimated 21 million people aged 12 or older needed substance use treatment and of these 21 million people, about 2.2 million people received substance use treatment at a specialty facility in the past year.
NSDUH is a scientific annual survey of approximately 67,500 people throughout the country, aged 12 and older. NSDUH is a primary source of information on the scope and nature of many substance use and mental health issues affecting the nation. SAMHSA is issuing its 2016 NSDUH report on key substance use and mental health indicators as part of the 28th annual observance of National Recovery Month. Recovery Month expands public awareness that behavioral health is essential to health, prevention works, treatment for substance use and mental disorders is effective, and people can and do recover from these disorders.
The Centers for Disease Control and Prevention released findings from its latest obesity study.
According to the study,all 50 states had more than 1 in 5 adults (20 percent) with obesity. The state with lowest rate of obesity was Colorado (22.3 percent); the state with the highest rate of obesity is West Virginia (37.7 percent).
The South had the highest prevalence of obesity (32.0 percent), followed by the Midwest (31.4 percent), the Northeast (26.9 percent), and the West (26.0 percent). Five states (Alabama, Arkansas, Louisiana, Mississippi, and West Virginia) now have more than 35 percent of adults with obesity.
Adults with more education were less likely to report being obese. Adults without a high school education had the highest self-reported obesity (35.5 percent), followed by high school graduates (32.3 percent), adults with some college (31 percent), and college graduates (22.2 percent).
Obese American adults are more at risk for serious chronic diseases and health conditions. These include:
Type 2 diabetes
Poorer mental health.
Infertility and problems with pregnancy.
Obesity negatively affects worker productivity, health care costs, and the ability to serve in the military.
Preventing and reducing obesity in the United States will require action by many parts of society. State and community leaders, employers, government agencies, healthcare providers, and many others can help make it easier for adults and their families to move more and eat healthier to reduce the risk of obesity.
New CDC report: More than 100 million Americans have diabetes or prediabetes
More than 100 million U.S. adults are now living with diabetes or prediabetes, according to a new report released today by the Centers for Disease Control and Prevention (CDC). The report finds that as of 2015, 30.3 million Americans – 9.4 percent of the U.S. population –have diabetes. Another 84.1 million have prediabetes, a condition that if not treated often leads to type 2 diabetes within five years.
The report confirms that the rate of new diabetes diagnoses remains steady. However, the disease continues to represent a growing health problem: Diabetes was the seventh leading cause of death in the U.S. in 2015. The report also includes county-level data for the first time, and shows that some areas of the country bear a heavier diabetes burden than others.
An Analysis of Hospital Prices for Commercial and Medicare Advantage Plans
by Jared Maeda
Prices for hospital admissions have received considerable attention in recent years, both because they are an important component of health care spending and because they can vary widely. In this presentation, we use 2013 claims data from three large insurers to examine the hospital payment rates of those insurers in their commercial plans and their Medicare Advantage plans and compare them with Medicare’s fee-for-service (FFS) rates; we also examine the variation of those rates across and within markets.
An Analysis of Private-Sector Prices for Physician Services
by Daria Pelech
Physicians’ services account for a substantial portion of health care spending in the United States, but research on the prices private insurers pay for those services has been limited. Using 2014 claims data from three major insurers, we analyzed the prices paid for 21 common services and compared them with the estimated amounts that Medicare’s fee-for-service (FFS) program would pay.
Fiscal Year (FY) 2018 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long Term Acute Care Hospital (LTCH) Prospective Payment System Proposed Rule, and Request for Information CMS-1677-P
On April 14, 2017, the Centers for Medicare & Medicaid Services (CMS) today issued a proposed rule that would update 2018 Medicare payment and polices when patients are admitted into hospitals. The proposed rule aims to relieve regulatory burdens for providers; supports the patient-doctor relationship in health care; and promotes transparency, flexibility, and innovation in the delivery of care.
Now that ICD-10 is in full swing, we are seeing a lot of activity with providers, payers, consultants and regulators who need to understand how Acute Inpatient and Long Term Care Hospital claims "behave" when the claim is coded in ICD-10. This includes both prospective and retrospective review of claims scenarios to understand MS-DRG grouping. This article offers a basic primer on MS-DRG grouping logic, and research techniques for using related MediRegs Coding Suite tools. If you'd like a personalized training on these tools, or a demonstration of them in action to see if they are a good fit for your research scenarios, please let us know!
OVERVIEW OF THE FY 2016 IPPS FINAL RULE: SUMMARY OF CALCULATION ELEMENTS
New Health Analytics, a national healthcare software developer and data analytics firm, is pleased to announce that it has released a special report with an concise review of the FY 2016 Hospital Inpatient Prospective Payment System (IPPS) Final Rule recently posted by the Centers for Medicare & Medicaid Services.