August 12, 2019

Hot and Heavy Discussions Around Surprise Billing During Congress’ August Recess
Even though the House Energy and Commerce Committee passed surprise billing legislation in July, with the promise of floor action in late September, two other House Committees are busy working on their own versions of the bill. Ways and Means Committee staff are now taking informal testimony from interest groups signaling that they are looking to vote on their own bill next month. While the Education and Labor Committee has indicated that it will look into the portions of the bill that impact ERISA laws under their jurisdiction. Click here for the Energy and Commerce bill, H.R. 3630, and here for the Rep. Lloyd Doggett’s (D-TX) bill H.R. 861. Doggett chairs the Health Subcommittee at Ways and Means and his bill is said to be more provider friendly. Meanwhile, 61 organizations sent a letter to the Senate HELP Committee supporting its surprise billing legislation passed last month. These organizations, including AFL-CIO, Laborers’ International Union of North America, the ERISA Industry Committee and the Colorado Business Group on Health, support the HELP committee’s approach of using a benchmark payment based on local, in-network rates to curb surprise billing. They argue that most of this surprise billing occurs from a few outliers, and this method is a market-based approach that disallows the bad players from engaging in surprise billing. They also address arbitration, which is the preferred method of providers and many members of Congress, claiming that it would put the decisions in the hands of government arbitrators, making the process more expensive and less efficient. Click here for the letter.
Trump Administration May Release Its New Health Care Reform Plan Next Month
The Trump administration is considering releasing its own health care plan in response to the release of 2020 Democratic presidential candidates’ plans and worry of the lawsuit working its way through the courts that could repeal the Affordable Care Act. Provisions being discussed for the plan include protections for people with pre-existing conditions, insurance sales across state lines and increased use of HSAs. The timing of the release may change. Click here for a Wall Street Journal article detailing the potential rollout.
  • A government-run health insurance program that pays hospitals at Medicare rates could result in more than 1,000 hospitals closing their doors, according to a new study. Funded by the Partnership for America’s Healthcare Future, a coalition of hospital, doctors and insurance groups that oppose expanding the government’s role as a health payer, the study also looked at the effects on creating a public option on hospitals. Click here for the study.
CMS Approves National Coverage of CAR-T
CMS announced its decision for Medicare to cover Chimeric Antigen Receptor (CAR) T-cell Therapy for cancers. The treatment is individualized to each patient, and costs either $375,000 or $475,000, depending on whether it is used for advanced lymphoma or pediatric leukemia. It is designed as a one time cure for certain cancers once the patients have begun to run out of options. With the decision, CMS decided to not include provisions that required hospitals to develop and collect data on the treatments after the hospital complained that such a process would be overly burdensome. Click here for the decision.  Click here for the news report.
Little-Noticed Drug Pricing Proposal Worries Oncology Community
A seemingly less important provision in a bill that contains many high-profile measures to cut down on drug costs has begun to worry oncology providers. The provision would require drug-makers to subtract the amount of patient assistance they provide from the calculations of average sales price reported to the government. This sales price is used to reimburse providers through Medicare Part B for outpatient programs, affecting primarily patients with serious conditions such as rheumatoid arthritis or cancer. With this provision, many are worried that pharmaceutical companies will cut patient assistance for expensive chemotherapy drugs in order to keep the sales price high so providers do not lose money to lower Medicare payouts. Click here for details.
Conservatives Break From Trump Over Concerns About Drug Pricing Provisions
Many conservative politicians and activist groups have come out in opposition to the Trump administration’s support of international drug pricing that caps Medicare payments to what other countries pay. Critics have argued that this would be “importing socialist price-controls” and other drug pricing provisions in the Senate Finance committee’s drug pricing policies. These typically Democratic policies face opposition from the GOP-controlled Senate and will likely go through many changes before being successful on the floor. Click here for an article on the rare GOP divide.
Health Systems Could See a Five Percent Spending Increase on Drugs in 2020
One of the country’s largest health care purchasing companies, Vizient, has released its Drug Price Forecast and it called for pharmaceutical costs that will far exceed both inflation and wage growth in 2020. This forecast also highlighted the increased importance of the prices of branded biologics, increased costs from drug shortages, as well as increases in the spending for treatments of Leukemia among other diseases. It makes suggestions, such as supporting biosimilars, but it paints a picture of a health care industry that is only increasing in its unsustainable costs. Click here for the report.
Naloxone Prescriptions Still Lag Far Behind High Dose Opioid Prescriptions: CDC
Pharmacies have dramatically increased their dispensing of Naloxone but prescriptions for the overdose-reversal drug are still low compared to the number of high-dose opioid prescriptions being filled, especially in rural areas, according to a new CDC analysis. Only 1 naloxone prescription is dispensed for every 70 high-dose opioid prescriptions. Click here for more from the CDC.  Click here for an AP article.
Medicaid Extensions Bill Signed
President Trump has signed into law a package of Medicaid extensions (H.R. 3253). Several Medicaid programs are extended under the bill, which also modifies Medicare payments for new Part B drugs. The measure extends or increases funding for the Certified Community Behavioral Health Clinics (CCBHC) demonstration program, Money Follows the Person (MFP) Rebalancing Demonstration Grant program, and Family-to-Family Health Information Centers program. It also extends a provision related to spousal income protections. Click here for a summary.
Administration Seeks to End Rule Requiring States To Monitor Whether Medicaid Rates Are High Enough
The administration, and many GOP-leaning states, argue that this requirement contributes to the Medicaid doctor shortage and requires a lot of time collecting and analyzing data with little benefit to providers. Supporters of the provision believe that it is necessary to ensure states keep high enough reimbursement rates to incentivize doctors to treat Medicaid patients. A proposal to weaken this provision had been put forth last year, but it had been met by strong opposition from both patient and provider groups. Click here for details.
Key Democratic Senator Calls For More Oversight of Medicaid Managed Care Companies
The Democratic Senator from Pennsylvania met with the CEO of Centene, the nation’s largest Medicaid managed care company to discuss a report that their Texas-based subsidiary had denied necessary care to patients. Casey has been vocal about his displeasure of the Trump administration’s failure to look into Medicaid contractors, and he wrote to CMS requesting that they investigate Centene. CMS has announced they have an action plan and will contact Senator Casey directly. For the letter sent to CMS Administrator Seema Verma, click here.
CMS Discontinues Medicare Advantage Demonstration for Clinicians
CMS will discontinue the Medicare Advantage Qualifying Payment Arrangement Incentive Demonstration due to low participation, the agency has announced. Included in the physician fee schedule proposed rule for calendar year 2019, the demonstration exempted clinicians who participate in certain payment arrangements with Medicare Advantage organizations from the Merit-based Incentive Payment System’s reporting requirements and payment adjustment. Click here for the CMS page on the demonstration.
Pediatric Telemedicine Receives Push-back After the Release of Multiple Studies
A group of pediatric health experts believe more research into apps that let parents video-chat clinicians directly from their phones is needed before children receive care over video. Two recent studies published in the journal Pediatrics suggest that doctors on these direct-to-consumer telemedicine platforms treat patients differently than they would in-person: children are prescribed antibiotics more frequently after direct-to-consumer consultations than after in-person urgent or primary care visits, according to a UPMC study from earlier this year. Another study published last week finds that parents are more likely to report satisfaction with video consultations for respiratory tract infections when their children are prescribed antibiotics. These possible complications lend the efficacy of this telemedicine to questioning.  Click here for details.
FDA Creates “Hospital” For DefCon Hacking Conference
As a part of addressing the vulnerability of medical devices to cyber-attacks, a “Medical-Device Village” is being created in Las Vegas for the DefCon hacking conference. This conference attracts many cyber-security industry workers and researchers, and this display hopes to give awareness to the real life threats that cyber-attacks pose for our healthcare system. The hospital is built to look like a regular hospital with real machines that will be used for hacking competitions to find the weaknesses in the security of these devices. Click here .
Medical Schools Are Being Pushed to Include the Health Effects of Climate Change in Their Curriculum
The movement backed by the AMA is pushing schools to teach their students how to treat patients as temperatures, extreme weather events, and air pollution all increase. Schools have been slow to take up this challenge, as many see their curriculum as already jam-packed, but some schools are making efforts to teach about subjects such as increased asthma diagnoses from wildfires and increased tick-borne diseases from rising temperatures. Click here for the report.
FDA Notifies Four Companies to Remove 44 Flavored E-liquid and Hookah Tobacco Products
The FDA issued these warning letters because these companies did not have the required market authorizations. These warnings come at a time when more e-cigarette companies are coming under fire for their high usage by, and aggressive marketing to, children.  Click here for the FDA’s statement.
  • 14 Teenagers Hospitalized for Vaping. With 14 young people hospitalized with shortness of breath, trouble breathing, and lung disease, this may shed light on how dangerous vaping actually may be. However, the chemicals that they were vaping in addition to nicotine are still unknown. For the full report click here.
Town in Rural Missouri Raises Sales Tax to Save Local Hospital
Nevada Regional Medical Center, which serves much of the area between Joplin and Kansas City, was slated to close before voters chose to increase their taxes in order to save the hospital. The increase is projected to raise $800,000 per year, enough to pay off the hospital’s debts. For the full report, click here.
Fewer Than 4 in 10 Americans 65 and Older Got the Shingles Vaccine in 2015
Not enough Americans do their preventative treatments that are recommended, according to the Agency for Healthcare Research and Quality. This study looked at compliance in preventative measures, including the shingles vaccine, and found many troubling trends. Along with the lack of vaccines being received by older Americans for shingles, they also found that uninsured adults ages 35–64 were less likely to receive most of the recommended services than their counterparts with insurance coverage. Click here for the analysis.
North Carolina Blues Shifts To More Risk Sharing With Providers to Lower Premiums
The push to get doctors and hospitals to focus on how they care for a whole person, not just a single symptom, got a boost from North Carolina’s largest insurer as it plans to reduce Obamacare premiums by $238 million. Moving to value-based provider reimbursements, which hold medical providers financially accountable for higher costs and inefficiencies in treating patients, played a role in Blue Cross and Blue Shield of North Carolina’s ability to propose premium reductions of 5.2% in the individual market and 3.3% in the small business market for 2020, the company said. The state Department of Insurance must approve rates for the plans, which will be offered on Affordable Care Act exchanges from Nov. 1 through Dec. 15. Click here for more.
Eating More Plant-Based Foods Linked to Better Heart Health
A study of more than 12,000 adults finds that eating a diet that’s rich in plant-based foods may be better for heart health than an animal-based diet or one that doesn’t have many servings of fruits and vegetables. Researchers surveyed the adults periodically between 1987 and 2017 about their food habits and recorded any cardiovascular-related incidents. People who ate a plant-heavy diet — where they consumed between four and five servings of fruits and vegetables and less than a serving of red and processed meat daily — had a 16% lower risk of cardiovascular disease and about a 30% lower risk of cardiovascular-related mortality compared to those who didn’t eat as many plant-based foods. Click here for the study.
Discovery May Lead to Treatments for Hearing Loss
A study from Johns Hopkins Medical School on mice revealed that two proteins are crucial in the development and organization of hair cells. These hairs are responsible for picking up sound waves in the inner ear. Further studies of these proteins may lead to groundbreaking treatments for hearing loss. For the study, click here.
The Ten Best and Ten Worst States For Healthcare in 2019: WalletHub
The release came from WalletHub and was a strong showing for the Midwest and Northeast as the top ten included Minnesota, Massachusetts, Rhode Island, District of Columbia, Vermont, New Hampshire, Hawaii, Maine, North Dakota, and Iowa. The south, and in particular the southeast came under criticism with the ten worst states being Louisiana, Alabama, Texas, Louisiana, Oklahoma, Georgia, Arkansas, South Carolina, Mississippi, North Carolina, and Alaska in last. Click here for the full rankings and methodology.
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