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In the News: November 1–November 8

CMS Continues With Site-Neutral Payment Cuts in 2019 OPPS Final Rule

In the recently finalized 2019 Medicare Hospital Outpatient Prospective Payment System (OPPS) final rule, CMS continued its site-neutral payment course by equalizing the payment for clinic visits in nonexcepted hospital outpatient departments (HOPDs) with the payment under the Physician Fee Schedule for clinic visits; amounting to a 40% reduction from current reimbursement for these HOPD clinic visits.

Groups like the American Hospital Association and America’s Essential Hospitals have expressed discontent with these changes. They argue that CMS is overstepping its statutory authority with these site-neutral payment provisions and intend to challenge them in court.

Given how common clinic visits are in off-campus HOPDs, Sg2 believes that health systems will need to reevaluate their outpatient strategy to account for this new reimbursement landscape. To learn more about the implications of the 2019 OPPS final rule on health systems, register for the upcoming Experts Live Q&A: Payment and Policy Update (Winter 2018).


Online Cognitive Behavioral Therapy May Address Access Challenges in Behavioral Health

A recent article from Becker’s Hospital Review discusses the potential of ongoing advancements in telemedicine to transform behavioral health care. Clinicians now have the option of treating patients with mental health conditions using Internet-based cognitive behavioral therapy (iCBT), which employs online behavioral health techniques that were traditionally available only in person. Structured content comprised of education, skills training and other exercises is delivered using audio and video in the convenience and privacy of a patient’s home.

The authors assert that iCBT may be the future of behavioral health care due to its: ease of access; role in addressing stigma and privacy concerns; lower cost of care; ability to alleviate the clinician shortage; and ease of integration into existing health care systems.

First deployed as telepsychiatry, virtual health continues to evolve to solve behavioral health access challenges. Sg2 believes that virtual health options, such as online or app-based treatment and disease management programs, can help address access limitations driven by workforce shortages, geographic mismatch and payer/coverage issues. To learn about virtual health modalities that are being deployed to address these challenges in the behavioral health population, watch the Sg2 On-Demand Webinar: Behavioral Health Update 2017: Integrating Virtual Health.


FDA Approves Potent New Opioid Despite Opposition

A November 2nd article published by National Public Radio (NPR) reported that a potent new opioid called Dsuvia was recently approved by the FDA. Dsuvia contains 30 micrograms of sufentanil in tablet form, which provides pain relief after it dissolves under a patient’s tongue. Despite opposition from the chair of the FDA advisory committee, Raeford Brown, MD, and the consumer advocacy group Public Citizen, the FDA’s Anesthetic and Analgesic Drug Products Advisory Committee approved the medication with a 10-3 vote.

Pamela Palmer, MD, PhD, cofounder of AcelRx, which manufactures Dsuvia, claims the opioid fills an “unmet need” by providing an alternative route for fast pain relief, rather than injecting medication or giving a patient a pill to swallow. However, critics are referring to Dsuvia as an “unnecessary opioid” and are particularly concerned about the appeal of the size and strength of the drug to individuals looking to misuse or sell it. After years of efforts to reduce the presence of potent opioids on the street, the approval of Dsuvia has raised concerns about this drug’s potential role in the ongoing opioid crisis.

The Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act that was recently signed into law allocates $8 billion towards addressing the ongoing US opioid epidemic. As the law is enacted, Sg2 believes organizations will need to respond quickly to changes in regulation and state spending. To learn more about how to prepare for the implementation of the SUPPORT Act, read the Sg2 Expert Insight National Focus on Opioid Epidemic Results in $8 Billion Legislative Package.

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As of February 11, 2016, Vizient, Inc. has completed its purchase of MedAssets Sg2 and spend and clinical resource management segments from Pamplona Capital Management, LLC. MedAssets revenue cycle business will continue to operate as a wholly-owned subsidiary of Pamplona Capital Management LLP.

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