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What We're Reading: Hospice Payment Increase; Overdose Death Rates; Price Transparency Lawsuit
Hospices will receive a $520 million increase in payments from CMS in fiscal year 2020; urban areas accounted for more drug overdose deaths rates than rural areas in 2016 and 2017; a federal judge has ruled that a lawsuit against a California price transparency law can proceed.
Hospices to Get Boost in Medicare Payments
Under a final rule issued by CMS, hospices will see a $520 million (2.5%) increase in their payment rates for fiscal year (FY) 2020. According to CMS, the boost is based on the FY 2020 hospital market basket increase of 3% reduced by the multifactor productivity adjustment of 0.4%. The increase is smaller than the $540 million (2.7%) increase that was proposed in April. For hospices that fail to meet quality metrics, they will receive a 2% reduction to the annual market basket update for the year. The final rule will also cap the amount of overall payments per patient made to a hospice annually at $29,964.78.
Urban Areas Now See More Overdose Death Rates
Data from the CDC have revealed that urban areas now see more drug overdose deaths rates than rural areas. In 2016 and 2017, the overall drug overdose death rate was 22.0 per 100,000 in urban counties compared with 20.0 per 100,000 in rural counties. Overdose death rates in urban areas surpassed the rates seen in rural areas for overdose deaths involving heroin (5.2 vs 2.9), synthetic opioids other than methadone (9.3 vs 7.0), and cocaine (4.6 vs 2.4). The data also put a spotlight on gender differences, with men having drug overdose rates that were higher in urban counties and women having overdose death rates that were higher in rural counties.
Judge Allows Lawsuit Over California Price Transparency Law
Two years ago, California implemented a law that requiring drug makers to notify insurers and government health insurers at least 60 days before increasing the list price of any drug that costs more than $40 by at least 16% in a 2-year period. This week, a federal judge ruled that the Pharmaceutical Research and Manufacturers of America, the pharmaceutical industry's leading lobby group, could proceed with its amended lawsuit alleging that the law is unconstitutional because it violates interstate commerce and free speech principles, unfairly holds drug makers responsible for prices, and purposely has fuzzy language about the time frame for notice of a price hike, reported STAT News.
Prices for care at hospital trauma centers vary across hospitals; drug shortages reached a record high during the first quarter of 2024; although 3 of the biggest makers of asthma inhalers pledged to cap out-of-pocket costs for some US patients at $35, these do not apply to daily inhalers used by the youngest kids with asthma.
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Navigating Health Policy in an Election Year: Insights From Dr Dennis Scanlon
April 2nd 2024On this episode of Managed Care Cast, we're talking with Dennis Scanlon, PhD, the editor in chief of The American Journal of Accountable Care®, about prior authorization, price transparency, the impact of health policy on the upcoming election, and more.
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The Biden administration recently launched the Global Health Security Strategy, a new effort to combat the spread of infectious diseases; lawmakers zeroed in on the risks of massive consolidation in health care during the first congressional hearing on the Change Healthcare hack; the FDA recently announced the recall of a pair of heart devices linked to numerous deaths and injuries.
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Exploring Medicare Advantage Prior Authorization Variations
March 26th 2024On this episode of Managed Care Cast, we're talking with the authors of a study published in the March 2024 issue of The American Journal of Managed Care® about their findings on variations in prior authorization use across Medicare Advantage plans.
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