Changes to the Merit-based Incentive Payment System Pertinent to Small and Rural Practices, 2018.

This brief highlights key regulatory changes to the Merit-based Incentive Payment System (MIPS) in 2018. We discuss the importance of these changes, particularly as they affect small and rural practices.

Phytochemical screening and antioxidant parameters data in prostatic rats fed with Laportea aestuans leaves.

Several plants have been used in ancient times as medicines to treat, manage and prevent many diseases in various traditional settings throughout the world. The effect of administration of hydro-ethanolic extract of Laportea aestuans (La) leaves at different doses in Wistar rats induced with benign prostatic hyperplasia (BPH) using antioxidant parameters and phytochemical screening data was obtained. Thirty (30) animals were randomly divided into six (6) groups (A-F) of five (5) animals each. BPH was induced in the animals by daily subcutaneous injection of testosterone propionate (TP) (3 mg/kg) in olive oil and administration of treatments for four (4) weeks were done concurrently. Group A received olive oil alone subcutaneously, group B was induced with BPH alone, groups C-E were induced with BPH but received different doses of La at 100, 200 and 400 mg/kg. Lastly, group F was induced with BPH but treated with finasteride (5 mg/kg) which serves as the positive control group. Phytochemical screening data of saponins, flavonoids (0.5010 ± 0.0009 mg/ml), alkaloids (0.528 mg/ml), phenols (0.6195 ± 0.0015 mg/ml), tannins (0.5410 ± 0.0013 mg/ml) and steroids (1.6230 ± 0.0210 mg/ml) in hydro-ethanolic extract of La. Antioxidant parameters such as superoxide dismutase, catalase and reduced glutathione data were alsoµ gotten at 400 mg/kg La (48.1 ± 4.17U/mg protein), (29.43 ± 1.38U/mg protein) and (30.60 ± 2.05 µg/ml) respectively when compared to the BPH group (35.5 ± 0.97U/mg protein), (11.36 ± 2.39U/mg protein) and (15.60 ± 1.14 µg/ml).

Prostate specific antigen and relative prostate weight data on effect of Tetracarpidium conophorum leaf extract on testosterone-induced benign prostatic hyperplasia.

Benign prostatic hyperplasia (BPH) is a common urological disorder of men, characterized by prostatic enlargement and urethral obstruction. In this study, BPH was induced in experimental groups by daily subcutaneous injections of testosterone propionate (TP) for 3 weeks. Tetracarpidium conophorum was administered daily by oral gavage at a dose of 100, 200 and 400 mg/kg BW of extract for three weeks, along with the TP injections and 5 mg/kg of finasteride for comparison. On day 21, the animals were sacrificed after anesthesia. Prostate were excised, weighed and used to determine relative prostate weight. Quantitative and qualitative phytochemical screening was also done and it showed the presence of flavonoids (0.370 mg/ml), tannins (0.458 mg/ml), phenols (0.508 mg/ml) and steroids (0.257 mg/ml). The prostate specific antigen level was evaluated, the result showed the data for extract group 200 mg/kg, 400 mg/kg, finasteride control group and BPH control group to be 0.186 ± 0.0023 ng/ml, 0.153 ± 0.005 ng/ml, 0.119 ± 0.0125 ng/ml and 0.332 ± 0.004 ng/ml respectively.

Update: Independently Owned Pharmacy Closures in Rural America, 2003-2018.

This Policy Brief continues the series of reports from the RUPRI Center updating the number of pharmacy closures in rural America with annual data. See our website for other analyses of trends and assessment of issues confronting rural pharmacies. Key Findings: (1) Over the last 16 years, 1,231 independently owned rural pharmacies (16.1 percent) in the United States have closed. The most drastic decline occurred between 2007 and 2009. This decline has continued through 2018, although at a slower rate. (2) 630 rural communities that had at least one retail (independent, chain, or franchise) pharmacy in March 2003 had no retail pharmacy in March 2018.

Issues Confronting Rural Pharmacies after a Decade of Medicare Part D.

Purpose. The RUPRI Center for Rural Health Policy Analysis has been monitoring the status of rural independent pharmacies since the implementation of Medicare Part D in 2005. After a decade of Part D, we reassess in this brief the issues that concern rural pharmacies and may ultimately challenge their provision of services. This reassessment is based on survey responses from rural pharmacists. Key Findings: (1) Rural pharmacists indicated that two challenges--direct and indirect remuneration (DIR) fees, and delayed maximum allowable cost (MAC) adjustment--ranked highest on scales of both magnitude and immediacy. Nearly eighty (79.8) percent of respondents reported DIR fees as a very large magnitude challenge, with 83.3 percent reporting this as a very immediate challenge. Seventy-eight percent of respondents reported MACs not being updated quickly enough to reflect changes in wholesale drug costs as a very large magnitude challenge, with 79.7 percent indicating it as a very immediate challenge. (2) Medicare Part D continues to be a concern for rural pharmacies--58.8 percent of pharmacists said being an out-of-network pharmacy for Part D plans was a very large magnitude challenge (an additional 29.0 percent said large magnitude) and 60.5 percent said it was a very immediate challenge (an additional 28.1 percent said moderately immediate). (3) Pharmacy staffing, competition from pharmacy chains, and contracts for services for Medicaid patients were less likely to be reported as significant or immediate challenges.

Characteristics of Rural Accountable Care Organizations (ACOs) ­ A Survey of Medicare ACOs with Rural Presence.

Accountable Care Organizations (ACOs) are groups of health care providers, principally physicians and hospitals, who develop a new entity that contracts to provide coordinated care to assigned patients with the goal of improving quality of care while controlling costs. Section 3022 of the Patient Protection and Affordable Care Act of 2010 created the Medicare Shared Savings Program (SSP). The Centers for Medicare & Medicaid Services (CMS) implements this program and has approved SSP contracts in five cycles since 2011, including some that participated in a special demonstration project that provided advance payment (as a forgivable loan). A new ACO Investment Model (AIM) program starts in 2015 that provides initial investment capital and variable monthly payments to ACO participants in rural and underserved areas who may not have access to the capital needed for successful ACO formation and operation. CMS also contracted with 32 organizations under a special demonstration project, "Pioneer ACOs" (as of November 16, 2014, there were 19 remaining).8 At the time of the research reported in this brief, there were 455 Medicare ACOs (Pioneer and SSP). While there is growing literature about ACOs, much remains to be learned about ACO development in rural areas. A previous RUPRI Center policy brief 2 examined the formation of four rural ACOs. The authors found that prior experience with risk sharing and provider integration facilitated ACO formation. This brief expands on the earlier brief by describing the findings of a survey of 27 rural ACOs, focusing on characteristics important to their formation and operation. Prospective rural ACO participants can draw from the experiences of predecessors, and the survey findings can inform policy discussions about ACO formation and operation. Key Findings from 27 Respondents. (1) Sixteen rural ACOs were formed by pre-existing integrated delivery networks. (2) Physician groups played a more prominent role than other participant types (including solo-practice physicians) in the formation and management of these rural ACOs. (3) Thirteen rural ACOs included hospitals with quality-based payment experience, and 11 rural ACOs included hospitals with risk-sharing experience. Twelve rural ACOs included physician groups with both quality-based payment and risk-sharing experience. (4) Managing care across the continuum and meeting quality standards were most frequently considered by respondents to be "very important" to the success of rural ACOs.