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Dan Diamond | 04/28/2016 10:10 AM EDT Andy Slavitt sits down for an exclusive interview with PULSE's new podcast, and Tom Coburn thinks the FDA has grown so unnecessarily strict, it wouldn't even approve aspirin today. But first: What's in CMS's monumental physician payment rule. WHAT'S IN MACRA - CMS on Wednesday proposed its highly anticipated changes to Medicare physician payment, the biggest reforms to doctor reimbursement in years. The agency's focus? Introducing more flexibility for physicians, who say they're over-regulated and over-measured, while further nudging them towards models designed to reimburse them for high-value care. PULSE pulled out five major takeaways from the 962-page announcement. 1) ACOs in "Track 1" of the Medicare Shared Savings Program won't qualify as an Advanced Alternative Payment Model. More for Pros. 2) CMS outlined three standards that will be used to determine whether providers are assuming more than "nominal" financial risk, a crucial metric for determining eligibility as an Advanced Alternative Payment Model. More for Pros. 3) To qualify as an Advanced Alternative Payment Model, clinicians will have to comply with a number of health IT requirements: 50 percent of clinicians must used certified EHRs by 2017, and 75 percent by 2018. 4) Meanwhile, CMS will sunset its meaningful use program - as expected - and replace it with the new Advancing Care Information program, which is intended to offer more flexibility. For instance, the ACI program would not require all-or-nothing electronic health record measurement. 5) MIPS-eligible clinicians will still be on aggressive upgrade timelines for their health IT. By 2018, clinicians will have to use 2015-edition certified products only, and will have to perform requirements which "correlate" with meaningful use stage 3. See the rule: http://go.politicoemail.com/?qs=429bc1d9ff63d7e9970923c30b16baaa1d7c37d8730e679ac093948353611321 See the release: http://go.politicoemail.com/?qs=429bc1d9ff63d7e93e87f6c4584f10d4f9f38cb9db0e6291851f2e03d8fc51d3 Watch HHS's new explainer video on payment reform: http://go.politicoemail.com/?qs=429bc1d9ff63d7e9dc611d03d349c69450c1edccb07a35b95f349f7db23a7aca What they're saying - Bullish: The American Medical Association. "Our initial review suggests that CMS has been listening to physicians' concerns," said AMA president Steven Stack. "In particular, it appears that CMS has made significant improvements by recasting the EHR Meaningful Use program and by reducing quality reporting burdens." - Bearish: The American Hospital Association. "We are deeply disappointed by CMS's narrow definition of alternative payment models, which could have a chilling effect on providers' ability to experiment with new patient-centered, value-driven payment models," said AHA's Tom Nickels. "Today's rule fails to recognize the significant resources and risk assumed by the highly motivated, early adopters of alternative payment models." EXCLUSIVE: ANDY SLAVITT ON MACRA AND MORE - The CMS acting administrator sat down with PULSE for the debut of our brand-new podcast, "Pulse Check." Slavitt shared thoughts on the new physician payment rule, the future of Obamacare pilots, why drug prices could be the top priority for his successor and much more. Read the story: http://go.politicoemail.com/?qs=429bc1d9ff63d7e94beea466e717102becb7088536d32299cbba97c9e6b66fa1 Listen to the podcast: http://go.politicoemail.com/?qs=429bc1d9ff63d7e97917e51676e005b5c1e7ddf750a3ef6baa20c5c98320a8d4 Subcribe on iTunes: http://go.politicoemail.com/?qs=429bc1d9ff63d7e9e1cfa4a3f52944e84df11b8c128d7949da0dbd790590f27a Three fun Slavitt tidbits we learned from the podcast . He estimates he gets 27 comment letters per week - from Capitol Hill alone . He thinks "health care" is two words, not one . His willingness to be direct and honest on Twitter freaks out his colleagues THIS IS THURSDAY PULSE - Where we're bidding good morning to a certain CMS administrator, who confessed he uses PULSE to determine whether it's a good day to get out of bed. (We'd propose he rise and shine, and if that turns out to be a punitive recommendation, he can always let us know in the comment period.) Tips to [email protected] or @ddiamond on Twitter. With help from Sarah Karlin-Smith (@SarahKarlin) THE BIPARTISAN PUSH TO KILL THE PART B DEMO - Republican lawmakers are planning to ask HHS as soon as this week to kill a Medicare demonstration project, which would reduce reimbursements for high-cost drugs given in doctors' offices and hospital outpatient centers in some parts of the country - and Democrats are joining them now too. The demonstration project is "awful," Sen. Richard Burr told Pro's Jennifer Haberkorn and Sarah Karlin-Smith. "We've spent a decade driving things out of the hospital and now all of a sudden, they're reverting back to putting it all back into the hospital," he said, citing doctors' concerns they will be driven out of business. The story for Pros: http://go.politicoemail.com/?qs=429bc1d9ff63d7e9f4a6a8a17e3db53ff5d959782f48ace296cde5e2efa1aa6f - Why Democrats want significant changes. All 12 Democrats on the Senate Finance Committee signed on to a letter expressing their concerns with the program, including how it will interact with other payment reform efforts and Medicare demonstration projects. "We have heard numerous concerns from patients, providers and other stakeholders about the model's potential to have unintended consequences on Medicare beneficiaries' access to care and physician-administered drugs," the Democrats warn. They also caution that while CMMI "should initially implement focused demonstrations," the Part B demonstration proposes "significant and complex" changes that could affect up to 75 percent of providers. MEET HILLARY CLINTON'S TOP THREE HEALTH CARE ADVISORS - The trio of Chris Jennings, Neera Tanden and Ann O'Leary are the inner circle hoping to shape the policies guiding the Democratic front-runner into the White House, Pro's Nancy Cook reports. Clinton's known for cultivating small, loyal circles of advisers, and her top health care experts fit the bill; Jennings has guided Clinton since her 1990s health reform effort, and Clinton's relationships with Tanden and O'Leary also date back to her husband's administration. Collectively, their strategy centers on stressing Clinton's "bold and practical" stance on health care - the only politician left in the race who's vowed to preserve the Affordable Care Act and improve upon it rather than start anew. More for Pros: http://go.politicoemail.com/?qs=429bc1d9ff63d7e950b24ab54aab71d1ef73f35872bec7fe35c6b1b2a07e30a4 PAUL RYAN WANTS TO END OBAMACARE'S PROTECTION FOR PRE-EXISTING CONDITIONS - The House speaker on Wednesday called for an end to the Affordable Care Act's ban on underwriting for pre-existing conditions, arguing that there's a less expensive alternative to cover America's sickest patients. "Let's fund risk pools at the state level to subsidize their coverage, so that they can get affordable coverage," Ryan said in a speech to students at Georgetown University. "You dramatically lower the price for everybody else. You make health insurance so much more affordable, so much more competitive and open up competition." More from Reuters: http://go.politicoemail.com/?qs=429bc1d9ff63d7e949c037ea7434a300c718ac8c89a3a8633bbb6e83c09ac377 49 percent. That's the percentage of Americans who say they or a family member have a pre-existing medical condition like cancer, diabetes or heart disease, Kaiser Family Foundation CEO Drew Altman points out. SENATE TO VALEANT: APOLOGY NOT ACCEPTED - Valeant's executive suite on Wednesday came prepared to publicly apologize for their price-hiking tactics at the Senate Aging Committee's drug price hearing. But committee leadership was on the attack before the company's executives could even testify, Pro's Sarah Karlin-Smith reports. "As for turning over a new leaf, I remain skeptical," said ranking member Claire McCaskill. Valeant hiked the price of sixteen of its drugs the last six months, McCaskill added later in the hearing. "How can you sit here and say you are sorry?" - Why the Senate was so unhappy. Lawmakers also didn't accept Valeant's claims that its pricing tactics were just a small part of the company's business plan or that it had made efforts to provide patients and hospitals with discounts on its drugs. "We have yet to find any hospitals that have received those discounts," chairwoman Susan Collins said. "Your patient assistance program does not have a good track record and has been very difficult to navigate," she added. - What's next for Valeant: A major shake-up. The company's planning to drop five long-standing board members and add four new ones in an effort to change its ways, the Wall Street Journal reports. The new board members are drawn from the pharma industry - an unusual move for Valeant, given that it publicly derided pharma firms while trying to position itself as an upstart. ** A message from PhRMA: Biopharmaceutical intellectual property (IP) protections, such as patents, provide the incentives that spur research and development and lead to lifesaving treatments and cures. Learn more here about the outcome of strong IP policies. ** THE SELLING OF OBAMA - AND OBAMACARE. Writing in POLITICO Magazine, Mike Grunwald details the "never-ending internal battle over the Obamacare message" that plagued White House media strategy in the early days of the administration. And because top officials never settled on a single message, the media strategy on the Affordable Care Act constantly fluctuated as a result. "One month we'd emphasize coverage, the next month cost, the next month taking on the insurers," former spokesman Reid Cherlin said. "The more polling you do and the more of a beating you take, the more you try different things. And you lose the narrative." Read the story: http://go.politicoemail.com/?qs=429bc1d9ff63d7e941b053e7c20401056c3bd450f86b00c25bcd8e1886c164e7 - Media struggles extended beyond 1600 Pennsylvania Avenue. On Twitter, Grunwald adds that HHS was "furious" at the White House and wanted a major advertising push to defend reform. But White House aides "didn't trust HHS [and] thought the less said the better politically." GROWING NUMBER OF DEM VOTERS WANT CONGRESS TO BUILD ON ACA - That's according to this morning's Kaiser Family Foundation tracking poll, which found that 51 percent of Democratic voters now want Congress to expand the law's scope rather than just leave it as is. That's the highest level of support for ACA expansion in at least a year and a significant increase from 36 percent of respondents in December 2015. Why the surge? The foundation's analysts muse that the rhetoric around universal coverage in the Democratic presidential campaign may be the chief culprit. See the poll: http://go.politicoemail.com/?qs=429bc1d9ff63d7e961080455f03e54a53e63c41918895b4a0726413f9039c578 U.S. MILITARY WILL FINALLY EXPLAIN WHY IT BOMBED A DOCTORS WITHOUT BORDERS HOSPITAL - That's according to NBC News, which reportsthat the military on Friday will release its investigation into the October bombing of a Doctors Without Borders trauma center in Afghanistan that killed at least 42 people. According to NBC's report: . The military will offer a detailed timeline and release a heavily redacted version of the investigation . Several service members faced administrative punishment, but not criminal charges SOME STATES PAY MORE THAN DOUBLE WHAT OTHERS DO FOR HEALTH CARE - That's according to a new analysis from the Health Care Cost Institute, the latest report to quantify the massive cost variation in the U.S. health care system. The authors acknowledge that the existence of regional cost variation is widely known, but say they're still puzzled by the forces behind them. And they call on regulators and researchers to keep exploring a key question: "Why do prices for the same service differ markedly across distances of only a few miles, and what amount of that difference is justifiable?" See the report: http://go.politicoemail.com/?qs=429bc1d9ff63d7e92adf6ea61dab497096c4c85e31b807dcb3a13933abc5cb5b States with the highest health care prices, relatively . Alaska (164 percent higher than the national average) . Wisconsin (91 percent higher) . North Dakota (68 percent higher) States with the lowest health care prices, relatively . Florida (21 percent lower) . Arizona (18 percent) . Maryland (12 percent) MANHATTAN INSTITUTE OFFERS PRESCRIPTION ON CANCER DRUG REFORMS - The free-market think tank is out with a new report on using precision medicine to improve outcomes and value, ahead of its 10 a.m. briefing on Capitol Hill today. The report's chief argument: That a series of regulatory reforms and emerging technologies would allow FDA to more quickly bring drugs to market, better reward innovative drug makers and lower costs for patients and providers. For instance, the institute concludes that the growing focus on cancer genomics won't only lead to new breakthroughs in targeted medicine, but improve oncology pricing too. "The rise of precision-medicine databases and analytical tools that can tell doctors and patients how best to match a specific drug with a specific patient's disease may well help solve the problem of drug-price sticker shock," the report reads. See the report: http://go.politicoemail.com/?qs=429bc1d9ff63d7e944bf1ebf3bab3374aea53126221031da1613d4040ea13d2c - Coburn no fan of FDA. At a small dinner on Wednesday, retired Sen. Tom Coburn - a Manhattan Institute adviser - said that the agency is missing opportunities to approve innovative drugs because it's grown too focused on relatively inconsequential risks. "Aspirin would not be approved today by the FDA," Coburn said. CANCER RESEARCH FIRM CEO'S SALARY: $329.7 MILLION - Patrick Soon-Shiong was the highest-paid U.S. executive of 2015, according to the Bloomberg Pay Index this morning. The CEO of NantKwest made most of his money from stock options granted before the company's initial public offering. NEW YORK CHANGES TUNE ON HEP C DRUGS FOR MEDICAID PATIENTS - The state is backing off guidelines that deny Medicaid patients access to Sovaldi and Harvoni until they became very ill, POLITICO's Dan Goldberg and Kassie Parisi report. http://go.politicoemail.com/?qs=429bc1d9ff63d7e935456104fe379109909ecdfffa6fafeb0bce92c2d7c0d2ad HAPPY (BELATED) BIRTHDAY ... to Aubree Eliza Weaver, the terrific POLITICO Web producer who'll be the first person to see this, given how early she gets up to help get PULSE out the door. WHAT WE'RE READING by Paul Demko Addiction treatment centers are plagued by staffing shortages, a problem being exacerbated by the opioid crisis, reports the Wall Street Journal. http://go.politicoemail.com/?qs=429bc1d9ff63d7e9be65b01c22a82122682960ee7141821074e9ed05217ac1b0 Tennessee Gov. Bill Haslam signed legislation allowing mental health counselors to refuse treatment to a patient based on the therapist's personal beliefs. The American Counseling Association calls it a "hate bill," the Tennessean points out. http://go.politicoemail.com/?qs=429bc1d9ff63d7e9df13d6e33ffea034507f6f17a36538b4a5ba60b23bbfbd91 A comprehensive opioid treatment model developed in Maryland is spreading to other states, reports Stateline. http://go.politicoemail.com/?qs=429bc1d9ff63d7e9b5618aca68a3eaf0032c5ca1ea597e0fe129c7b45a193ee7 Mounting evidence suggests outcomes from telemedicine appointments are at least as good as results from in-person doctor visits, explains Austin Frakt at Academy Health. http://go.politicoemail.com/?qs=429bc1d9ff63d7e9a5a6354d87a94be517ad979230165a031cbef6a729a61f2f A trio of prominent health systems are trying to reduce the number of complex surgical procedures performed by inexperienced doctors, Kaiser Health News reports. http://go.politicoemail.com/?qs=429bc1d9ff63d7e980e8c4f598738b4e421ef3137541678e1f1c0d97f40ef20f ** A message from PhRMA: Take a moment to consider the impact that strong and robust IP policies have on our daily lives and on the country. Due to the complexity of developing a medicine, strong IP protections are necessary to ensure that innovative biopharmaceutical companies are able to secure resources for future investments in research, giving hope to patients who await tomorrow's medicines. Learn more here about the outcome of strong IP policies. ** To view online: http://go.politicoemail.com/?qs=429bc1d9ff63d7e99aba2df22afd4cb6df35c957f0c9a3feb8d961c60527e796 To change your alert settings, please go to http://go.politicoemail.com/?qs=429bc1d9ff63d7e957fc884e5f0b214bb7432006ac6e08067082b2ed718956ef or http://click.politicoemail.com/profile_center.aspx?qs=57cf03c73f21c5ef65b9c058ca0f6cfa66691761e73177ec71081a6811b13f7f5ec717e6e2e538f496f2fade9b4485db69121fe8a9b78c6aThis email was sent to [email protected] by: POLITICO, LLC 1000 Wilson Blvd. Arlington, VA, 22209, USA To unsubscribe,http://www.politico.com/_unsubscribe?e=00000154-5d35-dbae-a95f-5ffd07d70000&u=0000014e-f112-dd93-ad7f-f917a8270002&s=fbb607ed1cfa1ee1b2479b57376ae001e0ab6f9f8afc95f64feb70ec181a1f2a75c60ff393835f93990bfd8fcce77d087f95db28cbe4cb9d64188fdb8c8954c0