CMS presents new rules for MACRA; a diabetes therapy gets a new indication; and a study shows Medicaid expansion brought new patients to emergency departments
Welcome to This Week in Managed Care, I’m Laura Joszt.
Proposed Changes to MACRA Implementation
CMS will exempt more small practices from having to comply with the Medicare Access and CHIP Reauthorization Act (MACRA), under a proposal released this week. The draft rule would exempt practices with less than $90,000 in Medicare revenue, which would leave about 834,000 doctors out of the quality reporting program.
CMS estimates only about 37% of doctors will be required to bill under the program. Said CMS Administrator Seema Verma:
"We've heard the concerns that too many quality programs, technology requirements, and measures get between the doctor and the patient. That's why we're taking a hard look at reducing burdens."
Under the rule, small practices would be allowed to create virtual groups to go after incentives under MACRA. Comments are due August 21.
ED Use With Medicaid Expansion
A new study finds that Medicaid expansion brought new patients to the emergency department, but more of them had insurance. The study from Vanderbilt University, published in the Annals of Emergency Medicine, examined data from the Agency for Healthcare Research and Quality.
It found that emergency department use increased by 2.5 visits per 1000 people in 14 Medicaid expansion states in 2014, compared with 11 states that did not expand Medicaid. However, compared with those states without Medicaid expansion, the share of visits not covered by insurance fell by 5.3 percentage points in states that expanded the program.
In an editorial, Ari Friedman, MD, PhD, asked whether this represents a failure, since the data show the increases were largest for injury related visits and greatest in states were benefits were leanest before expansion.
He wrote: “We need to move beyond the value judgments that have dominated so much of emergency department utilization towards a more rational basis for how we structure unscheduled visits in the health system.”
Emergency department visits tied to opioid use have doubled over the last decade, and inpatient stays are growing by 64%. Data released by the Agency for Healthcare Research and Quality show that hospitalization rates related to the opioid epidemic rose 55% for men and 75% for women between 2004 and 2014.
Adults between the ages of 25 and 44 were most likely to be admitted for opioid-related problems, followed by adults ages 45 to 64. However, admissions for the older group is now growing faster, according to the report.
Senate Health Bill
This week, the Senate released its version of a repeal of the Affordable Care Act, with a vote expected before the July 4th recess.
Liraglutide Gets CV Indication
An FDA panel voted this week to give a second diabetes drug a label change signaling it reduces the risk of cardiovascular events. Liraglutide, sold by Novo Nordisk as Victoza, received a 17-to-2 vote from the Endocrinologic and Metabolic Drugs Advisory Committee.
A year ago, the LEADER trial showed that liraglutide, a GLP-1 receptor agonist, reduced cardiovascular deaths by 22% and cardiovascular events by 13%.
Novo Nordisk’s chief medical office praised the committee for its deliberations and vote, saying: “Cardiovascular disease is the number one cause of death for people with type 2 diabetes, and [this] discussion is an important reminder that there is an unmet need to provide benefits beyond A1C control in this population.”
Empagliflozin, an SGLT2 inhibitor, became the first drug for type 2 diabetes to receive a cardiovascular indication in December. Janssen is expected to seek a cardiovascular indication for canagliflozin later this year.
Palliative Care in EBOTM
The current issue of Evidence-Based OncologyTM explores the need to expand availability of palliative care. Despite evidence that early use of palliative care can improve quality of life for patients and save health systems money, a perception that its use should wait until end of life can delay services.
Editor in chief Joseph Alvarnas, MD, writes:“In embracing the full range of needs of our patients, including the need to manage the distress associated with a cancer diagnosis, we can continue to bring increasingly effective, patient-centered care to those in need.”