09 Dec December 9, 2019

Deal Reached on Surprise Billing Between House and Senate Committees
The Senate Health Committee and House Energy and Commercy Commitee announced the agreement Sunday in a news release, but omitted details about the precise mechanism for resolving disputes between insurers and health care providers when out-of-network bills arise. Senator Lamar Alexander of Tennessee, the chairman of the health committee, said in a statement that the solution “includes arbitration,” language that could encompass a few subtly different approaches.  It’s not guaranteed passage, but the deal will be viewed as the biggest move forward since the summer when opposition to the legislation slowed it down to a crawl.  Click here for a New York Times report.  White House officials have made it known that the Administration would be comfortable with some sort of dispute resolution process, generally supported by providers and opposed by insurers. While the Administration has not supported any one way of preventing surprise billing, White House Domestic Policy Council chief Joe Grogan penned an op-ed last week calling on lawmakers to “come back to Washington in December ready to vote to protect patients from surprise medical bills.” To read Grogan’s piece in USA Today, click here.

Hospitals File Suit Against Administration Over Price Transparency Rule
The American Hospital Association, Association of American Medical Colleges, Children’s Hospital Association, Federation of American Hospitals and several individual hospitals filed suit against HHS last week alleging that the Administration does not have the authority to force hospitals to publicly disclose the privately negotiated payment rates with insurance companies for services. The lawsuit also argues the rules, slated to take effect in January 2021, violate the First Amendment, exceeds HHS’ statutory authority, and would be costly to implement. The hospitals claim that HHS only has the authority to compel the disclosure of “standard charges,” not prices specific to individual health plans. An HHS spokesperson quickly shot down the lawsuit saying, “Hospitals should be ashamed that they aren’t willing to provide American patients the cost of a service before they purchase it.” To view the suit, click here, and for more on the issue including the Administration’s reaction from The Hill, click here.  For a more detailed analysis of hospital associations’ lobbying efforts around this and related issues, click here for a Wall Street Journal report.

• Insurance industry groups have asked the Administration to extend the comment period by 90 days on the proposed price transparency rule that would require insurers to reveal the negotiated prices with providers and patients’ out-of-pocket costs, click here.
• CMS to hold a special conference call on December 10 to allow stakeholders to ask questions about the price transparency rules, click here.

HHS, CMS – Turmoil at the Top
Normally I don’t put stories about inside agency politics in this Weekly Report; however, over the past week plenty of stories have been written about it so I am informing you here.  In part because you may be interested and in part because it is uncertain how the reported feud between HHS Secretary Azar and CMS Administrator Seema Verma could impact a variety of agency policy initiatives.

• The President personally intervened last week to settle the feud.  Click here.
• HHS took the extraordinary step of bringing in outside counsel earlier this year to investigate allegations of sex discrimination. Click here.
• For a deeper dive into the dispute, click here.
• VP Pense has also intervened.  Click here.

House to Vote on Pelosi Drug Reform Bill this Week
House Democrat Leadership says it will bring up for a vote this week the drug price measure championed by Speaker Nancy Pelosi (D-CA). The bill would allow Medicare to negotiate some drug prices and use fees to pressure drug companies to offer lower prices to private insurers. The legislation was approved by the Energy and Commerce Committee, the Ways and Means Committee, and the Education and Labor Committee months ago and has awaited official cost estimates to which the Leadership states they enough guidance from the Congressional Budget Office in order to take the measure to the House Floor. Click here for the statement.  It is highly unlikely this bill will be voted on in the Senate as senators continue their work on an alternative.

• The White House Council of Economic Advisors estimates that H.R. 3 could result in 100 fewer drugs being available in the U.S. and cost the economy $1 trillion over ten years, click here.
• The Senate Health Committee voted to advance the nomination of Dr. Stephen Hahn, a Texas oncologist, as the next FDA Administrator by a vote of 18-5 last week, click here.

House Subcommittee to Hold Hearing on Universal Health Coverage, Including Medicare-For-All
The House Energy and Commerce Health Subcommittee will hold a hearing Tuesday on proposals to expand to universal health insurance coverage, including bills  that would create Medicare-for-All. The subcommittee will look at seven bills in all including policies that would allow for a public option, Medicare buy-in, and Medicare X. Other than Medicare-for-All, the legislation that will be debated during the hearing will expand government coverage and offer ways for non-seniors to “buy-in” to the Medicare program at varying stages of life. For a full list of legislation under consideration, click here, and for more information on the hearing itself as it becomes available, click here.

• The Washington Post reports on how lobbyists either helped draft or made extensive revisions to opinion columns published by three state lawmakers in a way that warned against the dangers of Medicare-for-all and other government involvement in health care, click here.
• The “less disruptive health care options”, like the public option, could actually be very disruptive to the entire health care system, click here for an explanation.

Vermont Is Healthiest State as Diabetes and Drug Deaths Increase Nationwide: America’s Health Rankings
In its 30th year, America’s Health Rankings Annual Report ranked states across 35 measures of health and drew from 19 publicly available data sources in 2019. Some of the largest increases in the last 30 years included a 37 percent increase in drug deaths, a 148 percent increase in diabetes,  and a 45 percent and 43 percent decrease respectively in smoking and infant mortality. In 2019, Vermont claimed the ranking of the Healthiest State. For the full report, click here.

• According to analysis from the Office of the Actuary at CMS, U.S. health care spending grew at lower rate than the overall economy and represented 17.7% of GDP in 2018, compared to 17.9% a year earlier, click here.
• Sens. Cory Booker (D-NJ)  and Ron Wyden (D-OR) sent letters to the FTC, CMS, and several insurers regarding a report in Science that revealed that a widely used health care algorithm demonstrated racial biases favoring white patients, click here.

Nearing End of Open Enrollment, ACA Sign-Ups Still Behind Last Year’s
As we near the last two weeks of open enrollment, the number of people signing up for plans through the Affordable Care Act Marketplaces is down about 10 percent from last year. The Week Five Snapshot shows that 2.9 million people have gone onto Healthcare.gov to pick a plan with a little over 500,000 in the week that included the Thanksgiving holiday, which traditionally has lower numbers. The numbers only reflect federal-run plans in 38 states and saw drop-offs in both new enrollments and returning customers. Click here for the CMS Snapshot.

• A new report has found that consumer satisfaction scores for health insurers increased from 73 to 74 out of 100 possible points this year, the highest in a decade, click here.
• A recent report from the Commonwealth Fund finds that many working families are spending more of their income on health care, as insurance premiums and deductibles continue to grow faster than earnings, click here.
• Medicare Advantage open enrollment continues, but according to at least one report, the benefits can be a mixed bag for the beneficiaries.  Click here.

Rural Hospitals Affiliated with Systems Improve Finances But Can Lose Services
That’s according to an new article in Health Affairs. The researchers found that rural affiliating hospitals’ operating margins increased by 1.6 to 3.6 percentage points in the first two to five years after affiliation and at the same time experienced a significant reduction in on-site diagnostic imaging technologies, the availability of obstetric and primary care services and outpatient non-emergency visits. Overall, the researchers stated that “While joining health systems may improve rural hospitals’ financial performance, affiliation may reduce access to services for patients in rural areas.” Click here for the study.

• Even the Mayo Clinic is having issues maintaining rural facilities, according to Minnesota Public Radio. The system will shutter two rural facilities early next year, click here.
• Telehealth services are improving though a new report, with 10 states paying the same for telehealth services as in-person, click here.
• According to a new report from the Association of American Medical Colleges, U.S. medical schools have seen a 28% decrease in enrollment of students from rural communities over the last 15 years, click here.

Nursing Home Therapists and Patients Struggling with New Payment Model
The Patient-Driven Payment Model went into effect October 1, and therapists in nursing homes are feeling the difference – and so are their patients. Before Oct. 1, Medicare reimbursed nursing homes for therapy based on the number of minutes provided to each patient, up to 720 minutes a week. Now therapists find themselves having working hours cut, lost employment, and increasingly ineffective results with patients. Medicare allows for up to 25% of therapy to be performed in a group session and patients find themselves with reduced time with individual therapists. One therapist commented, “The time for the patients dropped drastically… Same patients, same diagnoses, different payment system.” For the report from the New York Times, click here.

Flu Mortality Already on the Rise 
With flu season barely underway, CDC officials added to this year’s death count last week, bring the total deaths to 5 so far. Currently the flu outbreak has spread to 10 states, with CDC officials report that 2.9% of outpatient visits involved flu-like illnesses during the week ending Nov. 23, up from 2.5% during the previous week and exceeding the 2.4% national baseline. For more information on the rise of the flu, click here.

Teen Tobacco Usage Up; Vaping Deaths Now at 48
About 6.2 million middle and high school students used tobacco products in 2019, an increase of more than 10 percent, according to the Centers for Disease Control and Prevention.  The CDC’s new National Youth Tobacco Survey found that about 1 in 3 high school students (4.7 million) and about 1 in 8 middle school students (1.5 million) are current tobacco users. And despite all the added media coverage over the dangers of vaping, for the sixth year in a row, e-cigarettes were the most commonly used tobacco product among high school (27.5 percent) and middle school students (10.5 percent). The CDC also reports that as of Dec. 4th, 48 people have died due to lung injuries associated with vaping in 25 states and Washington, D.C. All 50 states as well as D.C., Puerto Rico, and the Virgin Islands report patients hospitalized with lung injuries from vaping. For more on teen tobacco use, click here, and for the vaping statistics, click here.

HHS Initiative: PrEP to Prevent HIV
Following the latest analysis from the CDC finding that 14 percent of people with HIV are unaware of their status and only 18 percent of people who could benefit from an HIV prevention drug were actually getting it. Last week, HHS announced a national program that provides prophylactic HIV medication at no cost to individuals without prescription drug coverage. This program is a part of the National Plan for Ending the HIV Epidemic. PrEP or pre-exposure prophylaxis drug will start to be dispensed by March 30, 2020 by most pharmacies. This initiative is thought to be able to reach 200,000 patients, although it should be noted this aspect of the program does not cover lab tests for HIV diagnosis. For more information on the PrEP program, click here. For the CDC, report click here.

60 Million Americans Monthly and 15 Million Daily Suffer from Heartburn
The burning pain of acid reflux, or heartburn, impacts an estimated 60 million Americans at least once a month and 15 million people daily, according to reports from the American College of Gastroenterology. This information comes on the heels of the popular indigestion drug Zantac being pulled from the market because of the presence of a potentially cancer-causing chemical. To avoid ongoing issues, experts suggest, among others, to avoid foods and beverages that contribute to heartburn: chocolate, coffee, peppermint, greasy or spicy foods, tomato products and alcoholic beverages – not easy in this holiday season. For more, click here.

JAMA Study Concludes Prevention is Key for Prediabetes in Teens
Prediabetes has been found to be extremely prevalent in adolescents (18 percent) and in young adults (24 percent) in the sample taken from 5,800 people from 2005 to 2016. These recently released findings “highlight the need for primary and secondary prevention efforts tailored to the young segment of the US population.” For the JAMA study, click here.

Study on Health Related Messages on Instagram Shows “Anti-Vaxxers” Have Higher Influence
A study conducted by researchers at Drexel University and Thomas Jefferson University reveals that health campaigns may have more success in reaching their audiences if they use narrative techniques similar to how social media (i.e., Instagram) influencers use it. The study, which analyzed 360 posts about HPV vaccinations found that the anti-vaccination posts, which used narrative techniques, had a higher engagement – receiving an average of 62 more “likes” than the pro-vaccination posts, which only focused on a call to action. From this finding, the researchers believe that pro-vaccination posts (and in the larger picture, healthcare professionals) would see more engagement if they adjusted their tactics to incorporate narratives into their posts. Click here for the study.