POLITICO's Morning eHealth: Congress: the CHRONIC and user fees — Notes from FDA’s cybersecurity forum — PDMP update

By Darius Tahir | 05/19/2017 10:00 AM EDT

With help from David Pittman (@David_Pittman)

CONGRESS - THE CHRONIC AND USER FEES: Congress did some legislative spadework Thursday:

- CHRONIC: The Senate Finance Committee unanimously approved the CHRONIC Care Act (S. 870), which - among other changes - would alter the landscape for telehealth reimbursement in Medicare.

Specifically, those changes include: a two-year extension for Medicare's Independence at Home demonstration. A small addition tacked onto the bill would have participating practices assess use of health IT, including remote monitoring.

Additionally, the provision allowing certain Medicare ACOs to use telemedicine, including in patients' homes, earned the approval of the National Association of ACOs. But the organization was dismayed it only applies to those ACOs at risk for losing money if they don't hold down costs. "While NAACOS would like to see these same allowances expanded to all ACO models, this legislation is a significant step in the right direction," Clif Gaus, the group's president, said in a statement.

With the bill's passage from the Finance Committee, you might wonder when it'll get the full chamber's vote. Don't expect a separate one, our colleague David says. His sources on and off the Hill expect the legislation to hitch a ride with other must-pass legislation - such as CHIP reauthorization in September.

- USER FEES: The House Energy and Commerce Health Subcommittee gave the A-OK to the FDA's user fee reauthorization bill Thursday. The subcommittee approved four amendments, including Rep. Joe Kennedy's over-the-counter hearing aid approval.

NOTES FROM FDA'S CYBERSECURITY FORUM: Your correspondent caught the beginning of FDA's forum on cybersecurity in medical devices. Other than an allusion from the agency's Dinesh Patwardhan (with the Office of Science and Engineering Laboratories) to a yet-to-be-published report on regulatory science gaps in cybersecurity, most of the presenters focused on device security in the real world.

One point brought up persistently was the difficulty of translating any cybersecurity gains from big hospitals and manufacturers to the small-sized equivalents of both.

"Mayo Clinic is not the real world," said that hospital's director of clinical information security, Kevin McDonald. While fixes to vastly improve a hospital's cybersecurity posture are relatively simple, in practice they involve a devoted, large staff which smaller hospitals simply cannot afford.

Also frustrating, McDonald noted, is the economic state of security. Plenty of medical device manufacturers tout the security features - but only note that they're an extra add-on once it's time to close the sale.

We'll be watching the session this afternoon as well.

eHealth tweet of the day: Aaron Rowe @soychemist "Overly Punny Headline Idea: From FDA to ABC: Califf's New Caliphate is Verily Packed with Devices and Data

FRIDAY: With the second straight 90+ degree day, your correspondent can safely say it's summertime once again - or, the time of year when all Washingtonians come to suspect they're being baked in a fine béchamel (or some other sauce, who knows). What kind of food would you make? Discuss with dtahir@politico.com. Discuss eating food socially @David_Pittman, @athurallen202, @DariusTahir, @POLITICOPro, @Morning_eHealth.

PDMP UPDATE: Plenty of updates from prescription drug monitoring and IT responses to the opioid crisis:

- Missouri: In the latest twist of the PDMP drama in the Show Me State, Sen. Claire McCaskill has endorsed calls for a special legislative session to finally settle all the differences when it comes to database establishment.

The PDMP bill got closer to the finish line than ever this year, with separate versions of the legislation getting each chamber's approval. But those differences - such as a mandate that prescribers check the PDMP - ended up fracturing the coalition supporting the bill.

Whether any special session would resolve those differences appears unresolved. State Rep. Holly Rehder, who's doggedly pushed PDMP, admitted to POLITICO that she is "not sure that I have the votes." But, she said, additional time might do the trick.

Meanwhile, State Sen. Rob Schaaf - the primary antagonist for years - suggested McCaskill's appeal would dent her electoral hopes. "I think her willingness to force everyone's private facts onto a government surveillance system will hurt her at the ballot box."

Contextually speaking, your correspondent found Schaaf's statement surprising: while Schaaf opposed a PDMP for years, nearly singlehandedly obstructing it by filibuster, he had relented this year - on the condition the Senate add the mandatory-check requirement that split the pro-PDMP coalition. Schaaf's statement suggests his support is only temporary, though he didn't answer when we inquired if he had changed his mind once again.

- Washington: Earlier this week, Washington passed an opioids bill - which, naturally, includes some PDMP language. That includes a provision to give providers feedback regarding prescription patterns, and a proactive alert system that notifies them of an overdose. Additionally, the bill requires the state's health department to report on the progress of PDMP-to-EHR integration yearly.

HHS MANEUVERING: The department is further delaying the Obama-era Medicare bundled payment program until Jan. 1, 2018. In the rule announcing the delay, the department suggested that more time would allow providers to prepare for the necessary changes in coordination.

ANOTHER APPLE TODAY: Another Apple update: company CEO Tim Cook has been test-driving a blood glucometer device connected to his Apple Watch. Blood glucose has been an area of interest for the Cupertino colossus, and the revelation would seem to back up the rumors in that area. Reactions on Twitter were mixed. Some said they'd totally buy that product; while some doctors were not exactly pleased : "Blood sugar monitoring for the worried well? Didn't know this was a thing. Glad I'm an EP doc."

Cook also said he'd lost 30 pounds, in part because of his watch, in an interview with Jim Cramer. "Because it motivates you and it constantly gives you feedback, it constantly gives you rewards, and this makes a difference over time," he said.

"The Watch has been an incredible move into health, in the wellness and fitness piece," he also said.

ATHENA UH-OH: Activist investors Elliott Management have acquired 9.2 percent of athenahealth, an SEC filing today reveals. The filing states that Elliott believes athenahealth's stock is "significantly undervalued," due to its technology and disruptive potential, but also notes that it intends to chat with the company's board of directors to maximize value of the stock.

Precisely what Elliott will do is undetermined. The investors have been known to restructure companies, or make takeover offers or take up other activist techniques.
Athenahealth is publicly sanguine, with its spokeswoman saying they "look forward to talking with them to hear their views about the Company ... We have great confidence in the Company and where we are headed."

Of course, athenahealth has been under the baleful eye of investors before. Back in 2014, top short-seller David Einhorn made a big presentation about his short-driven skepticism of the company. (Jonathan Bush confused him with the "Scarsdale Diet guy.") Since Einhorn's gambit, the company's stock has done OK: from just under $127 a share in May 2014 to $106 on Wednesday. (The stock shot up to $130 when Elliott's filing was revealed Thursday.)

TEXAS TELEMEDICINE APPLAUSE: With the Texas telemedicine tussle on track to be resolved any day now - the bill updating the state's telemedicine laws is on the governor's desk - we've gotten some praise from the Texas Association of Business, whose CEO gave shoutouts to the legislators involved in crafting the bill, and concluded, "Understanding the potential for telemedicine to help Texas businesses address the state's low physician supply and rising health care costs, we felt it was important to be active participant in this debate."

WHAT WE'RE CLICKING ON:

A profile of the Chan-Zuckerberg Initiative in Cell.

The challenges of managing remote patient monitoring data in the EHR, from AHIMA.

An analysis of a UDI-in-claims case study, in Pew Charitable Trusts.

Will interoperability get worse before it gets better?

To view online:
http://www.politico.com/tipsheets/morning-ehealth/2017/05/19/congress-the-chronic-and-user-fees-220409

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