July 22, 2019

Growing Provider Opposition Results in Major Changes to Surprise Billing Legislation 
The House Energy and Commerce Committee has approved several amendments to legislation to ban surprise medical bills in attempt to make the bill more friendly to providers. The approved bill, the No Surprises Act (H.R. 2328), prohibits balance billing and limits patient cost-sharing to the in-network amount for emergency services and for scheduled care, requires that patients receive notice of out-of-network care 72 hours in advance of the service, and establishes a payment benchmark for out-of-network services. The legislation contains a new arbitration provision offered by Rep. Raul Ruiz (D-CA) and Rep. Larry Bucshon (R-IN), which is different from the arbitration language introduced earlier by the Congressmen. The amendment would create an independent dispute resolution process that allows nonparticipating providers to appeal the payment for an out-of-network after exhausting the internal appeals process, a provider may appeal to the IDR entity. Committee Chairman, Rep. Frank Pallone (D-NJ) has stated that he expects the bill, which also included a delay to upcoming DSH cuts, to go to the House floor in September. Click here for the markup website and here for the Strategic Health Care memo on the Committee passed bill.

  • Payment rates to doctors and hospitals could fall by as much as 20% on average nationally if the Senate’s surprise billing legislation becomes law, according to the analysis by the Congressional Budget Office, click here.
  • The Los Angeles Times investigates how high medical bills caused by rising deductibles is impacting middle class Americans, click here.
  • The IRS will allow patients with chronic conditions enrolled in high-deductible health plans to purchase drugs and medical equipment without having to first pay off their deductibles, click here.

Bill to Repeal Cadillac Tax Passes the House
The House voted last week to repeal the Affordable Care Act’s 40 percent excise tax, most commonly known as the Cadillac Tax, for the most generous and expensive employer funded health plans. The tax, which was never implemented due to continuous delays by Congress, was meant to help subsidize other plans under the ACA, but became very unpopular even among many Democrats as unions fought against the implementation. The Senate has yet to schedule a vote on the Middle Class Health Benefits Tax Repeal Act of 2019 (H.R. 748) that passed the House by a vote of 419-6. Click here for the legislation.

DSH Cut Delay, Drug Pricing, Medicare Extenders, Robocall Measures Pass House Committee
In addition to the surprise billing package, the House Energy and Commerce Committee passed a number of other bills including legislation aimed at stopping annoying robocalls, extensions to various Medicare programs, and a bill to stop massive increases in drug costs. Several bills voted on during the Committee markup extended a variety of Medicare and health programs such as health care and nursing workforce development grant programs, newborn screening programs, the Lifespan Respite Care program, and Community Health Centers, among others.  Legislation also passed that would delay cuts to the Disproportionate Share Hospital payment program for at least two more years.
— The Protecting Patients and Doctors from Unlawful Robocalls Act of 2019 (H.R. 3375) would target the wave of unwanted and unlawful robocalls specifically to patients and providers cell phones and hospital phone lines, which has become a big problem particularly in emergent situations.
— The Fair Accountability and Innovative Research Drug Pricing (FAIR Drug Pricing) Act of 2019 (H.R. 2296) seeks to curb drastic increases in drug prices by requiring drug manufacturers to submit documentation to HHS 30 days before increasing the price of a qualifying drug passed the Committee by voice vote as well.
— Click here for the Committee memo on all the legislation that was voted on, and here to watch the markup itself.

  • Website GoodRx finds that New York City, San Francisco, and Los Angeles are the most expensive cities to but drugs while Atlanta is the cheapest, click here.
  • Canada opposes any U.S. plans to buy Canadian prescription drugs that might threaten the country’s drug supply or raise costs for its own citizens, click here.
  • Even with all the pressure from Congress and the Administration, the drug companies are not heavily impacted by the changes, click here.

Insurer To Operate California Health System
In a deal announced last week, UniteHealth’s Optum will be taking over all major “non-clinical functions” for San Francisco, CA health system John Muir Health in a plan that is taking a new twist in the consolidation of provider and health insurance companies. Optum will operate all information technology, revenue cycle management, analytics, purchasing and claims management as well as transferring about 540 John Muir Health employees, or nearly 10% of the health system’s workforce to Optum. For more on the deal, click here.

Looking to Capitalize on Trump Initiative, CVS Begins Clinical Trial for Home-Dialysis Device
The large company will attempt to navigate into the world’s medical-device sales amid the Trump Administration’s push to move more dialysis care into the home rather than outpatient settings. This push comes from the Trump administration as the U.S. is looking for ways to curtail the costs of treating chronic diseases. The Wall Street Journal details the initiative here.

ACO Participation: More Taking Risk, Fewer Joining Program
CMS Administrator Seema Verma last week reported on the participation data for the Medicare ACO program since the agency overhauled the program late last year, which took effect on July 1st. Medicare ACOs will now be required to take on downside risk sooner in the program and although participation in the program overall declined recently, more ACOs are taking on risk compared to previous years. In the blog, the Administrator states that 48-percent of the ACOs are now taking on downside risk – much higher than the 18-percent that took on risk in 2018. To read the full blog, click here. But, overall, fewer are joining.  Click here for that report.

  • A study in the New England Journal of Medicine shows that CMS saved $48.6 million during the first year of the Accountable Care Organization Investment Model, developed to improve care in rural and underserved areas, click here.
  • In a new study, researchers at Harvard Medical School found that a payment plan from Blue Cross Blue Shield of Massachusetts that rewards doctors who control costs is linked to  smaller increases in health care spending and better-quality care. Click here.

New Standards Released By ACS To Improve Surgery for Elderly Patients
Seniors account for 40 percent of surgeries, a number which is projected to increase as the population ages. Special considerations need to be accounted for in elderly patients, as risk increases with age, and many seniors suffer multiple illnesses. The American College of Surgeons launched a program to encourage hospitals to comply with 30 new standards for patients 75 and older in order to improve outcomes. For the program outline, click here.

New CMS Rules Reduce Regs and Allows Arbitration For Nursing Homes
CMS released one proposed rule and one final rule that affect long-term care facilities. The proposed rule aims to allow providers to focus more time and energy on their patients rather than on paperwork and reporting. The rule “would eliminate prescriptive requirements and allow commonsense flexibilities” to improve patient outcomes. The final rule removes the ban on arbitration as a way to settle disputes in these nursing homes, but also allows for the patient to decide if they will pursue arbitration or litigation. This rule hopes to save both providers and patients money that could be spent on lengthy litigation processes. Click here for more from CMS.

Overdose Deaths Drop Following Record High in 2017: CDC
According to a new data released by the CDC, the drug overdose death rate fell by 5.1 percent in 2018, after a record-high number of deaths in 2017. CDC’s National Center for Health Statistics data predicts 68,557 individuals died from drug overdoses from December 1, 2017 – November 30, 2018. By contrast, in 2017, the predicted deaths was 72,224 – a 10 percent increase over the previous year. While the CDC showed most states experiencing a decrease in overdose deaths over the past year, about a third are still predicted to have an increase in deaths, particularly among those in the west. To view all the statistics, click here.

  • In an analysis of the DEA tracking database, there were only six companies that distributed 75 percent of opioids between 2006 and 2012: McKesson Corp., Walgreens, Cardinal Health, AmerisourceBergen, CVS and Walmart, click here.

HRSA Announces $20 Million In Rural Residency Grants
The Health Resources and Services Administration awarded about $20 million in Rural Residency Planning and Development Program grants to recipients in 21 states. Grantees  will receive up to $750,000 over a three-year period to develop new rural residency programs as part of a multi-year initiative by HRSA to expand the physician workforce in rural areas. Recipients include rural hospitals, community health centers, health centers operated by the Indian Health Service, Indian tribes or tribal organizations, and schools of medicine. Click here for the full list of the 27 recipients.

  • The House Ways and Means Committee launched the “Rural and Underserved Communities Health Task Force” last week to better address the needs of residents in rural and underserved communities co-chaired by Reps. Danny Davis (D-IL), Terri Sewell (D-AL), Brad Wenstrup (R-OH), and Jodey Arrington (R-TX), click here.
  • The Washington Examiner looks at why 107 rural hospitals have closed since 2010, pointing to, among other safety-net programs, the assault on the 340B drug discount program, click here.
When Urban Hospitals Close, Poor People and Minorities Take the Biggest Hit
An article from U.S. News looks at the problem of closing urban hospitals that are often overburdened by patients that are under-or-uninsured, leaving their patient population in much worse positions. It details the attempted closure of Hahnemann Hospital, an institution that primarily serves a population of poorer people and minorities in Philadelphia. It also looks to community health centers in Chicago that have had success in treating these communities. Click here for the article.
New Report Promotes Innovative Payment Strategies To Tackle Maternal Health Crisis
A new report released by the Health Care Transformation Task Force reviewed literature and interviewed involved parties to form guidelines to improving maternal health care. First, it recommends three new payment programs that focus on value-based care. These payment programs include linking reimbursement to maternal outcomes and total cost, linking reimbursement to both maternal and fetal outcomes and total cost, as well as payment adjustments for high-value vs. low value care. It also includes provider suggestions to improve maternal health outcomes, including increased focus on listening to women while considering their social/cultural backgrounds as well as increasing research and collaboration. Click here for the report, and clickhere for HCTTF’s fact sheet.
  • NIH study links infants born to women exposed to high levels of air pollution to a higher incidences of admittance to a NICU, click here.
CMS Proposes to Cover Costs for Patients in Acupuncture Clinical Trials For Back Pain
As the medical community looks for alternatives to opioids, CMS is proposing to cover the costs for patients in Lower Back Pain Acupuncture clinical trials. CMS has reviewed covering acupuncture multiple times within the last couple decades and each time has decided against it due to a lack of evidence. This claim may receive push-back as there is limited scientific evidence that supports the effectiveness of acupuncture. Click here for more from CMS.
HHS Has Failed to Report Nearly Two-Thirds of Its Medical Malpractice Payments
For the last two years, HHS has not submitted 63% of its malpractice payment reports to the National Practitioner Data Bank. The NPDB uses its practitioner information to protect patients from negligent doctors. According to PublicCitizen, the HHS Inspector General had released a report alleging this exact non-compliance in 2005, yet the problem has persisted for another 14 years. Click here for the report.
The Spread of Measles Finally Appears To Be Slowing Down
The CDC recorded 14 new measles cases between July 3 and July 11, which is only a 1.3% increase from the previous week. This increase is continuing to grow smaller, as the outbreak of the disease, which had previously been declared eliminated in the U.S. in 2000, is successfully being contained. As more states strengthen their vaccine requirements and education, the CDC hopes future outbreaks can be avoided. For more information on the measles outbreak and history click here.
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