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This Week in Managed Care: July 10, 2020


This week, the top managed care news included CMS planning to pay more for at-home dialysis equipment; ACR supports continued use of telemedicine after the COVID-19 pandemic passes; AJMC®’s coverage of AIDS 2020, the 23rd International AIDS Conference.

CMS plans to pay more for dialysis equipment used at home, ACR supports continued use of telemedicine after the COVID-19 pandemic passes, and AJMC® covers AIDS 2020, the 23rd International AIDS Conference.

Welcome to This Week in Managed Care, I’m Laura Joszt.

CMS Seeks Incentives for At-Home Dialysis in Wake of COVID-19

This week, CMS announced it planned to pay more for dialysis equipment used at home, with the aim of moving more treatment outside dialysis centers while the nation grapples with the COVID-19 pandemic.

The proposed 235-page rule is CMS’ latest attempt to use dollars to steer patients with end-stage renal disease out of dialysis centers. Comments are due September 4, 2020, and most changes would take effect January 1, 2021.

End-stage renal disease has long been one of the most expensive and debilitating conditions that affects Medicare beneficiaries. Not only does dialysis cost $90,000 a year, but the need to travel to a dialysis center multiple times a week disrupts employment and home life.

With the COVID-19 pandemic, patients with end-stage renal disease were landing in the hospital in high numbers.

“CMS data shows that those with ESRD have the highest rate of hospitalization of any single group, a trend consistent with having to frequently leave home to receive dialysis,” Administrator Seema Verma said in a statement. “In the midst of a deadly pandemic that poses a particular threat to those with serious underlying conditions, President Trump’s call for increased access to home dialysis has never been more urgent. Unfortunately, government rules too often stand in the way.”

For more, visit ajmc.com.

ACR Position Statement Supports Use of Telemedicine After COVID-19 Crisis

The American College of Rheumatology, or ACR, has released a position statement in support of continued use of telemedicine as a tool to increase access and improve care for patients with rheumatic diseases, as well as continued parity of reimbursement for in-office visits, audio—visual visits, and audio-only visits once the COVID-19 public health emergency ends.

However, ACR noted in its position statement that telemedicine should not replace essential face-to-face assessments.

It also clarified that reimbursement parity should occur as long the provider—patient relationship includes both in-person and telemedicine services, patients have a choice of provider for telemedicine services, the standard and scope of care provided by telemedicine services is consistent with in-person services, and the provision of telemedicine services is properly documented.

ACR opposes geographical restrictions on telemedicine practice and payer policies that would dictate use of specified telemedicine platforms, create restrictive networks, or use telemedicine as a way to divert patients to preferred providers.

Telehealth Growth in April Suggests Continuing Impact of COVID-19

AJMC.com contributor Robin Gelburd, president of FAIR Health, has been providing regular updates on the growth of telehealth during COVID-19. She reported that in April, telehealth claim lines increased 8,336 percent nationally from 0.15% of medical claim lines in April 2019 to 13% in April 2020.

Notable findings include:

  • In the Midwest, diabetes appeared as one of the top 5 diagnoses in April 2020, which suggests telehealth was being used increasingly to treat chronic conditions as well as acute ones.
  • Joint/soft tissue disorders and issues were not in the top 5 diagnoses in April 2019 nationally or in any region except the West, but in April 2020 they were in the top 5 nationally and in every region.
  • Hypertension climbed from number 4 in the top 5 diagnoses in March 2020 to number 3 in April 2020, which may be related to increased stress during the pandemic and increased telemonitoring of patients with hypertension.

For more, visit ajmc.com.

Study Results Show Possible Link Between Medicaid Expansion, Drop in Advanced Breast Cancer

A new study in JAMA Surgery found that African American women with advanced breast cancer benefited the most following implementation of the Affordable Care Act in states that chose to expand their Medicaid coverage.

The retrospective analysis of nearly 1.8 million women used extracted data on diagnoses made between 2007 and 2016 from the National Cancer Database to identify trends resulting from a comparison of primary breast cancer rates in expansion and nonexpansion states both before and after Medicaid expansion occurred in 2014.

There was an 11.5% drop for all races in advanced stages of disease at diagnosis in expansion states, whereas nonexpansion states remained almost the same, with just a 2.9% drop.

African American women had the biggest improvements in advanced-stage disease at presentation with a drop from 24.6% to 21.6% in expansion states compared with a slight uptick from 27.0% to 27.5% in nonexpansion states.

To read more, visit ajmc.com.

AIDS 2020: Virtual

This past week was AIDS 2020, the virtual meeting of the International Aids Society, which highlighted the latest developments in HIV research and presented brand-new data on COVID-19 and HIV, as well as how HIV informs and intersects with the COVID-19 pandemic.

Coverage by The American Journal of Managed Care® of the meeting included:

  • Sessions with Dr Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, and Dr Deborah Birx, coordinator of the United States Government Activities to Combat HIV/AIDS
  • A session with Greg Millet, vice president at the Foundation for AIDS Research, on the persistent social and racial disparities that are hindering the fight to end HIV
  • A panel discussion on the 2025 targets for the global AIDS response and the role of social enablers in meeting the next generation of goals

For full coverage of the meeting, visit ajmc.com.

A Timeline of COVID-19 Developments in 2020

In just 6 short months, over the first half of 2020, the novel coronavirus has upended countries, overwhelmed hospital systems, and pushed the global economy into a recession.

The American Journal of Managed Care® has put together a timeline of the biggest events that occurred as COVID-19 developed, from the first announcement from the World Health Organization of the mysterious coronavirus appearing in Wuhan, China, to Fauci’s warning at the end of June that the United States was on a trajectory to hit 100,000 new cases a day.

For the timeline, visit ajmc.com.

Physician and Patient Tools to Improve Chronic Kidney Disease Care

And now, we bring you the Paper of the Week, which looks back at research and commentary from the past 25 years in The American Journal of Managed Care®, and why they matter today.

This week’s paper is a clinical trial from 2018, which examined whether primary care physicians who received alerts from an electronic health record would deliver appropriate care to patients with chronic kidney disease. The study found that the alerts were effective in getting high-risk patients referred to a nephrologist and in getting low-risk patients the right urine tests.

For the paper, visit ajmc.com.

For all of us at AJMC®, I’m Laura Joszt.

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