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18 posts from February 2018

February 22, 2018

Senate HELP Committee Holds Hearing on Opioids and the Impact on Families

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On February 8, 2018, the Senate Health, Education, Labor, and Pensions (HELP) committee held a hearing entitled “Impact of the Opioid Crisis on Children and Families,”  the fourth in a series of hearings on the opioid crisis. Committee members examined the various ways states are implementing adequate care for children impacted by drug abuse as set out by the Comprehensive Care Act (CARA).

Opening

During his opening statement, Committee Chairman Lamar Alexander spoke about legislation he helped to craft that allowed the National Institute of Health (NIH) more flexibility in funding opioid addiction research. He also noted that while additional legislation may be needed to ensure that newborns and children suffering from drug abuse receive adequate care, Congress had taken steps to protect these children through various legislative acts.

Ranking Member Patty Murray discussed the unrelenting need to respond to the opioid crisis with additional federal funding. She criticized the current Administration and stated that the child welfare system should be reoriented towards prevention services for families, in hopes that such a change of focus will decrease the number of children entering the foster care system due to loss of parental rights due to opioid addiction.

Committee Discussion

Child Welfare Funding

The Committee discussion seemed to have an emphasis on the growing number of children entering child welfare programs. The discussion touched upon ways to best to address mental health and drug education in schools, the growing strain on the foster care system, and the additional burden put on grandparents who act as primary care givers for children with parents with opioid addictions. 

Senator Robert Casey cited the opioid crisis as both a human and economic problem as growing numbers of grandparents raise children of OUD suffering parents. Grandparents who raise these children save the country billions of dollars by keeping these children out of foster care but often deal with a lower quality of life under the added burden.

Senator Tim Scott asked how best to fiscally support children born with NAS through the first several years of their lives when they lack financial support from their parents. Dr. Stephen Patrick, an Assistant Professor of Pediatric Health at Vanderbilt University Health Center, believes that one way is for Congress to push for additional funding for early intervention services such as speech and occupational therapy in order to provide the greatest benefit to these children.

Senator Elizabeth Warren also mentioned the financial impact that parental overdose could have on a child. She suggested restoring survivor benefits granted to children through the Social Security Act through the age of twenty-two to help support full time students who “age out” of the foster care system.

Educating and Supporting Adolescents

Along the same lines, another topic that was discussed was how to educate and support adolescents to try to prevent another generation from coming under the grips of opioid addiction.

Becky Savage, the co-founder of the 525 Foundation, cited peer counseling groups and open dialogue drug education programs in schools as effective methods to reduce the stigma around opioid use and lower drug use rates in teens and adolescents, while Dr. Bell called for stronger efforts to make schools a “safe haven” for children in the community who may be at risk for drug abuse and addiction.

Senator Todd Young suggested a nationwide public awareness campaign that would be aimed at adolescent and high-school aged students in an attempt to educate them about OUDs and the potential for overdose.

Conclusion

In a moment of rare bipartisanship, Committee members came together to agree that additional funding was needed to address the opioid crisis and provide opioid use disorder (OUD) sufferers with adequate anti-addiction resources. The bipartisanship ended, however, Democrats specifically criticized recent budget cuts by the administration and recommended that additional federal funding should be directed towards Medicaid and other health care institutions that work to support the families of opioid users. 

February 21, 2018

ACCME Releases Report Highlighting 2017 Successes

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The Accreditation Council for Continuing Medical Education (ACCME) recently released a new report, Transforming Continuing Medical Education Together: 2017 Highlights from the Accreditation Council for Continuing Medical Education. The inaugural year-in-review report showcases the efforts of the ACCME and the continuing medical education (CME) community to leverage the power of education to respond to the changing healthcare environment. 

The report aims to celebrate the CME community’s initiatives to drive meaningful change for educators, clinicians, and ultimately patients, including: 

  • The Menu of Criteria for Accreditation with Commendation which represents the CME community’s vision of the future of education. From engaging with students, patients, and teams to tackling population and public health issues, CME providers that meet these criteria demonstrate the capacity of education to address healthcare challenges. 
  • Expanded opportunities for physicians to participate in education that counts for multiple requirements, thus reducing burdens and allowing clinicians more flexibility in choosing education that meets their needs, as a result of collaborations between accreditors, certifying boards, and educators. 
  • Freedom and flexibility in employing blended, new, and innovative approaches to education through the alignment of ACCME/American Medical Association requirements. 
  • Collaborations with other organizations, including the nursing and pharmacy accreditor colleagues to initiate a new IPCE credit mark that identifies education designed to improve team collaboration and patient care, helping to increase recognition for interprofessional continuing education (IPCE).
  • Increased engagement with healthcare leaders to promote the value of CME as a strategy to fulfil institutional and health system priorities.
  • Becoming a model of accreditation standards for other CME systems and providers around the world.

The report also describes the ACCME’s commitment to supporting the CME community. With its new annual meeting and online learning portal, as well as other educational offerings, the ACCME aims to build a community of practice that assists CME professionals in achieving their full potential. 

The ACCME published Transforming Continuing Medical Education Together as part of its efforts to build visibility for the CME community and communicate the value of accreditation and accredited CME.  

Graham McMahon, MD, MMSc, ACCME President and CEO said, “The CME community has much to be proud of. We look forward to continuing our work together, as we fulfill our shared aspiration to enhance education, drive improvements in clinician and team performance, and—most important—to optimize care for the patients we all serve.”  

February 20, 2018

The Congressional Budget Deal's Effect on Health Care

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In early February, Congress passed a massive bipartisan budget deal to fund the government through March 23, 2018, suspend the debt ceiling until 2019, raise budget caps by nearly $300 billion over two years, and fund various parts of the government.

Naturally, passage of the budget agreement means that quite a few health care priorities made their way into the law. For example, several health care “extenders” were reauthorized, community health centers (CHCs) were funded, cuts to safety net hospitals were delayed, as were cuts to the CHRONIC Care Act and the Part B Improvement Act, while revisions to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) were made.

Then, the deal reached in the Senate added $6 billion in funding to address opioid and mental health treatment, $4 billion for VA hospitals, and $2 billion in new funding for research at the National Institutes of Health (NIH). The Senate deal also extend funding for the Children’s Health Insurance Plan (CHIP) by an additional four years — a ten-year extension when combined with the six-year reauthorization secured last month.

Interestingly, the agreement also permanently repeals Medicare’s moribund Independent Payment Advisory Board (IPAB), while also making adjustments to the prescription drug “donut hole” that will require pharmaceutical companies to provide steeper discounts for seniors in the coverage gap.

IPAB Repealed

Before it could go into effect, Congress included the repeal of the unpopular Affordable Care Act (ACA) Independent Payment Advisory Board (IPAB), which would have been responsible for identifying potential Medicare savings to Congress. Congressional representatives of both parties had disdain for IPAB because it had the ability to limit Congress’ power over its recommendations. While Medicare spending has yet to hit the designated threshold that would have triggered the creation of the panel, the most recent Medicare trustees report estimated that it may have been enacted as soon as 2021.

The repeal of IPAB is likely to benefit drug makers and private Medicare plans as without the repeal, the Board would have been precluded from rationing care, increasing beneficiary spending, or cutting payments to hospitals and hospices.

The Donut Hole is Closed

The bill increased the discounts that drug companies pay to beneficiaries whose drug costs fall into the coverage gap of Part D, from the current 50 percent level to 70 percent. This change is estimated to save the federal government $10 billion over the course of a decade but is expected to cost drug companies close to $40 billion over that same decade.

Part D plan sponsors, on the other hand, had a decrease in their liability from the 25 percent they were expected to pay to begin in 2020 all the way down to 5 percent. The hole will remain the same for patients – 25 percent.

Changes to MACRA

The Medicare Access and CHIP Reauthorization Act (MACRA) had several changes made to it by way of the budget deal, including excluding the cost of Part B drugs from the calculation of doctor pay, delaying the use of cost measures in doctor performance scores, giving CMS three more years to transition to the performance threshold, and allowing the Physician-Focused Payment Model Technical Advisory Committee (PTAC) weigh in earlier on the payment models that providers design.

Physician advocate groups had been lobbying for the ability to exclude the cost of drugs they administer from the calculation of their Merit-Based Incentive Payment System (MIPS) scores because they were concerned that specialty therapies do not always have consistent coverage in reimbursement. In addition to listening to the concerns on that front, lawmakers also allowed CMS the flexibility to determine the weight of the cost performance category between 10 percent to 30 percent for three years.

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