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LTC Pharmacy News
July 2017
The healthcare industry is in the beginning of massive change and the long term care pharmacy industry will be affected by this change. LTCPharmacynews.com is your guide to understanding this process, the legislation and regulation that will implement this change and the key to adjusting your approach to succeeding in this new environment. We will try to not just tell you the "what" of this change, but the "how" as well.
LTC Pharmacy News Will Not Publish in August
We will be taking a brief break from publication here at LTC Pharmacy News during August. However, unlike others who shall remain nameless, we won't be basking on the shores of the Hamptons or the Jersey Shore. We will we busy cleaning up the website and gathering more stimulating content to help keep you up to date in the coming months. Look for your next newsletter in early September. 
 Guest Blog: Is now the time to sell your pharmacy?
 You may have heard that healthcare mergers and acquisitions  are all the rage in the current environment. Does this translate  to high valuations for LTC pharmacies?

 According to our industry's leading M&A experts, Ira  Cammeyer and Mark Alford, of Harbor Healthcare, the market  is stronger than it has been for years as companies look for  ways to compete in a market that values size and efficiency.

 So, if the thought has at least entered your mind, you may  want to read this.
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Getting to a Unified Post-Acute Care Payment System
Various Federal agencies have been working for years to come up with a unified payment system for post-acute care (PAC). In this paper, Elise gives us a much-needed history of the policy and its development, featuring the star players CMS and MedPAC. 

Why should you care? Your PAC customers have a lot riding on how the drama finally resolves. They care about this, and so should we. See more here.

CMS Reverses Its 2016 Position on Pre-Dispute Arbitration
On June 8, 2017, CMS issued a proposed rule that reversed its position prohibiting pre-dispute arbitration agreements in long term care facilities. This was the culmination of policy making and unmaking that, with respect to the latest clash on Skilled Nursing Facility/ Nursing Facility arbitration practice, started on October 4, 2016. See more here

CMS Publishes Draft SNF PPS Updates for 2018
Ah Spring! The flowers in bloom, pollen in the air and CMS busy delivering fresh assaults in advance of the next fiscal year.

If thoughts of wading through another proposal rule fills your heart with dread, fear not! Our intrepid Elise Smith proves herself equal to the challenge of deciphering the most obtuse policy jargon and delivering prose simple enough for an online news editor to understand. See it here.

CMS Releases Proposed Case-Mix Payment Proposal
While you have been frolicking over these past several years, CMS has been steadily preparing an assault on the status quo as it relates to Medicare payment policy for SNFs under Part A.

According to another insightful analysis by Elise, CMS suspects SNFs have been gaming the RUGs system and proposes a new payment methodology based on more "objective" standards than the number of rehabilitation hours a resident will require.

Read this and your confusion over the new proposal will vanish like your paycheck in Las Vegas.

More Elise Smith Insights
The list of Elise's publications was getting too lengthy to continue listing on the newsletter, so we have created her own page on the LTC Pharmacy News site. See it all now.
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Legislative Highlights

Senate Struggles with Health Reform
The replacement of the Affordable Care Act is now in the hands of the Senate, However, Republicans are having a difficult time agreeing on what the replacement should look like. 

Although Majority Leader Mitch McConnell (R-KY) hoped for a Senate vote before the July 4th recess, the votes weren't there to pass anything. This isn't because they can't find enough Democrats. They can't find enough Republicans to agree to new legislation.

The sticking points are conservatives insistence that premiums have to be lower and the moderates requirement that pre-existing conditions have to be covered. Beltway pundits, and increasing numbers of Republican senators, believe it's unlikely anything will get passed. 

So, if replacement legislation doesn't get passed, Majority Leader McConnell notes that Republicans and Democrats will need to come to some agreement over ways to shore up the current law without necessarily replacing it. Republicans fear this could lead to big disappointment in next year's mid-term elections. 

House Ways and Means Panel Introduces SNP Reauthorization
Ways and Means Health Subcommittee chairman Pat Tiberi (R-OH) and ranking Democrat Sander Levin (D-MI) have introduced legislation to reauthorize special needs plans (SNPs) in Medicare. Current authorization expires at the end of this fiscal year and there appears to be consensus that nursing home SNPs should be made permanent, along with other measures. 

House Drug Compounding Legislation Introduced
Congressmen Morgan Griffith (R-VA) and Henry Cuellar (D-TX) have introduced HR 2871, which would clarify that pharmacies that engage in compounding that is within the provisions of their state license are exempt from federal registration. The bill has 10 co-sponsors and has been referred to the Energy and Commerce Committee Subcommittee on Health. See story in Drug Topics


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Federal Agency News
DEA Publishes Drugs of Abuse Resource Guide
The Drug Enforcement Administration has released its latest edition of Drugs of Abuse, A DEA Resource Guide, which has become the definitive guide to the most commonly abused drugs in the US. 

AHRQ Publishes Data on Hospital Stays
The Healthcare Cost and Utilization Project (HCUP) has posted a new statistical brief on the following: Trends in Hospital Inpatient Stays in the United States, 2005-2014.

The brief can be found here

FDA on Pace for Record Approvals
MedCity News reports that the FDA has approved 23 drugs so far this year and is on pace to break its 2015 approval record of 45 approvals. Among the major new drugs approved is edaravone, a novel treatment for ALS, which was approved without any US clinical trials. 

ONC Publishes Certified EHR Database
The National Coordinator for Health IT published an updated list of certified health IT products, including electronic health records. The agency's plan is to maintain the accuracy of the database and note where corrective action has been ordered. See Healthcare IT News.

Manufacturer Packaging vs Multicompartment Dispenser
Is there a difference in dispensing accuracy based on from what type of package a drug is dispensed? Well, the Agency for Healthcare Quality and Research points us to a study suggesting a multi-compartment dispensing device was associated with a lower dispensing error than manufacturer packaging. The comparison was performed in a nursing home, making this relevant to us.

Dual Eligibles Office Releases 2016 Report
The CMS Medicare-Medicaid Coordination office published its Report to Congress on FY 2016 activities. The report shows that more than 720,000 dual eligibles are enrolled in integrated care models and references efforts to reduce rehospitalizations from nursing home residents. 

CMS Releases Survey Interpretive Guidelines, Delays Penalties
The much-anticipate interpretive guidelines have been released by CMS, along with a policy note that will delay penalties for one year. The effective date of the phase 2 guidelines remains November 28, 2017. See McKnights for story and links. 

Bureau of Labor Statistics Reports on Disease-Based Pricing
The Bureau of Labor Statistics is not generally heard from until the first Friday of the month, when it reports on national employment. Recently the agency reported on a project it has been working on for a year: tracking health care inflation in terms of the cost of a disease. I would elaborate, but it would be quicker for you to read the post

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Go to the LTC Pharmacy website for regular updates on what's coming from CMS, including proposed and final rules, new programs, news from Medicare and Medicaid and updated Medicare Learning resources. Go there now.

The FDA often updates its website with drug safety information, news about drug approvals and implementation information on laws, such as the Drug Quality and Security Act. Keep checking our site for the latest news from FDA.

THE HHS Office of Inspector General publishes audit reports and results of investigations on federal health programs, such as Medicare and Medicaid. Congress frequently looks at these reports when deciding where to focus on oversight and legislation. Keep in touch here.

The Government Accountability Office is the official investigative arm of Congress and publishes important reports that often guide the national conversation. We keep track of announcements coming out of GAO, so you don't have to. All you need to do is click here.
News Items of Interest
Walgreen Ends Bid for Rite, Will Buy Stores Instead
Looks like Walgreen has read the writing on the regulatory wall and has decided to abandon its pursuit of a merger with Rite Aid. Instead, the Illinois chain drug behemoth will buy more than 2100 of Rite Aid's stores and move on. 

One Quarter of Hospital Readmissions Linked to Meds
Drug Topics reports on a study emanating from Hawaii's Pharm2Pharm program showing that 26 percent of hospital readmissions were preventable and were related to medication adherence and inaccurate dosing. The article notes the study will soon be published in the APhA journal. 

Hospitals that Avoid SNFs Have Better Outcomes
Fierce Healthcare highlights a MIT study that suggests that hospitals that invest in emergency departments and inpatient services have better outcomes than hospitals that routinely refer patients to SNFs for their rehabilitation and recovery. It seems getting patients well enough to return home is a better option. 

Big Data and Helping Seniors Remain at Home
You may have thought about "big data" as a tool for complex scientific problems, but experience suggests that the insights gained through automated data collection can help better manage how seniors receive care at home. McKnight's

Quintiles IMS : Understanding the Dynamics of Drug Expenditure
This report examines the changes in drug expenditure patterns across major industrial nations over the past 20 years, showing that categories that once dominated have been replaced by new treatments. A fascinating look at trends that are only obvious when viewed from a distance.

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