House E&C Leaders Ask for DOJ Involvement in Risk Corridor Lawsuits
House Energy and Commerce Committee leaders are asking the Justice Department to get involved with risk corridor questions. They are unhappy with CMS Acting Administrator Andy Slavitt and HHS Secretary Sylvia Mathews Burwell for not answering their questions about the White House’s effort to settle risk corridor-related lawsuits. In a recent letter, the leaders petition Attorney General Loretta Lynch for answers by Nov. 7.
To read the letter, click here.
Senate Finance Committee Leaders Release Chronic Care Draft Bill
Senate Finance Committee leaders pitched a series of Medicare reforms in a draft bill on Oct. 27, in a bid to improve care for beneficiaries suffering from chronic conditions. Among the Chronic Care Act’s provisions is new permission for certain kidney disease patients to enroll in Medicare Advantage plans starting in 2021. It would also widen the supplemental benefits that Medicare Advantage plans can offer the chronically ill.
The draft bill also looks to expand Medicare payment of telehealth services across Medicare Advantage, accountable care organizations and for stroke care. The proposal does not include any financial offsets for its policies.
For a summary of the bill’s provisions, click here.
For the lawmakers’ letter to the Obama administration, click here.
CMS Releases Final Rule Setting Pay Rates for Kidney Disease
CMS finalized a slight increase in 2017 Medicare payments for dialysis facilities treating end-stage renal disease patients. The agency’s final rule published on Oct. 28 estimates that facilities will see a 0.73 percent average increase in payments next year. Hospital-based dialysis facilities should see the biggest increase, at 0.9 percent. Medicare expects to pay about $9 billion total to 6,000 facilities treating the debilitating kidney disease in 2017.
The new regulations also alter how Medicare pays for home and self-dialysis training, changing the nurse training time used to calculate the payment rate to 2.66 hours, from one-and-a-half hours. The change raises the training add-on payment adjustment to $95.60, from $50.16.
The final rule takes effect Jan. 1.
CMS Announces Updates to Dialysis Facility Compare: Patient Experience Ratings Now Available
On Oct. 28, CMS announced changes to the Dialysis Facility Compare (DFC) website on Medicare.gov, which provides information about thousands of Medicare-certified dialysis facilities across the country, including how well those centers deliver care to patients.
The changes are in response to the feedback CMS received from dialysis patients and their caregivers about what is most important to them in selecting their dialysis facility. Since the initial release of the Dialysis Facility Compare website, patients have emphasized in their feedback to CMS that understanding how others like them view a dialysis center—in particular the cleanliness of the facility and how well the staff cares for them—is valuable information when choosing a facility. As a result, visitors to the updated Dialysis Facility Compare website will now be able to see how patients rate their experiences with dialysis facilities.
CMS collects patient experience data though the In-Center Hemodialysis Consumer Assessment of Healthcare Providers and Systems (ICH-CAHPS) Survey, which measures patients’ perspectives on the care they received at dialysis facilities. A total of six ratings on patients’ experiences with care will be reported, including three that cover specific aspects of patient experience and three overall patient ratings of the kidney doctors, the facility staff and the dialysis facilities. For each dialysis center on Dialysis Facility Compare, the site will include this patient experience information, the quality star rating and detailed clinical quality information.
CMS is also adding two quality measures to Dialysis Facility Compare:
- The standardized infection ratio (SIR) is a ratio of the number of bloodstream infections that are observed at a facility versus the number of bloodstream infections that are predicted for that facility, based on national baseline data.
- The pediatric peritoneal dialysis Kt/V measure equals the percent of eligible pediatric peritoneal dialysis patients at the facility who had enough waste removed from their blood during dialysis.
Other major changes to the site include modifications to the methodology for calculating dialysis facility star ratings based on recommendations from a 2015 Technical Expert Panel. The updated methodology for calculating star ratings:
- Establishes a baseline to show improvement by taking into account year-to-year changes in facility performance on the quality measures compared to performance standards set in a baseline year. Star ratings will reflect if a facility improves (or declines) in performance over time.
- Limits the impact of a few very low scores by applying a statistical method called truncated z-scores to percentage measures. This ensures that star ratings are not determined by extreme outlier performance on a single measure.
- Ensures accuracy of ratings by keeping the continuity of the measures.
A final change to the DFC website relates to ratio measures:
- The Standardized Mortality Ratio, Standardized Hospitalization Ratio, Standardized Transfusion Ratio and Standardized Readmission Ratio will now be reflected as rates to display them more clearly.
For more information, click here.
White House Releases New Actions on Mental Health Parity Enforcement
On Oct. 27, the White House announced new actions to limit insurance coverage discrimination of mental health and substance abuse treatment amid the nation’s opioid abuse epidemic.
The White House’s Mental Health and Substance Use Disorder Parity Task Force, assembled last spring, awarded $9.3 million to help states enforce federal parity protections requiring equal coverage for mental health and behavioral health. So far, enforcement has been lagging in most states.
The Labor Department will also be releasing annual data on closed federal parity investigations and listing any plans that have violated the law. The Task Force also said that CMS will evaluate compliance with the parity law in its review of plans subject to the ACA’s essential benefit requirements, and it expects states to do so as well. The report recommends Congress provide the Labor Department with the authority to assess civil monetary penalties for parity violations.
HHS and the Labor Department are also unveiling a new website to assist consumers with parity complaints, appeals and other actions.
CMS Announces 15 Target Markets for 2017 Open Enrollment
On Oct. 27, CMS announced 15 target markets for this year’s open enrollment that starts Nov. 1. The 15 major urban markets are Miami, Dallas, Atlanta, Houston, Tampa, Orlando, Northern New Jersey, Chicago, Philadelphia, Charlotte, Detroit, Salt Lake City, Phoenix, St. Louis and San Antonio.
There are 3 million individuals eligible for Obamacare coverage in the 15 markets that are not currently insured, according to CMS. The Miami market currently has the highest number of exchange enrollees, with nearly 650,000.
The Obama administration will partner with local organizations to increase enrollment efforts. In Philadelphia, for example, the administration will work with Philadelphia Gas Works to send out information about enrollment opportunities to the utility’s 500,000 customers.
The 15 targeted markets will also receive visits from administration officials and additional paid advertising.
Liberal Groups Want Cures Legislation Delayed
The Center for American Progress (CAP) is leading a new effort to delay the medical innovation bill. Among CAP’s co-signers: AFL-CIO, Consumers Union, Doctors for America, Public Citizen, SEIU and more.
“We write to urge you not to move forward with the 21st Century Cures Act during the lame duck session,” the groups write, asking lawmakers to instead wait until the next administration—and until new drug price controls can be added.
The groups say that the Cures legislation makes unnecessary and potentially risky changes to how FDA evaluates new drugs. For instance, the legislation would speed agency approval for some drugs—but “the FDA’s current extensive use of such pathways is already raising serious safety concerns,” they write.
Click here to read the letter.
On the other end of the spectrum, Research America is pushing Congress to pass the Cures legislation in the lame-duck session. The nonpartisan public health group urged action in a letter on Oct. 28 to House and Senate leaders.
CMS to Reopen Sign-Ups for Two Advanced APMs
On Oct. 25, CMS announced that it is giving health plans and providers another chance to participate in two advanced alternative payment models (APMs), saying it will reopen the application process for two advanced APMs. New enrollees will be able to join the models for the 2018 performance year.
The agency plans to allow new sign-ups for the Comprehensive Primary Care Plus Model and the Next Generation Accountable Care Organization Model, which are among the seven advanced APMs that can earn participating clinicians a 2017 incentive payment under MACRA’s Quality Payment Program.
CMS is also making the Oncology Care Model with two-sided risk available in 2017, which will qualify the program as an advanced APM starting in the 2017 performance year.
About 70,000 to 120,000 clinicians are expected to participate in advanced APMs and qualify for a 5 percent incentive payment in 2017, the agency said. That number should grow to 125,000 clinicians by 2018.
Conway Wants to Update Medicare Advantage Star Rating Measures
CMS Deputy Administrator and Chief Medical Officer Patrick Conway recently said the Medicare Advantage star rating system needs new quality measures now that more than 70 percent of plans have achieved a rating of at least four out of five stars.
As with other performance measures, CMS wants star ratings to differentiate among performance to help consumers pick the best plans, and Conway said the agency seeks “iterative improvements” in plan performance. Medicare pays rebates to plans with four or more stars, which are passed to beneficiaries as increased benefits or reduced cost sharing, and Medicare must restrict the percentage of plans that receive those rebates.
CMS has taken two approaches when it has had to adjust performance measure systems in the past: cut pay rates to make up for the extra bonuses, which is what happened to nursing homes, or add pay measures that are needed while removing those that are no longer needed.
Conway said he wants to change the performance metrics. He has heard about interest in adding outcome measures, adding measures that are meaningful to plans and aligning Medicare Advantage measures with other performance-rating systems throughout Medicare.
Obamacare Premiums to Jump 25 Percent Next Year
On Oct. 24, HHS released a report showing premiums for a crucial category of Obamacare plans on Healthcare.gov will increase by an average of 25 percent next year—more than three times larger than this year’s price increases. By comparison, average prices for the second cheapest silver-level plan—which is used as the benchmark to determine premium subsidy levels—had increased by just 7.5 percent on average in 2016 and 2 percent in 2015.
Federal health officials also confirmed that roughly one in five people in the states that use Healthcare.gov must shop from only one insurer following decisions by several major national and regional insurers to pull back from the Obamacare marketplaces in 2017. On average, exchange customers will have 30 plan options to choose from for 2017, down from 47 this year.
Premiums vary greatly across the country. Some states will see average monthly prices for benchmark silver plans increase at least 50 percent for 27-year-olds. Those states include Alabama, Arizona, Nebraska, Oklahoma, Pennsylvania and Tennessee. The price increase for Arizona’s benchmark plan, at 116 percent, is the highest of any state.
However, HHS is stressing that nearly three-quarters of federal marketplace consumers will have the option of paying a monthly premium of less than $75 with federal financial assistance next year. The number of people who are eligible for federal tax credits will increase this year along with premiums. The department estimates 78 percent of people who are marketplace-eligible would qualify for financial assistance.
HHS has referred to 2017 as a “transition year” for the marketplace, attributing premium increases to insurers who underpriced their policies during the early years of the marketplace making up for that now that they have more data, and to the end of the temporary reinsurance and risk corridor programs that the law included to help insurers adjust to the new marketplace.
HHS says 15 new insurers will enter the exchanges in 2017, while 83 insurers are dropping off the marketplaces. About 80 percent of customers will have at least two companies to choose from; just more than half will have at least three. The Obama administration expects 13.8 million people nationwide to pick a plan during the upcoming open enrollment season, about 1 million more than signed up this year.
On Oct. 21, CMS extended for the foreseeable future a safe harbor for student health plans that lets university employers continue to offer students reimbursement to offset the cost of their health coverage.
The administration determined via rulemaking in 2013 that certain health reimbursement arrangements that help workers purchase individual coverage were not acceptable under the ACA, and said employers would be penalized for such arrangements. In February, however, the administration offered a safe harbor for any student plan beginning prior to Jan. 1, 2017. The FAQ out Oct. 21 extends that safe harbor until further guidance is issued.
Many colleges and universities have “premium reduction arrangements” for graduate student health coverage that are sometimes intertwined with a large, complex admissions process, the FAQ says. Additionally, Congress in the ACA expressed its intent to preserve the student health plans.
Therefore, the FAQ concludes that CMS considers it “appropriate to further extend the enforcement relief provided in the February 5, 2016 guidance and will not assert that a premium reduction arrangement offered by an institution of higher education fails to satisfy PHS Act section 2711 or 2713 if the arrangement is offered in connection with student health coverage (insured or self-insured).”
Employers are still banned from similar arrangements, and repealing that prohibition is a key lobbying priority for the U.S. Chamber of Commerce and other small business groups.
CMS, FDA Permanently Extend Medical Device Review Program
CMS and FDA are indefinitely extending a program that aims to reduce the time between FDA marketing approval and Medicare coverage decisions, to ensure prompt and efficient patient access to medical devices.
The Parallel Review program allows FDA and CMS to review the clinical evidence on a medical device at the same time rather than sequentially. The agencies said the program also helps companies design and conduct better clinical trials that answer both CMS and FDA questions—thus making it more likely that manufacturers need to conduct only a single study.
Companies apply to join the program, with priority given to devices expected to have the most impact on the Medicare population. However, CMS will accept no more than five devices per year because of its existing resources.
FDA Announces Second Round of Generic Drug User Fee Agreement
On Oct. 21, FDA announced that the next round of the generic drug user fee program will tie industry fees to approved abbreviated new drug applications as opposed to requiring industry to pay fees when an application is submitted regardless of whether it is approved. FDA also announced the fee will be charged in three tiers rather than a per-ANDA basis, in an effort to align fee responsibility with costs and ability to pay.
Previously, FDA sometimes asked ANDA sponsors to submit a Prior Approval Supplement (PAS), which required a fee, and the number of submissions was unpredictable, leading to industry’s and FDA’s agreement to eliminate the PAS fee.
Under the GDUFA II proposal, the three tiers in which the fee would be charged are as follows:
- Small would pay one-tenth the large program fee (1-5 ANDAs).
- Medium would pay four-tenths the large program fee (6-19 ANDAs).
- Large would pay the full program fee (20+ ANDAs).
GDUFA I assumed the agency would receive only 750 ANDAs per year; however over the first four years of the agreement FDA received approximately 1,000 per year. As a result, FDA hired additional staff to address the workload and is expecting to spend $430 million in the final year of GDUFA I.
Under the proposed changes recommended by FDA and industry, the total generic drug user fee collection will be increased to $493.6 million per year, in order to maintain current staffing levels and implement GDUFA II improvements. The user fee will be annually adjusted for inflation.
Government sponsors or manufacturers of drugs that do not commercially distribute them will not be charged a user fee, according to FDA.
3. State Activities
California: Physicians Group Sues Over California “Surprise” Medical Bill Law
The conservative Association of American Physicians and Surgeons (AAPS) has filed a lawsuit against a new California law designed to protect consumers from unexpected out-of-network medical bills. The law, which will go into effect in July, prevents individuals from getting hit with large medical bills when they unknowingly receive care from an out-of-network provider at an in-network facility. Insurers will be required to let individuals pay the same cost-sharing that they would pay for in-network care, and out-of-network providers will be required to accept reimbursement at 125 percent of Medicare rates or at the insurer’s average contracted rate—whichever is greater. AAPS argues that the California law violates both U.S. and state constitutions in numerous ways, including denying physicians just compensation for labor. However, Consumers Union—one of the law’s biggest proponents—says the lawsuit is “groundless.”
District of Columbia: Council Will Take Up Right-to-Die Legislation
The D.C. Council will take up “right-to-die” legislation on Nov. 1. The legislation would let physicians prescribe lethal medication to terminally ill patients. Council members are required to vote twice on the legislation before it is sent to the mayor. If it is approved by both the council and the mayor, D.C. will join five states that have authorized right-to-die laws—California, Montana, Oregon, Vermont and Washington state.
Kentucky: CMS Extends Comment Period on Madicaid Expansion Proposals
In an Oct. 19 letter, CMS agreed to continue accepting comments for Kentucky Gov. Matt Bevin’s waiver proposal, which would change the state’s Medicaid expansion. The federal comment period on the proposed Kentucky HEALTH waiver was supposed to end Oct. 8, but consumer groups protesting Bevin’s requested changes asked for an extension. According to the Kentucky Center for Economic Policy, the comments CMS has received thus far have mostly urged the Obama administration to reject the plan—approximately 90.1 percent of comments were unfavorable toward the plan. The plan seeks to add a work requirement, impose new out-of-pocket costs for enrollees and boot them out of coverage if they do not adhere to certain criteria. CMS has received more than 1,700 comments on the proposal.
Minnesota: Gov. Dayton Proposes 25 Percent Rebate to Blunt Rate Hikes
Minnesota Gov. Mark Dayton is proposing that the state fund a 25 percent rebate to cushion rate hikes for Obamacare customers who do not qualify for federal premium subsidies.
Roughly 123,000 Minnesotans who are expected to purchase individual market coverage next year would qualify for the state assistance, according to a new fact sheet outlining the governor’s proposal. The rebate program would reduce average rate increases in Minnesota from 55 percent to 16 percent.
Dayton has said the state should use a $313 million surplus to pay for the rebates. He wants a plan in place by Nov. 1, when the next open enrollment period begins.
To read the fact sheet, click here.
Nevada: Mental Health America Ranks Nevada Last in Terms of Access to Mental Health Care
Nevada received the worst score in the country for access to mental health care this year in Mental Health America’s annual state rankings report. According to the study, 67.5 percent of Nevada residents in need of mental health treatment have not received care. The report also found that the uninsured rate among the state’s residents in need to health treatment is 28.2 percent. Massachusetts has the lowest rate at 2.7 percent.
New York: New York State Health Foundation Awards Grants to Increase Health Care Access
The New York State Health Foundation awarded $1.2 million in grants to five organizations that will work on projects to increase consumers’ access to health care information. The grantees and their projects are as follows:
- MergerWatch will review the state’s Certificate of Need process.
- IMPAQ will create a consumer tool for estimating out-of-pocket costs under different health plans for expensive but common medical conditions.
- National Partnership for Women and Families will work with New York hospitals to make it easier for patients to access their medical records.
- Cynosure Health will conduct an analysis of New York provider network adequacy.
- Northeast Business Group on Health will use quality data to create a rating system for hospital maternity services in New York City and Long Island.
Ohio: Ohio Hospitals claim bad debt has increased post-ACA
According to a new report from the Ohio Hospital Association, hospitals in Ohio saw a decline in spending on charity care but boosted spending on “bad debt” in the first year after Ohio expanded Medicaid under Obamacare. Hospitals spent $1.03 billion in charity care in 2013 before expansion, and $809 million in 2014 post-expansion. But bad debt expenses climbed from $1.04 billion to $1.23 billion, which the hospital association mostly blames on the growing prevalence of high-deductible plans.
To read the report, click here.
Vermont: Vermont Proposes Caps on Opioid Prescriptions
Vermont Gov. Peter Shumlin and Health Commissioner Harry Chen proposed capping all new opioid prescriptions to no more than a seven-day supply. The proposed changes to the state’s opioid prescribing rule would cap prescriptions for relatively minor pain to between nine and twelve pills but provide some exemptions for treating severe pain due to complicated procedures or major trauma. The new rule would also require the co-prescription of the opioid overdose drug Naloxone with opioid prescriptions above certain strength or when they are combined with benzodiazepines. The governor’s office said in a release that the rule would be finalized in December.
Click here to read the proposed rule.
4. Regulations Open for Comment
IRS, Treasury Release Proposed Rule on QHP Benchmarks
The IRS and Treasury Department, in a proposed rule released July 6, proposed to alter how qualified health plan (QHP) benchmarks are determined so that they account for the costs of pediatric dental benefits. If finalized, the rule would go into effect for the 2019 plan year.
Although pediatric dental care is one of the 10 “essential health benefits” that plans are required to cover under the Affordable Care Act (ACA), several plans do not include such coverage, and consumers instead buy stand-alone dental products. Meanwhile, the marketplace determines the amount of tax credits a family can receive to cover the cost of coverage based on the second-cheapest silver-level plan.
However, as the proposed rule said, “because qualified health plans that do not offer pediatric dental benefits tend to be cheaper than qualified health plans that cover all ten essential health benefits, the second lowest-cost silver plan (and therefore the premium tax credit) for taxpayers purchasing coverage through a Marketplace in which stand-alone dental plans are offered is likely to not account for the cost of obtaining pediatric dental coverage.”
Treasury and IRS added that the existing rules “frustrate” the goal of making all essential health benefits affordable to those receiving premium tax credits, so the administration wants to update its interpretation to ensure all 10 services are addressed.
“Consistent with this interpretation, the proposed regulations provide that for taxable years beginning after December 31, 2018, if an Exchange offers one or more silver-level qualified health plans that do not cover pediatric dental benefits, the applicable benchmark plan is determined by ranking (1) the premiums for the silver-level qualified health plans that include pediatric dental benefits offered by the Exchange and (2) the aggregate of the premiums for the silver-level qualified health plans offered by the Exchange that do not include pediatric dental benefits plus the portion of the premium allocable to pediatric dental benefits for stand-alone dental plans offered by the Exchange,” the proposal said.
The rule aims to create the ranking by adding the premium for the lowest-cost silver plan that does not include a pediatric dental benefit to the premium for the cheapest stand-alone dental plan, and the premium for the second-cheapest silver plan without pediatric dental benefits to that of the second-lowest stand-alone dental plan. The second-cheapest amount from this combined ranking would be the taxpayer’s applicable benchmark plan premium, the rule said.
HHS Proposes Updates to Title X Rules
On Sept. 2, HHS proposed to preclude Title X grant recipients from using criteria in their selection of family planning providers that are unrelated to the ability to deliver services effectively.
Since 2011, 13 states have attempted to restrict participation by family planning providers in Title X based on factors unrelated to their ability to provide services. The Title X program provides funding for certain family planning services, including STD screening and treatment, but funding is not used to pay for abortions. Although Planned Parenthood is not mentioned by name in the proposed rule, it has often been the subject of defunding actions by states and Congress.
In the proposed rule, HHS said the effects already felt by the restrictions in many states justify the department’s rulemaking. HHS said grant recipients that do not provide services directly would also be required to follow the updated standards when choosing subrecipients.
HHS also proposed that a tiered structure governing how funds are distributedwould not be allowed unless it can be proven that a provider in a top tier delivers Title X services more effectively than a lower-tier provider. According to the Guttmacher Institute, a research organization that supports reproductive rights, four states have a priority system for distributing family planning funds, which often disadvantages family planning centers.
Children's Insurance Rate Hits New Historic High
According to a new paper from the Georgetown University Center for Children and Families, the children’s health coverage rate has hit a historic high of 95 percent. Between 2013 and 2015, 41 states saw a statistically significant decline in the rate of uninsured children. Just over half of the 3.5 million children who are still uninsured live in seven states: Arizona, California, Florida, Georgia, Ohio, Pennsylvania and Texas (although it should be noted that as of May, California began enrolling undocumented children into the state’s Medicaid program).
CDC Study Finds Counselling Mandates Hurt Tobacco Cessation Programs
To read the paper, click here.
According to a study published in the CDC journal Preventing Chronic Disease, tobacco users are less likely to try cessation medications if they are also required to seek counseling. The study surveying state Medicaid programs targeting tobacco use found patients tried quitting more often—and were more successful—when they had access to both therapies and medication, but were not required to do one to get the other.
To read the study, click here.
Report Finds 38 Percent of Health Care Dollars Went Through Quality-Linked Models in 2015
According to surveys compiled by an HHS public-private partnership group, an estimated 38 percent of health care dollars flowed through alternative payment models tied to health care quality in 2015.
The Health Care Payment Learning & Action Network’s first-ever APM adoptions study found while most payments are still made on a fee-for-service basis, a segment of health plans and providers are shifting to quality-linked or population-based models. About 15 percent of health care dollars in 2015 were paid through fee-for-service structures measuring quality and value, according to the data collected by the network.
Another 23 percent of dollars flowed through non-fee-for-service APMs, a proportion that could increase based on an early look at 2016 payments included in the report. The Learning & Action Network predicted that about a quarter of health care dollars could be subject to non-fee-for-service APMs this year, including 41 percent of Medicare Advantage dollars.
The Learning & Action Network relied on surveys conducted by AHIP and the Blue Cross Blue Shield Association, as well as its own data collection. Those efforts gathered information from 70 health plans representing 67 percent of the nation’s covered lives across the commercial, Medicare Advantage and Medicaid managed care segments. Two Medicaid fee-for-service states also participated. However, the report did not gather any data about traditional Medicare.
CMS, FDA Study Finds Bundling and Drug Label Changes Lead to Better Outcomes
According to a study conducted by CMS and FDA, end-stage renal disease patients had better health outcomes following CMS’s 2011 move to bundle payments for dialysis patients and FDA’s calls for more conservative dosing of ESAs—drugs often used to treat these patients.
The agencies looked at nearly 70,000 Medicare patients over 66 years old for the study. While the overall risk of major adverse cardiovascular events and death by any cause did not change, there was a significant reduction in the risk of stroke after the policy.
“The reports document a win-win for patient safety, public health, and the financial stability of the federal ESRD program,” Robert Steinbrook of Yale School of Medicine wrote in an accompanying editorial. Steinbrook said FDA and CMS should collaborate more to study the effects of changes in prescribing information and reimbursement practices on health care costs and quality.
CDC Study Finds Patients Often Receive the Wrong Antibiotics
According to a new study from the CDC and Pew Charitable Trusts, only about half of U.S. patients treated with antibiotics receive the appropriate drug. The study findings “indicate that the problem of inappropriate antibiotic prescribing includes not only prescriptions that are unnecessary altogether, but also selection of inappropriate agents,” researchers wrote in JAMA Internal Medicine. Previous CDC and Pew research found that at least 30 percent of outpatient antibiotic prescriptions (or 47 million) each year are unnecessary.