The two-phase blueprint includes actions Trump 'may direct HHS to take immediately' and other items under consideration for the future.
White House officials unveiled on Friday the broad contours of a plan to counteract rising prescription drug prices.
The 44-page document, titled "American Patients First," includes a three-page outline of the Trump administration's two-phase blueprint.
The first phase involves actions the president "may direct HHS to take immediately," and the second involves additional items under active HHS consideration, for which the department is soliciting feedback, the document states.
Those two phases are reflected in each of the four key strategies the plan proposes to undertake: improved competition, better negotiation, incentives for lower list prices, and lowering out-of-pocket costs.
Although stakeholders generally said they appreciate the administration's goals, some said they want more detail on the specifics of the White House's plan.
The language from the document's three-page blueprint outline is reproduced below:
1. Increased competition
Immediate Actions
Steps to prevent manufacturer gaming of regulatory processes such as Risk Evaluation and Management Strategies (REMS)
Measures to promote innovation and competition for biologics
Developing proposals to stop Medicaid and Affordable Care Act programs from raising prices in the private market
Further Opportunities
Considering how to encourage sharing of samples needed for generic drug development
Additional efforts to promote the use of biosimilars
2. Better negotiation
Immediate Actions
Experimenting with value-based purchasing in federal programs
Allowing more substitution in Medicare Part D to address price increases for single-source generics
Reforming Medicare Part D to give plan sponsors significantly more power when negotiating with manufacturers
Sending a report to the President on whether lower prices on some Medicare Part B drugs could be negotiated for by Part D plans
Leveraging the Competitive Acquisition Program in Part B.
Working across the Administration to assess the problem of foreign free-riding
Further Opportunities
Considering further use of value-based purchasing in federal programs, including indication-based pricing and long-term financing
Removing government impediments to value-based purchasing by private payers
Requiring site neutrality in payment
Evaluating the accuracy and usefulness of current national drug spending data
Investigating tools to address foreign government threats of compulsory licensing or IP theft that may be harming innovation and development, driving up U.S. drug prices
3. Incentives for lower list prices
Immediate Actions
FDA evaluation of requiring manufacturers to include list prices in advertising
Updating Medicare’s drug-pricing dashboard to make price increases and generic competition more transparent
Measures to restrict the use of rebates, including revisiting the safe harbor under the Anti-Kickback statute for drug rebates
Additional reforms to the rebating system
Using incentives to discourage manufacturer price increases for drugs used in Part B and Part D
Considering fiduciary status for Pharmacy Benefit Managers (PBMs)
Reforms to the Medicaid Drug Rebate Program
Reforms to the 340B Drug Discount Program
Considering changes to HHS regulations regarding drug copay discount cards
4. Lowering out-of-pocket Costs
Immediate Actions
Prohibiting Part D contracts from preventing pharmacists’ telling patients when they could pay less out-of-pocket by not using insurance
Improving the usefulness of the Part D Explanation of Benefits statement by including information about drug price increases and lower cost alternatives
Further Opportunities
More measures to inform Medicare Part B and D beneficiaries about lower cost alternatives
Providing better annual, or more frequent, information on costs to Part D beneficiaries
What do operating margins and net patient revenue look like post-merger, and has the cost of providing care decreased due to greater scale? Has merger activity been beneficial to quality outcomes?
This issue includes targeted solutions, an intelligence report, and the cover story 'Your Nurses Can Fix the Hospital.'
The latest edition of HealthLeadersmagazine has been published online, with insights on mergers and acquisitions, population health, cost containment, and more.
In his introductory letterto the March/April issue, HealthLeaders Media interim Editor in Chief Jim Molpus addresses an often-overlooked disconnect in the current frenzy of healthcare M&A activity.
“If all healthcare is local, as the saying goes, then are mergers counterintuitive?” Molpus writes.
“What's always missing in the stampede to merge are the operational, financial, and cultural realities.”
In this edition’s cover story, “Your Nurses Can Fix the Hospital,” HealthLeaders Media Senior Editor Jennifer Thew, RN, shares insights from nursing leaders on how they solve problems, support innovation, and improve the culture of their respective organizations.
“We need [nurses'] eyes and ears to help us recognize how we can improve not only the care in a hospital setting, but in an ambulatory setting and all the places where care is going to be delivered going forward," said Maggie Fowler, RN, BSN, MBA, NEA-BC, system vice president and chief nursing officer for SSM Health in St. Louis.
These stories are in addition to the magazine’s intelligence report, an interview with American Nurses Association President Pamela F. Cipriano, three targeted solutions, and more.
The latest issue of HealthLeaders magazine is live online, with insights on IT investments, change management, boosting payments, accounting for uncompensated care, and more.
The January/February edition reflects a renewed commitment to cut through the clutter and deliver the information and analysis that healthcare leaders need, writes interim Editor in Chief Jim Molpus in his introductory letter.
“With this issue of HealthLeaders magazine, we create a fresh new start based on that original mission: to get you the information and ideas you need to lead a better healthcare organization,” Molpus writes.
Healthcare execs read our leadership stories to keep up with the latest news and trends. Can you guess which story was most popular?
We at HealthLeaders Media have had a busy year covering the latest developments in the business of healthcare. We've met interesting people, unpacked complex regulatory trends, and kept on eye on who's making waves.
Below you'll find a listing of the eight most-read stories from our leadership coverage this year—with the top spot going to a feature that truly reflects the state of the industry in 2017.
If the acquisition is completed, terms of which were not disclosed, the 12-hospital Presence Health will be added to AMITA Health, which is a Chicago-based joint venture between Ascension’s Alexian Brothers Health System, based in Arlington Heights, Illinois, and Adventist Midwest Health in Hinsdale.
7. What's Next for Retail Healthcare?
Facing the undeniable popularity of various forms of convenience care, healthcare systems have increasingly gotten into the retail game through partnerships with or creation of store-based clinics, standalone walk-in and urgent care clinics, and supplemental telemedicine services.
Debra Shute wrote about this trend in September.
6. Freestanding Emergency Dept. Care Significantly Costlier Than Urgent Care
When he looked into the cost of emergency care in March, John Commins found that the total price of a freestanding emergency room visit in Texas can cost 10-times as much as a trip to an urgent care clinic, according to research published in the Annals of Emergency Medicine.
(One of the study's co-authors later criticized those who interpret the findings inappropriately, contributing "to the false undervaluing of emergency care and emergency physicians.")
5. Micro-Hospitals Fuel Growth Strategy at a Texas Health System
CHI St. Luke's Health, a six-hospital health system in Houston, like other health systems, is looking outside the traditional hospital environment by adding physician practices and other outpatient sites of care. Part of its growth strategy involves combining inpatient and outpatient services into a smaller, more scalable and less capital-intensive facility model, as Philip Betbeze wrote in March.
4. Beating Clinician Burnout
Burnout is not, as many believe, a failing of an individual. Rather, it's a sign that something is amiss within an organization, and that systemic dysfunction can prevent an organization from achieving the desired outcomes of today's value-based care efforts, Jennifer Thew wrote in April.
2. Catholic Health Initiatives And Dignity Health to Merge
Our second-most popular leadership story of the year broke just a few weeks ago, when two huge Catholic health systems announced plans to merger. Their plan includes an unusual power-sharing agreement.
1. Healthcare's Consolidation Landscape
Perhaps unsurprisingly, the most popular leadership story on our website this year was about the nationwide trend toward consolidation in healthcare. After all, 87% of healthcare executives say their organizations are expected to both explore potential deals and complete deals in the foreseeable future, as Christopher Cheney wrote in June.
In addition to our dedicated reporting and original analysis, we aggregate the biggest healthcare stories from across the internet, which can lead to unusual results. Check out our list of the most intriguing Around the Web items from 2017.
Below is a list of some of the most memorable headlines from the stories we've gathered for our daily newsletter.
10. Kentucky nurse's viral selfie spiked searches about skin cancer, research says - International Business Times
9. Patient sues surgeon who took Spanish test on cellphone while operating - The Journal News
8. The intruder in the Brigham OR — how did she get there? - Boston Globe
7. Opinion: Why Colorado Anschutz Medical Campus has a world-class art gallery - Denver Post
6. Woman: Emory doctors left a camera in my body after surgery - AJC.com
5. Darth Vader alive and working at a Memphis hospital - FOX 13
4. Man swallows dental bridge during knee surgery. Who should pay? - NJ.com
3. Munchausen by proxy: Mom arrested after son has 323 hospital visits, 13 surgeries - WBIR
2. Hospital spends $300,000 to transplant a massive, 100-year-old sequoia to a new home - The Associated Press
1. His tattoo said ‘Do Not Resuscitate.’ Doctors wanted another opinion - The New York Times
Take a look back at HealthLeaders Media's most popular coverage of 2017.
Thousands of readers come to our site every day looking for the latest news and analysis on the ever-changing healthcare industry from our team of dedicated editors. Below are the 12 most-read stories of 2017. Have you read them all?
By Kimberly A. H. Baker, JD, Director of Medicare and Compliance, H3.Group
Healthcare executives should challenge assumptions about how to operate current and new service lines by conducting detailed financial analysis.
When healthcare executives are planning new service lines, the default has been to provide them through a provider-based department.
Medicare reimbursement, which has typically been higher at provider-based facilities, was a driver.
Recently, Congress and CMS have made a two-prong assault on provider-based department reimbursement that should cause healthcare executives to carefully consider the financial ramifications and options before developing new provider-based departments.
Strategic analysis should result in reconsidering the structure of existing provider-based departments.
In the Bipartisan Budget Act of 2015, Congress required a change to payments for new off-campus provider-based departments developed after November 2, 2015.
CMS implemented this change with a payment rate that equals half of the applicable rate for the same service on campus, with a few exceptions for drugs, lab, and therapy.
Next year, CMS is proposing that the rate for these services will equal only one-fourth of the applicable on-campus rate.
This substantial reduction in payments was directed at off-campus locations, but all provider-based departments, including on-campus departments, have been experiencing a reduction in reimbursement related to increased packaging for at least three years.
Many common ancillary services such as minor procedures, labs, and x-rays are no longer paid separately to the facility.
The following table shows the reimbursement for an example provider-based clinic visit with ancillary services, across different years and under different organizational structures.
The first two columns show a 41% decline in Medicare reimbursement for the same on-campus provider-based department services in just three years.
The "Off-Campus New Department" column shows the reimbursement if the visit is provided in a clinic developed after November 2, 2015, even if the diagnostics are provided at an established department of the hospital.
The "Freestanding Office Only" column shows the reimbursement if the visit is provided in a freestanding physician clinic owned by the hospital, but the diagnostics were provided by an established department of the hospital.
The "Fully Freestanding" column shows the reimbursement if both the office visit and diagnostics are provided by a freestanding clinic owned by the hospital.
Operating clinics as hospital-owned, freestanding entities might allow them to operate at much lower costs, while maintaining levels of reimbursement.
Although certain departments such as wound care or infusion clinics, typically staffed by nurses when provider-based, would require a physician to be present if operated as freestanding.
In light of reimbursement changes, healthcare executives should challenge assumptions about how to operate current and new service lines.
Detailed financial analysis, including the changing reimbursement landscape and regulatory costs, will provide better information for decision-makers as departments are developed.
