Tag: Healthcare Legislation

New Jersey hospital emergency room becomes first in U.S. to end use of opioid painkillers

St. Joseph’s Regional Medical Center announced it has become the first hospital in the country to implement a program that will manage patients’ pain in the emergency room without the use of opioid painkillers.

Painkillers most frequently used in the emergency room in the past were oxycodone, vicodin and percocet, according to Dr. Mark Rosenberg, the Emergency Department chair.

“Our job here together is to look at the whole equation and understand how we can stop people from going from a prescription, to an addiction,” he said.

About a half-mile down the road from St. Joseph’s, recovering addicts are lining up for treatment at Eva’s Village.

Demetria Washington said she started on pills before moving on to heroin.

“Then I couldn’t get to it no more and a girlfriend of mine was like well you could just try heroin. And I tried it and I liked it.”

She used drugs for 18 years, before entering recovery. She’s been clean for 8 years and currently works as a recovery specialist at Eva’s.

“A lot of people use prescription drugs and then they end up turning to heroin,” she added.

Washington’s co-worker told us that she warns her son about the dangers of abusing prescription painkillers everyday.

“That’s what I tell my son because he’s seen me at my lowest point,” said Geraldine Lowe.

Lowe is also a recovering addict and a recovery specialist at Eva’s Village.

“As a matter of fact, and I’m not ashamed to say it, he was born addicted to drugs,” she said, adding that her son is now using pills.

America’s pill problem hits close to home, even for the head of St. Joseph’s Emergency Department. Dr. Rosenberg said his mother-in-law recently broke her wrist.

“She went to the local emergency department without telling me, and she got 5 percocet and told to see her family doctor. Family doctor gave her a prescription for 100. She’s 93 years old. 100 percocet. The point being is we, our culture is such that it’s really, really out of control,” said Dr. Rosenberg.

According to the Centers for Disease Control, more people died from drug overdoses in 2014 than than in any year on record, beating out deaths caused by car crashes and guns. Heroin and painkiller abuse are driving this problem, according to the Drug Enforcement Administration.

“In 2012, there were enough opioid prescriptions issued – nearly 260 million – to give every man, woman and child in the country their own bottle of pills,” said U.S. Senator Bob Menendez (D-NJ).

Federal and local lawmakers, law enforcement and health officials met for several hours at St. Joseph’s today to discuss how to stem the tide of opioid addiction.

“Everybody is at this table that should be, except for a few other people. We need the pharmaceuticals here, because they’re shoving drugs down our throats,” said U.S. Congressman Bill Pascrell (D-NJ).

St. Joseph’s Emergency Department, one of the busiest in the nation, has already begun to treat over 250 patients with alternative medicine or treatments, who would have otherwise received opioids. While opioids will still be used by St. Joseph’s staff to treat chronic pain, they will no longer be the first line of treatment.

“We have to acknowledge the fact that opioids are an essential drug to managing people with severe pain, like cancer pain,” said Dr. Rosenberg.

Federal legislation known as the Comprehensive addiction and recovery act is currently pending that could provide federal grants to states and local governments to combat the national epidemic of heroin addiction and prescription painkiller abuse.

It passed the Senate this month, it has not been voted on in the House.

Congressmen share insights for physician advocates

Three members of Congress spoke to physician leaders last week at the 2016 National Advocacy Conference about the top federal issues in health care and the importance of physician advocacy. Find out what they had to say about new payment systems, telemedicine and the role of the physician.

Physicians need to be at the center of meaningful change

“What we need to actually do is [support] something that makes sense,” said Rep. Pat Tiberi, R-Ohio. “How do we have a model health care system that’s patient-centered, and at the very top of that patient-centered health care system is the importance of the doctor-patient relationship?”

Tiberi told physicians that, other than treating their patients, there is no more important way they can spend their time than advocating for medicine. “There really isn’t anybody more important in the health care space than you,” he said, “a doctor.”

“If your child is sick, who is the most important person—the pediatrician. I’ve been there,” he said. “[There is] nobody more important in the world. If you have an aging parent who maybe now is beginning to be forgetful or you see some signs of disease, there is no more important person than the right doctor.”

Rep. Xavier Becerra, D-Calif., reminded physicians of a major victory from just one year ago. “We just buried [Medicare’s sustainable growth rate formula],” he said to great applause. “Now, we’ve got this new baby and this was a complicated birth—this new physician payment system. We’re still trying to incubate it.”

“Make sure you’re working with us so we can make sure the implementation of this new payment scheme works for everyone,” Becerra suggested. “It will have bugs, but come to us, and we [will] all go together to Andy [Slavitt] and the folks at CMS.”

Telemedicine is advancing

Physicians also heard a congressional perspective on telemedicine. The possibilities for telemedicine abound, but current legislation and regulation prevent its expansion. Sen. Brian Schatz, D-Hawaii, is leading a coalition to propose the Creating Opportunities Now for Necessary and Effective Care Technologies or CONNECT for Health Act, which it introduced earlier this month.

“The CONNECT for Health Act … will lift Medicare restrictions on the practice of telemedicine,” Schatz said. “It will do so in a cost-effective, quality-oriented way that will keep safeguards for doctors and patients.”

Schatz pointed to the Social Security Act as the basic problem in telemedicine that must be fixed. “This is an old law that was written before the advent of smartphones and other technologies,” he said. The senator cited these five statutory restrictions that are holding telemedicine back:

  • Patients receiving a telemedicine visit only may be in certain locations that include a physician office, rural health clinic or hospital.
  • Patients must be located only in certain rural areas.
  • Only certain practitioners can provide telemedicine services, according to existing definitions.
  • Store and forward technology is permitted only in federal telemedicine demonstration programs conducted in Alaska or Hawaii.
  • Telehealth coverage is restricted to specific codes under the U.S. Department of Health and Human Services rules developed in an annual process.

“We structured [the CONNECT for Health ACT] in a way that it will still lift restrictions,” Schatz said, “but do so in a way that would save Medicare money.”

Some of the key elements of the bill include:

  • A bridge program to help physicians transition to the new Medicare Access and Chip Reauthorization Act payment system through the use of telehealth.
  • The lifting of geographic restrictions is subject to state licensing requirements. It allows alternative payment models in Medicare to use telehealth without the existing restrictions.
  • Allowing telehealth to be a basic benefit under Medicare Advantage plans.
  • Expanding originating sites for telestroke and Native American programs.

“The AMA commands respect in the nation’s capital on both sides of the aisle, and your support for our bill is a big boost,” Schatz said. “Being here today is special for me because I’m the son of a physician. … [My father] was my role model for public service, and as a result my admiration for the medical profession is deep and is personal.

“I also know from my father that the personal and professional satisfaction from being in medicine being a doctor in America in 2016 comes with its share of frustrations, from billing and bureaucracy to EMR to managed care and everything in between,” he said. “But [now] there is something to be hopeful about. The CONNECT for Health Act … will lift Medicare restrictions on the practice of telemedicine.”

“But in order to do that we need this bill to get a hearing in both chambers,” Schatz said. “And we need it to eventually pass through the legislative process. That won’t happen without all of your advocacy.”

Colorado could become the first state with universal health care

A plan to make Colorado the first state to opt out of the federal health law and replace it with universal health care, funded by the taxpayer, is going to be on the Colorado ballot in 2016.

Supporters of universal health care gathered 158,831 qualified signatures, which is more signatures than are required to put the measure on the ballot.

Backers of the measure say employers would pay around 7 percent of a worker’s wages into the system. Workers would put around 3 percent into the system. Supporters say the plan would cost around $3 billion a year, but would save $9 billion.

Skeptics of the measure say costs would spiral out of control. It is likely the proposed measure will be discussed in the upcoming presidential election, since Colorado is a battleground state. Groups from both sides are likely going to invest a lot in order to advance the measure or defeat it.

If the ballot is passed, an entirely new government entity would be in charge of running the new health care program. Elected officials in 21 districts would be on the board and would be in charge of raising taxes to fund the new health care system.

Colorado is not the first state to attempt something like this. A few years ago, Vermont got support for a single payer health care system, but eventually the state admitted a large program couldn’t be financed due to a lack of money.

Spending Bill Could Mean More Health Funding, but Government Shutdown is Still Possible

Lawmakers have until Dec. 11 to pass an omnibus bill for fiscal 2016, and with extra money made possible by last month’s budget deal, HHS and the National Institutes of Health could see extra funding.

If they cannot get an omnibus passed, there could be another continuing resolution agreement to keep funding for a period of time. Otherwise, the government will shut down.

Analysts said lawmakers will add riders to the bill that will be the focus of negotiations and familiar disagreements and could impede a final agreement.

The budget deal raised the sequester caps by $80 billion in the next two fiscal years. For fiscal 2016, $50 billion of that is available and half will go to defense spending.

David Reich, senior policy consultant with the Center for Budget and Policy Priorities, said a shutdown is possible but an omnibus agreement is also not an unreasonable hope. A continuing resolution wouldn’t solve much.

“It’s a problem for agency operations to not know what their budget is well into the fiscal year,” he said.

Ellie Dehoney, vice president of policy for Research America, said a path to repealing the medical device tax, although it has received some bipartisan support, has not been forged.

It could be tied in with efforts to repeal the “Cadillac” tax on high-end health insurance plans but nothing concrete is in the works for that yet either, she said.

Reich said the extra money could go to departments throughout HHS, but lawmakers may get stuck on issues such as financing for the Affordable Care Act, some research agencies and Planned Parenthood.

The House appropriations bill calls for rescinding past funding of the ACA and eliminating most new spending. It would get rid of Title X family planning funds and also essentially eliminates the Agency for Healthcare Research and Quality and the Center for Medicare and Medicaid Innovation, he said.

Those provisions would be mostly unpalatable for Democrats and the White House, Reich said.

Dehoney said the NIH is likely to get more money than in previous years and it will probably not be earmarked but be used to bolster ongoing research.

“I think it will lift all boats,” she said

The original House Labor, Health and Human Services Funding Bill would allocate $71.3 billion to HHS, which is a slight increase from the year before but about $4 billion below the president’s budget request for the agency.

It would also give $31.2 billion to the NIH, $7 billion to the Centers for Disease Control and Prevention and $6 billion to the Health Resources and Services Administration. It would provide $3.3 billion for the CMS, which is nearly $1 million below the president’s request.

Dehoney said the budget deal has changed the game, however.

“They’re definitely renegotiating all of this because they have extra money,” she said.

In 2013, a government shutdown over implementation of the ACA stalled medical research and FDA drug approvals.

Modern Healthcare Editorial: A green light for attacking Obamacare

Last week’s election results in Kentucky and Virginia dashed any hope that attacks on Obamacare might finally be losing their political currency. Healthcare providers and payers should brace themselves for a full year of well-funded assaults on the law.

There was never any doubt that the many presidential candidates running in the wide-open Republican primaries would call for repealing and replacing the Affordable Care Act. The law has almost no support among the tea party and social conservative voters who dominate the GOP electorate in the early primary states.

But after the King v. Burwell decision last June upheld exchange plan subsidies, there was hope that victories by ACA supporters in off-year general elections in two Southern states might finally mute criticism of the law. It would have sent a clear signal to the campaign professionals running next year’s general election for the GOP that such attacks aren’t a winning issue with the broader electorate.

Instead, the pendulum swung the other way.

The dominating win by outsider businessman Matt Bevin in the race for the Kentucky governorship and the failure of Virginia Democrats to win control of the State Senate tells GOP funders and their super PAC allies that attacking the ACA can be a winning strategy with general election voters. Attacking Kentucky’s successful insurance exchange and Medicaid expansion was a centerpiece of Bevin’s campaign.

Democrats will argue the results were not indicative of broader public opinion. In an off-year election, only 31% of Kentucky’s 3.2 million registered voters turned out. Democrats still outnumber Republicans by a wide though shrinking margin in the state, and they are disproportionately concentrated in groups that fail to turn out in off-year elections.

But Bevin’s 52.5% to 43.8% margin (an independent siphoned off less than 4% of the vote) shows subsidized coverage expansion still isn’t popular, even among some of the people it was designed to help. Bevin focused his attack on the financial burden imposed on states by Medicaid, which enrolled 80% of the half million Kentuckians who signed up for insurance through Kynect, the state exchange.

Next year, he told voters, Kentucky will have to begin picking up part of the Medicaid expansion tab, eventually growing to 10% by 2021. “It’s financially untenable,” he said during the runup to the election. “We are already fast on the road to insolvency as a state.”

The economic reality is far different, of course. The billions poured into the state through the federal government’s share of Medicaid is a huge boon to the local economy and eventually translates into lower costs for the privately insured, who subsidize charity care. Try putting that explanation on a bumper sticker.

The ACA is not the main issue on voters’ minds. The state of the economy will dominate the debate during next year’s primaries and general election.

While the official unemployment rate may be down to 5.1%, this has been the most joyless recovery in the nation’s post-World War II economic history. People are working longer, more pressure-packed hours than ever before. Those not earning promotions haven’t had a raise higher than inflation in more than a decade.

Structural changes in the economy have taken their greatest toll among less educated workers, which is leading to unprecedented social problems. A report published last week in the Proceedings of the National Academy of Sciences showed that white, middle-aged Americans are now seeing rising annual death rates for the first time in modern American history. A startling rise in drug and alcohol poisonings, suicides and chronic liver diseases more than offset marginal improvements in the death rates from lung cancer and heart disease.

These conditions can be ameliorated when people have access to care through health insurance. But it’s no cure.

President Barack Obama expended a huge amount of political capital in getting the ACA passed. It contributed to the Democrats losing both houses of Congress. Republicans steadfastly opposed to the ACA now sit in 32 out of 50 governors’ mansions and control 30 out of 50 state legislatures, a complete turnaround from when Obama first got elected.

He can argue until the cows come home that Republican opposition stopped him from fixing the economy. But until the economic fortunes of this nation turn around, the insurance expansion created by the ACA—a bandage on that larger problem—will be at risk.

House passes bipartisan budget plan with debt-limit increase

The House passed a bipartisan budget deal Wednesday that would cut funding for Medicare and avoid a looming spike in premiums for about 30% of Medicare Part B beneficiaries.

About $80 billion would be offset by spending cuts elsewhere in the budget. The deal, reached after intense negotiations between the White House and congressional leaders, raises the federal borrowing limit to avert a spending showdown.

The legislation now heads to the Senate, which is expected to approve it before Tuesday’s deadline for increasing the so-called debt limit. It gives the government authority to borrow freely through March 2017.

The plan retains spending cuts known as sequestration under the Budget Control Act of 2011 and limits future payment rates for hospitals that set up or buy off-campus facilities.

The bill also calls for approximately $112 billion in additional spending over two years to be allocated in upcoming legislation negotiated by the House and Senate.

A coalition of Democrats, GOP defense hawks and pragmatic Republicans supported the measure.


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