Tag: 2019 News

The Centers for Medicare & Medicaid Services (CMS) launched the Patients Over Paperwork Initiative in 2017, which seeks feedback from industry stakeholders on ways to reduce administrative burdens in health care and improving the patient experience.

The Initiative was in accord with President Trump’s Executive Order that directs federal agencies to “cut the red tape” to reduce burdensome regulations.

This year, CMS received over 560 comments in response to its request for information.

The American Hospital Association (AHA) asserted that providers spend nearly $39 billion each year on administrative activities related to regulatory compliance.

Other stakeholders pointed to prior authorization as a problematic practice, with the American Academy of Ophthalmology calling it the “most burdensome requirement in Medicare.”

The American Association of Neurological Surgeons argues that patients are experiencing significant barriers to medically necessary care because of prior authorization requirements.

Numerous stakeholders called for prior authorization reform in Medicare Advantage plans, but America’s Health Insurance Plans (AHIP) has pushed back, saying that less than 15 percent of covered treatments and services require prior authorization.

However, stakeholders agreed that greater automation would reduce the burdens of prior authorization. Greater standardization of prior authorizations would increase the speed at which they are approved and reduce care delays.

CMS has enacted several regulatory reforms as a result of information gathered through the Patients Over Paperwork Initiative, including reforming evaluation and management (E/M) coding, simplifying office visit documentation, and reducing the complexity of the Quality Payment Program.

Will prior authorization reform be the agency’s next target?

Reuters reports that Endo International Plc and Allergan Plc have agreed to pay $15 million to avoid going to trial in October in a landmark case by two Ohio counties accusing various drug manufacturers and distributors of fueling the U.S. opioid epidemic.

The tentative deals disclosed on Tuesday came ahead of the first trial to result from 2,000 lawsuits pending in federal court in Cleveland largely by local governments seeking to hold drug companies responsible for the deadly epidemic.

Endo announced said it had reached an agreement-in-principle to pay Cuyahoga and Summit counties $10 million to and provide them up to $1 million worth of two of its of its drug products free of charge.

Allergan has tentatively agreed to pay $5 million to resolve claims involving its branded opioids, though the deal does not resolve claims involving generic painkillers, said Frank Gallucci, a lawyer for Cuyahoga County.

The accords are the first to result from the counties’ cases, which were selected for the first bellwether, or test, trial in the litigation to allow parties to gauge the value of the remaining claims and inform potential settlement talks.

Other companies still set to face trial on Oct. 21 include drugmakers Purdue Pharma LP, Teva Pharmaceutical Industries Ltd and Johnson & Johnson and drug distributors McKesson Corp, Cardinal Health Inc and AmerisourceBergen Corp.

Endo, which in 2017 withdrew its painkiller Opana ER from the market, said the settlement includes no admission of wrongdoing.

More than 2,300 lawsuits by state and local governments are pending nationally, accusing drug manufacturers of deceptively marketing opioids in ways that downplayed their risks and drug distributors of failing to detect and halt suspicious orders.

Most of the lawsuits are before U.S. District Judge Dan Polster in Cleveland, who has pushed for a settlement and will preside over the bellwether trial.

Purdue and Teva this year settled claims by Oklahoma’s attorney general for $270 million and $85 million, respectively, ahead of a trial before a state-court judge.

The state subsequently took Johnson & Johnson to trial. An Oklahoma judge will rule on Monday on whether the company should be held liable in a lawsuit by the state’s attorney general who argues the drugmaker should be forced to pay $17 billion for fueling the opioid epidemic.

Reuters reports that Endo International Plc and Allergan Plc have agreed to pay $15 million to avoid going to trial in October in a landmark case by two Ohio counties accusing various drug manufacturers and distributors of fueling the U.S. opioid epidemic.

The tentative deals disclosed on Tuesday came ahead of the first trial to result from 2,000 lawsuits pending in federal court in Cleveland largely by local governments seeking to hold drug companies responsible for the deadly epidemic.

Endo announced said it had reached an agreement-in-principle to pay Cuyahoga and Summit counties $10 million to and provide them up to $1 million worth of two of its of its drug products free of charge.

Allergan has tentatively agreed to pay $5 million to resolve claims involving its branded opioids, though the deal does not resolve claims involving generic painkillers, said Frank Gallucci, a lawyer for Cuyahoga County.

The accords are the first to result from the counties’ cases, which were selected for the first bellwether, or test, trial in the litigation to allow parties to gauge the value of the remaining claims and inform potential settlement talks.

Other companies still set to face trial on Oct. 21 include drugmakers Purdue Pharma LP, Teva Pharmaceutical Industries Ltd and Johnson & Johnson and drug distributors McKesson Corp, Cardinal Health Inc and AmerisourceBergen Corp.

Endo, which in 2017 withdrew its painkiller Opana ER from the market, said the settlement includes no admission of wrongdoing.

More than 2,300 lawsuits by state and local governments are pending nationally, accusing drug manufacturers of deceptively marketing opioids in ways that downplayed their risks and drug distributors of failing to detect and halt suspicious orders.

Most of the lawsuits are before U.S. District Judge Dan Polster in Cleveland, who has pushed for a settlement and will preside over the bellwether trial.

Purdue and Teva this year settled claims by Oklahoma’s attorney general for $270 million and $85 million, respectively, ahead of a trial before a state-court judge.

The state subsequently took Johnson & Johnson to trial. An Oklahoma judge will rule on Monday on whether the company should be held liable in a lawsuit by the state’s attorney general who argues the drugmaker should be forced to pay $17 billion for fueling the opioid epidemic.

Ehsan Alnimri sustained injury to his low back on June 20, 2010, while employed by Southwest Airlines as a ramp agent Ontario International Airport. He was required frequent lifting and carrying of weights up to 70 pounds and it occasionally involved lifting up to 100 pounds.

He was taken off work by his PTP, Dr. Sobol until September 2010 when he was returned to full duty.  Alminri continued to work full duty without restriction until he was taken off the job on November 26, 2011.

Dr. Sobol the PTP issued findings based on the AMA Guides of approximately 28 % but with no work restrictions appearing in the report. Dr. Wakim found 14% impairment under the AMA Guides and found work restrictions which precluded him from very heavy lifting on a constant basis and 70 pounds on an occasional basis.”

On November 26, 2011, Alnimri was informed that he was being removed from duty due to a doctor’s report, but was not told which one. He eventually obtained a supplemental report from Dr. Wakim which returned him to full duty as of May 2012. He actually returned to work on June 20, 2012. Thus he was removed from work until June 19, 2012, when he returned to work without restrictions.

The parties resolved the case in chief by Stipulations with Request for Award on August 8, 2013. It proceeded to trial on the remaining L.C. 132a claim for the lost pay between November 26, 2011 and June 19, 2012. The WCJ ruled in favor in Alnimri finding discrimination under L.C. 132a, and awarded a $10,000 penalty and back wages. The WCAB affirmed in th panel decision of Alnimri v Southwest Airlines.

The WCAB conceded the determination by the California Supreme Court in Department of Rehabilitation v. Workers’ Comp. Appeals Bd (Lauher) (2003 ) 30 Cal.4th 1281, 1298-1299 [68 Cal.Comp.Cases 831] that an employer “does not necessarily engage in ‘discrimination’ prohibited by section 132a merely because it requires an employee to shoulder some of the disadvantages of his industrial injury. By prohibiting ‘discrimination’ in section 132a, we assume that the Legislature meant to prohibit treating injured employees differently, making them subject to disadvantages not visited on other employees because the employee was injured or had made a claim.”

But, the panel went on to say “Based on its specific application to the facts of Lauher, we view the Court’s phrase “singled out for disadvantageous treatment ” to be an application of the broader standard adopted by Lauher-that, in addition to showing that he or she suffered an industrial injury and that he or she suffered some adverse consequences as a result of some action or inaction by the employer that was triggered by the industrial injury, an applicant “must also show that he or she had a legal right to receive or retain the deprived benefit or status, and the employer had a corresponding legal duty to provide or refrain from taking away that benefit or status.” (Lauher, supra at p. 1300.) Stated another way, an employee must show they were subject to “disadvantages not visited on other employees because they were injured. .. .” (Id.) Because the employee in Lauher was not deprived of a legal right to TDI, and therefore could not show he was treated differently than other employees with respect to his alleged detriment, he could not establish a prima facie case of discrimination.”

“Thus, on the record before us, including the absence of evidence that defendant acted upon its decision to refer applicant to a company physician or otherwise complete its usual process for resolving conflicts between work status reports before dismissing applicant, we conclude that defendant subjected applicant to disadvantages not visited upon other employees because they were injured.”

Created in 1984, the U.S. Preventive Services Task Force is an independent, volunteer panel of national experts in prevention and evidence-based medicine. The Task Force works to improve the health of all Americans by making evidence-based recommendations about clinical preventive services such as screenings, counseling services, and preventive medications. All recommendations are published on the Task Force’s Web site and/or in a peer-reviewed journal.

The influential group of health experts recommended that doctors screen all adults for use of illegal drugs, another step toward curbing the epidemic that claims tens of thousands of lives each year.

The U.S. Preventive Services Task Force said that health providers should attempt to determine whether their patients 18 or older are using illicit drugs, including nonmedical use of prescription drugs. But the panel said it did not have enough information to decide whether all adolescents should be screened.

The recommendation is the first time the panel has concluded there is enough evidence to support screening all adults. In 2008, it declined to do so.

The guidance is important because the Affordable Care Act requires that services recommended by the task force be covered free or with very small co-payments. The proposed recommendations are open for public comment until Sept. 9, after which the task force will consider them for final approval.

The panel concluded screening is effective when “services for accurate diagnosis of unhealthy drug use or drug use disorders, effective treatment, and appropriate care can be offered or referred.”

It cited the findings of a 2017 national survey that 11.5 percent of Americans 18 or older were using illegal drugs at the time and data that showed that 8.5 percent of pregnant women aged 18 to 44 had used drugs in the past month.

Among drug users aged 12 and over, 85.3 percent said they used cannabis and 19.5 percent used “psychotherapeutic drugs,” including opioids and other pain relievers.

In 2017, 70,237 people died of drug overdoses in the United States, according to the Centers for Disease Control and Prevention.

The panel suggested several questionnaires, administered by health care providers or taken by patients on their own, that it said were effective in picking up illicit drug use. It warned primary care providers that “screening tools are not meant to diagnose drug dependence, abuse, addiction, or use disorders. Patients with positive screening results may therefore need to be offered or referred for diagnostic assessment.”

It said providers also would have to be aware of state requirements for reporting results to legal authorities.