Skip to Content

In brief: MedPAC details spending, FTC slaps Surescripts 

In brief: MedPAC details spending, FTC slaps Surescripts 

WASHINGTON – The Medicare Payment Advisory Commission (MedPAC) has released its 2023 data book on health care spending and the Medicare program. 

The 200-page report provides Medicare data on spending, demographics, beneficiary access to care, and quality of care, among other information. 

Among MedPAC’s findings: 

  • Medicare was the largest single purchaser of personal health care in the U.S., gobbling up 24% of total spend; 

  • Medicare spending by type of service varied, from 18% on DME to 37% on home health. 

  • Medicare spending is expected to double in the next 10 years. 

  • Health care spending per enrollee has grown faster for the privately insured than for beneficiaries in traditional FFS Medicare from 2014-20. 

  • The declining ratio of workers to Medicare beneficiaries threatens the Medicare program’s financial stability. 

The complete list of sections in the report are: National health care and Medicare spending, Medicare beneficiary demographics, Medicare beneficiary and other payer financial liability, dual-eligible beneficiaries, alternate payment models, acute inpatient services, ambulatory care, post-acute care, Medicare Advantage, prescription drugs, and other services. 

View the report here

FTC reaches proposed settlement with Surescripts 

WASHINGTON – The Federal Trade Commission has filed a proposed order to remedy what it says is anticompetitive conduct by Surescripts that led to higher prices, stifled innovation and reduced customer choice in the e-prescribing market. 

The order follows a favorable federal court ruling that found Surescripts possesses monopoly power in e-prescribing services with a 95% “super share,” according to the FTC. 

“The FTC will not hesitate to take action in enforcing the antitrust laws to protect health care consumers,” said FTC Bureau of Competition Director Holly Vedova. “The proposed order is a victory in creating a fair and competitive playing field in the e-prescription drug market. In large part because of Surescripts’ conduct, virtually everyone today who has a prescription filled electronically does so via the Surescripts networks. The proposed order would eliminate the anticompetitive restraints Surescripts has imposed on its customers since 2010 and would create conditions that allow competition to flourish for the benefit of anyone who gets a prescription filled at a pharmacy.” 

In its lawsuit, the FTC alleged that Surescripts intentionally set out to keep e-prescription routing and eligibility customers from using competing platforms (a practice known as multihoming) by using anticompetitive exclusivity agreements, threats and other exclusionary tactics. 

The court denied Surescripts’ motion to dismiss in January 2020, and Surescripts and the FTC filed motions for summary judgment in March 2022. The court granted the FTC’s motion for partial summary judgment and encouraged the two parties to engage in settlement discussions in March 2023. The district court then referred the case to mediation. 

The FTC’s proposed order, which has a 20-year term, would prohibit Surescripts from engaging in the types of exclusionary conduct alleged in the FTC’s lawsuit. It also extends the same prohibitions to Surescripts’ medication history services and the company’s on-demand formulary services, which use data that identifies the patient’s group or plan level prescription benefit information for a specific or alternative drug. 

Specifically, the proposed order would: 

  • Prohibit Surescripts from entering into, maintaining or enforcing contracts that impose a majority share requirement (e.g., exclusivity or loyalty agreements) on its routing and eligibility customers, including through all-unit discounting. 

  • Prohibit Surescripts from implementing other problematic provisions it has used in the past to prevent or limit the ability of customers to do business with Surescripts’ competitors. 

  • Bar Surescripts from preventing customers from promoting competitors’ services; preventing and limiting customers’ ability to communicate with competitors; and requiring that customers provide Surescripts a right of first refusal. 

  • Bar Surescripts from entering into, maintaining or enforcing agreements that prevent rivals from competing with Surescripts in routing and eligibility. 

  • Prohibit Surescripts from discriminating against or threatening customers who refuse to agree to a majority share requirement. 

  • Extend the same relief to Surescripts’ medication history and on-demand formulary services.

  • Bar Surescripts from entering into or enforcing any employee non-compete agreement with current and former employees that would prevent those employees from working for a competing e-prescribing service provider. 

New Hampshire Medical Supply names new marketing exec, eyes growth 

WASHINGTON – New Hampshire Medical Supply, which has locations here and in Maryland, has named Stef Tasca as vice president of marketing & commercialization. Tasca joins the company with more than 20 years of experience in sales and marketing leadership in the DME, pharmaceutical and automotive industries, most recently as executive director of marketing and managed care contracting for Hart Medical Equipment in Grand Blanc Township, Mich. “Stef’s strategic vision, innovative ideas and dedication to excellence make her a perfect as we expand our operations,” said Saleem Shah, president. New Hampshire Medical Supply has served the Washington, D.C., community since 1962 and opened a branch in Temple, Md., in 2021. It plans to open additional locations in both areas. 

HealthWell provides co-payment assistance for Type 2 diabetes 

GERMANTOWN, Md. - The HealthWell Foundation has opened a new fund to provide financial assistance to individuals living with Type 2 diabetes. Through the new fund, HealthWell will provide up to $1,000 in medication co-payment assistance to eligible patients with annual household incomes up to 300% of the federal poverty level for management of their disease. “We are pleased to offer copayment assistance to underinsured individuals living with Type 2 diabetes, but we know that the funding we have available will only be enough to assist approximately 2,000 patients,” said Krista Zodet, HealthWell’s president and CEO. “We will not begin to address the greater need, but we are eager to help as many patients as possible before funding is exhausted. We are thankful to our dedicated donors for recognizing this paramount need and for providing HealthWell with the financial resources to offer co-payment assistance to people with Type 2 diabetes. No one should go without lifesaving medications simply because they can’t afford them." Visit HealthWell’s Type 2 diabetes page to determine a patient’s eligibility. A nationally recognized, independent non-profit organization founded in 2003, the organization has served as a safety net across more than 85 disease states for more than 822,000 underinsured patients. Since its inception, it has provided more than $3.3 billion in financial support through more than 1.3 million grants.  

VGM adds O2 Concepts to vendor network 

WATERLOO, Iowa – VGM & Associates has signed a new vendor agreement with O2 Concepts. "Embracing progress, we proudly expand the VGM Respiratory portfolio with the addition of O2 Concepts,” said Boone Lockard, director of VGM Respiratory. “With O2 Concepts’ innovative POC portfolio and revolutionary DNA platform, we enhance our ability to meet the evolving needs of VGM members and patients. This partnership is a step forward in our commitment to delivering exceptional respiratory care solutions.” O2 Concepts’ POCs provide both continuous flow and high-volume pulse dose oxygen in a 24/7 environment. Its proprietary, device-initiated DNA Technology connects providers with their fleet via a portal. “We are excited to bring the market leading performance and reliability of our devices and technology to the VGM membership and share our expertise in the use of POCs and utilizing technology to enhance and evolve their fleet management systems,” said Elby Beal, CEO of O2 Concepts. 

Inspire Medical names chief medical officer 

MINNEAPOLIS – Inspire Medical Systems has added Charisse Y. Sparks, MD, as its chief medical officer. She will be a member of the company’s executive leadership team and will lead its medical and clinical affairs functions, reporting to Tim Herbert, president and CEO. “We are excited to add Dr. Sparks, a board-certified physician with extensive business and leadership experience, to our executive team,” said Tim Herbert, resident and CEO of Inspire Medical Systems. "Inspire has long partnered with leading ear, nose and throat surgeons, and sleep physicians, as part of our medical advisory boards,” Herbert said. “In her role as our chief medical officer, Dr. Sparks will continue to amplify these important collaborations, further enhancing our focus on delivering high-quality patient outcomes. As a result of her deep knowledge of Inspire’s business from her service on the board, Dr. Sparks is well-positioned to lead Inspire’s clinical development initiatives to ensure optimized therapy design and inclusion of critical user inputs.” Sparks transitioned formally into the industry by joining DePuy Synthes, Inc., the orthopaedic company of Johnson & Johnson, bringing her expertise in medical affairs and her business acumen to the development and evaluation of new and advanced technologies. Subsequently, she served as chief medical officer of AppliedVR, Inc., a privately held company focused on virtual reality-based treatments that address pain and other conditions.   

NCART elects new members, seeks pricing data 

WASHINGTON – NCART has elected new members to its board of directors for the 2023-35 term. They are Bruce Bayes, president of Custom Mobility; John Goetz, consultant to Permobil; Larry Jackson, president of Sunrise Medical; Johnny Miller, president of Miller’s; Kyle Walker, regional vice president of Reliable Medical Supply; and Brett Zaer, president of Superior Mobility. “We’re very thankful to the strong and committed group of industry leaders who give their time, expertise and resources to NCART and our mission to ensure that people with disabilities can get the specialized equipment and supporting services they depend on,” the organization stated. Directors serve two-year terms with staggered elections…NCART is asking complex rehab providers to send them pricing data for seat elevation systems by Aug. 3. The organization will provide the data to CMS to help determine adequate reimbursement amounts. Providers who are interested in sharing pricing data should contact Mickae Lee at [email protected]. CMS announced on May 16 that it would cover seat elevation systems for Group 2, 3 and 5 power wheelchairs, and it’s now in the process of determining coding and reimbursement amounts. NCART submitted coding applications to CMS on July 3. 

AlayaCare tapped by Infusion Ventures 

TORONTO – Infusion Ventures will use AlayaCare’s next-generation home-based care platform to prepare for continued growth. Woburn, Mass.-based Infusion Ventures currently offers home infusion nursing services in six northeastern states. "As we provide more home infusion nursing services, our core functions of nurse scheduling, electronic visit verification, billing and data management are important areas of focus," said David Pliner, president of Infusion Ventures. "We are delighted that AlayaCare has built a platform that addresses our immediate needs and easily expands as we do." AlayaCare offers an end-to-end software platform for governments, home-based care organizations, and community care providers to manage the entire client lifecycle, including needs assessments, care plans, scheduling and visit verification, combining traditional in-home and virtual care solutions. 

Comments

To comment on this post, please log in to your account or set up an account now.