The PCSK9 Drugs - Epic success or epic failure? Print E-mail
Written by Dr. John M   
Wednesday, 24 June 2015 17:17

Earlier this month an FDA advisory committee recommended approval for the potent cholesterol-lowering drugs, evolocumab and alirocumab. The funny-sounding medications are called PCSK-9 inhibitor drugs.
Advisory committee members felt the benefits of the drugs outweighed the potential risks, especially in high-risk patients, such as those with Familial Hypercholesterolemia (FH).
The FDA usually-but not always-follows the recommendation of the advisory committee. A final decision from FDA will come later this summer.
In reading this piece, keep in mind that the goal of cholesterol drugs is to reduce the risk of heart attacks, strokes and death. It's easy to get side-tracked into thinking a drug is good if it lowers cholesterol. Changing lab values is worthless unless those changes result in better outcomes in the future.

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Lots of S. FL Faces in Latest FED Takedown Print E-mail
Written by FHI's Week in Review   
Monday, 22 June 2015 00:00

What Happened
Nina Lincoff reporting in the SFBJ on June 18 , 2015:

More than 30 percent of the people charged in the largest national Medicare fraud takedown in U.S. history were charged in the Southern District of Florida, according to an announcement Thursday <6.18.15> by the U.S. Attorney's Office.

Why it Matters
Despite occasional challenges from Southern California, Texas and New York, South Florida continues its reign as Medicare fraud champion.

Read more in the latest issue of Week in Review>>

Last Updated on Tuesday, 23 June 2015 15:47
CMS Issues Final ACO Rules: Key Legal Implications for Hospital & Health System ACOs Print E-mail
Written by   
Friday, 19 June 2015 16:33

On June 4, 2015, the Centers for Medicare & Medicaid Services (CMS) released a final rule (Final Rule) containing changes to its Medicare Shared Savings Program (MSSP). These changes have important legal implications for accountable care organizations (ACOs), particularly those owned and operated by hospitals and health systems.

In many respects, the primary focus of the Final Rule is to make changes designed to ensure continued robust participation in the MSSP. Under the previous rule, an ACO was permitted to participate in Track 1 (with shared savings potential, but no risk for losses) for only the initial three-year agreement period. After the initial three-year period, ACOs were required to move to Track 2 (which includes down-side risk for losses). Without the changes adopted in the Final Rule, CMS estimated that fewer than 15 percent of ACOs would opt for continued participation under downside risk in Track 2. Under the Final Rule, ACOs can renew in Track 1. At the same time, CMS has made changes to Track 2, and created a new Track 3, to incentivize ACOs to move to a two-sided performance-based track. Under Track 2, ACOs will now have a choice among several options for their applicable minimum savings rate and minimum loss rate, allowing ACOs to more closely tailor Track 2 to their individual risk tolerance. In addition, the Final Rule creates a Track 3, which incorporates a higher shared percentage (75 percent), prospective assignment of Medicare beneficiaries, and the opportunity for a programmatic waiver of the three-day skilled nursing facility (SNF) rule (which permits payment for otherwise covered SNF services when a beneficiary is admitted to a SNF without a prior 3-day inpatient stay).

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Last Updated on Tuesday, 23 June 2015 15:18
Cloud tech can make a Supreme Court decision against Obamacare irrelevant Print E-mail
Written by FHI's Week in Review   
Monday, 15 June 2015 00:00

What Happened
Steven Max Patterson, in a 6.10.15 post, reminds us that:

If the U.S. Supreme Court rules for the plaintiff later this month in the case of King v. Burwell, 7.5 million Americans stand to lose their Obamacare tax credits. Such a ruling would make it illegal to sell subsidized Patient Protection and Affordable Care Act (ACA) coverage on the insurance exchange website...

Why it Matters
According to the author:

When the website debuted two years ago, it was rife with bugs and system problems as was highly publicized at the time. When former U.S. CTO Todd Park was appointed by President Obama to oversee the fix, the site was also redesigned to run on Amazon EC2 clusters as a SaaSapplication that could be customized and operated by states as independent state exchanges. This enables states that want to keep Obamacare to offer subsidized insurance by moving from the federal exchange to a state-run exchange, like Oregon did with Cover Oregon.

Read more in the current issue of Week in Review>>

Last Updated on Tuesday, 16 June 2015 15:41
Sponsor Showcase Print E-mail
Written by Sponsor   
Wednesday, 17 June 2015 00:00
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Last Updated on Wednesday, 17 June 2015 14:21

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