Today’s Top Story
Highmark, Inc., to lower physician payments for patients covered by plans sold under the ACA.
On Friday, private health insurer Highmark Inc., announced it would reduce payments to doctors who treat patients covered by plans sold on the Affordable Care Act (ACA) marketplace. Highmark, which cited an estimated $500 million loss last year on plans sold under the ACA, will reduce physician payments by 4.5 percent starting April 1. Opponents argue that physicians should not be held accountable for Highmark setting plan costs too low to adequately cover patients’ care. Highmark contends that lowering physician payments will enable it to continue to participate in the federal marketplace, thereby bolstering marketplace sustainability, according to Alexis Miller, Highmark’s special vice president of individual and small group markets. Highmark made this announcement as other nationwide insurers report losses on the federal marketplace for 2015. Read more…
Other News
FDA issues final guidance on immunogenicity-related considerations for LMWH.
The U.S. Food and Drug Administration (FDA) has issued a final guidance for industry regarding immunogenicity-related considerations for low molecular weight heparin (LMWH) products, which can be associated with a potentially fatal adverse event, heparin-induced thrombocytopenia. In addition, the document finalizes the draft guidance published in 2014, Immunogenicity-Related Considerations for the Approval of Low Molecular Weight Heparin for New Drug Applications (NDAs) and Abbreviated New Drug Applications (ANDAs). As reported by PharmTech.com, the guidance includes recommendations regarding meeting the requirement for active ingredient sameness for ANDAs for LMWHs, helping to address immunogenicity-related considerations in the context of ANDAs. Other recommendations focus on areas such as addressing impurities and their potential effect on immunogenicity for ANDAs. In the guidance, FDA asserts that drug master file (DMF) holders should be aware of the requirements and “ensure DMFs are current. DMF holders must notify authorized applicants of changes.” Read more…
Read the guidance…
Amgen Inc. and UCB announce results of osteoporosis drug trial.
Top-line results from the Phase 3 placebo-controlled FRActure study in postmenopausal woMen with ostEoporosis (FRAME) indicate that patients who received monthly subcutaneous injections of romosozumab had a 73 percent reduction in the relative risk of a vertebral fracture through 12 months compared to those who received placebo, according to an announcement by Amgen, Inc., and Belgium-based UCB SA. The incidence of new vertebral fracture was reduced through months 12 and 24 in postmenopausal women treated with the drug, according to the companies. The data also suggest incidence of clinical fractures was reduced through 12 months in postmenopausal women with osteoporosis. Data indicated, however, that the incidence of nonvertebral fractures through months 12 and 24 was not reduced. Read more…
Deadline to attest to meaningful use pushed back 2 weeks.
The Centers for Medicare & Medicaid Services (CMS) has pushed, by 2 weeks, the deadline to attest to meaningful use under the Medicare Electronic Health Record (EHR) Incentive Program to midnight on March 11, 2016, EST. The deadline applies to physicians in all states who have determined they can attest to the meaningful use for a 90-day reporting period in 2015. The California Medical Association (CMA) is reminding its members that to attest, providers should submit their data through the CMS registration and attestation system, noting that physicians may select an EHR reporting period of any continuous 90 days from Jan. 1, 2015, through Dec. 31, 2015. CMA recommends that physicians attest during off-peak hours, such as evenings and weekends, to speed up the attestation process. “Physicians are also urged to take time now to ensure that their Medicare enrollment information is up-to-date before entering their 2015 attestation data,” CMA advises. CMA also notes that “as a result of the late publication date of the final meaningful use rules by CMS, CMA encourages all physicians to apply for a hardship exception. Applying for a hardship exemption will prevent physicians from getting a penalty for failing to demonstrate meaningful use.” Read more…
Access the CMS Registration and Attestation System…
Read more about applying for a hardship exemption in AAOS Advocacy Now…
Massachusetts.
The Massachusetts Medical Society (MMS) has given its endorsement to a joint statement by the National Governors Association and the American Medical Association calling for united action to end the epidemic of opioid abuse. The statement voices support for the use of databases and prescription drug monitoring programs “to improve prescribing practices and signal when a patient may need treatment for a substance use disorder.” The statement also calls for removal of federal barriers to buprenorphine for use in treating addiction as well as for loosening of access to naloxone for those at risk of overdose. “This joint statement by the governors and the nation’s largest physicians’ group,” said Dennis M. Dimitri, MD, president of the MMS, “demonstrates the intense effort on the part of both parties toward ending this epidemic. It calls for collaboration between physicians and public officials, and describes agreement on the strategies needed to fight the epidemic.” Read more…
Read the joint statement…
CMS proposes modest pay updates to Medicare Advantage plans.
CMS has released proposed changes for the Medicare Advantage and Part D Prescription Drug Programs in 2017 that will, if finalized, result in an average payment increase of 1.35 percent on Medicare Advantage plans, although the agency notes that individual plans will vary. In addition, CMS proposes to:
- improve the precision of payments to Medicare Advantage plans that serve vulnerable populations
- adjust Star Ratings to reflect the socioeconomic and disability status of a plan’s enrollees
- revise the methodology used to risk-adjust payments to plans to more accurately reflect cost of care for dually eligible beneficiaries
Free online advance registration for 2016 AAOS Annual Meeting ends Sunday, Feb. 28!
AAOS members can take advantage of free advance online registration when they register for the 2016 Annual Meeting by Sunday, Feb. 28. The 2016 AAOS Annual Meeting features an array of new learning formats and a variety of clinical and scientific topics. Among other things, this year’s meeting includes the following:
- 32 symposia
- 923 paper presentations
- 576 posters
- 88 scientific exhibits
- Orthopaedic Video Theater with more than 80 videos
- Specialty Day, featuring full programs by orthopaedic specialty societies
- Electronic Skills Presentations in the newly redesigned Technology Theater
On-site course fees now apply. On-site registration and check-in will be available Monday, Feb. 29 through Saturday, March 5, at the Orange County Convention Center, West Building, Academy Hall C. Read more…
Register for the AAOS Annual Meeting…
Call for volunteers: PCORI advisory panels.
AAOS seeks to nominate members to several Patient-Centered Outcomes Research Institute (PCORI) Advisory Panels. The Advisory Panels are: Assessment of Prevention, Diagnosis, and Treatment Options; Improving Healthcare Systems; Addressing Disparities; Patient Engagement; Clinical Trials; Rare Disease; and Communication and Dissemination Research. Applicants for these positions must be active fellows, candidate members, candidate members osteopathic, candidate member applicants for fellowship, or candidate member applicants for fellowship osteopathic. In addition, all applicants must provide the following: an online AAOS CAP application; a current curriculum vitae; a personal statement (250 to 600 words) that clearly describes their background, experience, degree to which expertise and background could improve PCORI’s work, and reasons for applying; and a PCORI application form. All supporting materials must be submitted by March 7, 2016 at 11:59 p.m. CT, to Kyle Shah at: shah@aaos.org
Learn more and submit your application…(member login required)
Learn more about PCORI panels and the application process…
Access the PCORI application form (PDF)…
