June 24, 2019

Senate’s Surprise Billing Plan Favors Insurers Over Providers
A key Senate committee last week released an updated version of its Surprise Billing and Transparency Legislation and plans to finalize it this Wednesday. The Health, Education, Labor and Pensions Committee settled on a policy to deal with surprise billing that will benchmark rates to the local in-network prices when there is a disputed payment.  Providers were quick to oppose the policy, which was also similar to the legislation that came out of the House Energy and Commerce Committee two weeks ago, saying it would give more power to insurers and reduce their bargaining power in price negotiations. The draft bill is supoprted by the top Republican and senior Democrat on the committee.  The legislation also includes a cap on surprise air ambulance bills, targets pharmacy benefit managers, improves the exchange of health information, and addresses public health issues, like vaccination misinformation and maternal mortality. If the committee passes the bill this week, it is expected to hit the Senate floor in July. To view the legislation, click here, and the Committee’s section-by-section summary, click here.

Surprise Billing Legislation Has Some Real Surprises for Providers
Tucked away in the Senate HELP Committee’s surprise billing legislation are provisions that require new billing and disclosure procedures for hospitals and other providers, according to a Strategic Health Care review of the legislation.  Click here for a two-page summary.

New Report Says Americans’ Cardiovascular Health in Decline – After Decades of Improvement
The death rate for cardiovascular disease—which includes heart disease and strokes—has fallen just 4% since 2011 after dropping more than 70% over six decades, according to mortality statistics from the CDC. Particularly alarming is that the death rate is actually rising for middle-aged Americans. The overall cardiovascular-disease death rate is an under-recognized contributor to the recent decline in U.S. life expectancy. While that has been driven mostly by deaths from drug overdoses and suicides, improvements in cardiovascular health are no longer providing a counterbalance. Click here for the Wall Street Journal report.

Executive Order Expected This Week on Price Transparency
As early as Monday, the President is expected to issue an Executive Order that could require price disclosures in health care including negotiated prices between providers and insurers. According to the Wall Street Journal, the EO will direct federal departments, such as HHS and Labor, to create regulations and guidance on how prices should be made public so that consumers may “shop” for their care. Industry groups including hospitals, physicians and insurers have already come out against the policy stating that it could cause prices to increase if competitors learn about each other’s discounted rates. Industry insiders point out that consumers are more interested in their out-of-pocket costs not negotiated rates their providers are able to work out with payers. Click here for details.

CMS Will Allow More Hospitals To Perform TAVR Procedures
CMS will now allow hospitals and medical centers that provide a lower volume of certain heart procedures to offer Transcatheter Aortic Valve Replacements. The procedure is used to treat aortic stenosis, a narrowing of the valve that sends blood from the heart to the rest of the body Previously, hospitals with no experience with the procedure had to meet stringent requirements in order to perform the surgery. But the surgery has become more commonplace since the first requirements were implemented in 2012. Last week’s update to the national coverage policy reflects the continued development of the therapy and streamlines elements of the original coverage plan. Click here for the announcement.

House Passes Extension of Several Medicaid Demonstration Programs
The House last week passed legislation that temporarily extends a number of bipartisan Medicaid programs including Money Follows the Person and Community Mental Health Services Demonstration Program. The Money Follows the Person program is extended for an additional four and half years to continue to provide funding for disabled patients and seniors to enable them to move out of long-term care facilities. The bill extends for two years the Mental Health Demonstration that pays mental health clinics a higher rate to provide services regardless of the patient’s ability to pay. Also included is a provision that clarifies the authority of State Medicaid Fraud and Abuse Control Units that investigate and prosecute abuse and neglect of Medicaid beneficiaries among others. To view the bill, click here.

Administration’s Proposal to Change Poverty Standards Could Lead to Less Health Benefits for Millions
The Office of Management and Budget requested comments several weeks ago on a proposal to update the Census Bureau’s poverty thresholds using an alternative, lower measure of inflation than the traditional Consumer Price Index. According to the Center on Budget and Policy Priorities, the proposal could result in fewer health benefits and less food assistance for millions of people. The analysis shows that the proposal will lower income thresholds and change the government’s poverty level leading to fewer people on public assistance. Researchers estimate that, over the next 10 years, more than 300,000 children would lose access to Medicaid or the Children’s Health Insurance Program, and more than 250,000 adults would no longer qualify for Medicaid expansion alone. Click here for the report.

  • A new study on Medicaid work requirements implemented in Arkansas found that while it forced people off of Medicaid, it did not increase employment. Arkansas officals are disputing parts of the Harvard study published in the New England Journal of Medicine. For the full study, clickhere.

Health Care and Tech Companies Unite Against Robocalls; House Committee Introduces Legislation
Robocalls have become more than a mere annoyance to most Americans. Hospitals have also victims of the intense calling efforts, with some describing instances when all their phone lines received a barrage of calls in short time frame, clogging up the phones and holding up staff from providing care to patients. Dave Summitt, Chief Information Security Officer for the H. Lee Moffitt Cancer Center, stated before an Energy and Commerce Committee hearing in April that in a span of 90 days the organization received 6,600 unsolicited and fake calls. As a result hospitals are working with tech companies to isolate the numbers to block them and train staff on best practices to take if they receive one of these robocalls. The House Energy and Commerce Committee has released bipartisan legislation aimed at stopping the unwanted calls. To view the hearing and read the testimony, click here, for the bill language, click here, and for the summary, click here.

FDA Releases Draft Guidance to Assess Benefits and Risks of New Opioid Drugs
The Food and Drug Administration released draft guidance last week with the goal of assessing the benefits and the risks of new opioid drugs. The new guidance describes the application of the proposed benefit-risk assessment framework that the agency will use in evaluating applications for new opioids. Under this framework, the FDA will evaluate the new drug’s benefits and risks as compared with other opioids already on the market as well as non-opioid pain medications. The agency also recommended that companies supply information on any potential safeguards, such as the drug’s ability to mitigate overdose, abuse or risk of addiction. To view the guidance, click here, and for the FDA announcement, click here.

  • Also, the FDA expanded coverage of a cystic fibrosis drug to include pediatric patients as young as six years old. Previously the youngest reccomended age was twelve. For the FDA news relase click here.

The Root Cause Coalition Releases Agenda for Upcoming Summit
The Root Cause Coalition, a national non-profit dedicated to addressing health equity through cross-sector collaboration, has released the event agenda for its Fourth Annual National Summit on the Social Determinants of Health on October 20-22, 2019 in San Diego. The National Summit is an annual opportunity for leaders from across disciplines – healthcare, community and national non-profits, the faith community, researchers, government leaders, educators and businesses – to learn how to improve health and well-being through meaningful collaboration and sustainable interventions. Click here for the agenda.

Study Finds Correlation between Sexting and Increased Risky Behavior in Children

A new study in JAMA Pediatrics found that across 23 different studies children under the age of 18 who sent sexually explicit content through electronic means were also likely to engage in high risk behaviors such as underage drinking, smoking, promiscuity, and were less likely to use contraception when engaging in sexual acts. The meta-analysis shows this correlation decreases with age. The authors note that the link between sexting and risky behavior does not indicate a cause and effect relationship. Additional research will be needed to determine causation. For the full study, click here.

Suicide in Young Adults Reaches Two Decade High

In a newly released study, the CDC reported a 30 percent increase in suicides from 2000 to 2016. The age ranges where the increase was the highest was 15-24, with upwards of a 14 percent increase a year, with young men more likely to commit suicide than young women. This age group is also at greater risk for anxiety, depression, self-harm, and social media use. Reporting from the 1990s indicated a decrease in suicide rates, and began to climb once more in the mid 2000s. For the full study click here.


Obesity Rate Declining in WIC Enrolled Children

Obesity in America is declining for the first time in years, a whopping 35% over the last decade, according to new studies. This change is further reflected in data newly released in JAMA and collected from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program. In children aged 2-4: 14 percent were obese, down 2 percent from 2010. Prior to 2010, obesity had been on the rise. For the full study click here.

New In-Home Technologies Can Detect Signs of Cardiac Arrest
Researchers at the University of Washington have developed a new tool to monitor people for cardiac arrest, even while they are asleep. Based on recent studies, the most common place for cardiac arrest is in a patient’s own home. Chances of survival greatly increases when CPR starts quickly. Researchers have developed technology that allows devices such as Alexa, Google Home, and smartphones to detect signs of cardiac arrest and call for help, with the potential to save countless lives. For the full report, click here.

Facebook Introduces New Blood Donation Feature
In the midst of constant recent scandals, the social media company Facebook is looking to make a positive public health impact. Facebook’s new blood donation feature will allow people to easily connect with blood donation groups in their area. These groups will be able to notify Facebook users when they need blood donors. Facebook has had success with this feature in India and Brazil, among other places. They are rolling out this feature initially to Chicago, New York City, San Francisco, Baltimore and D.C. before eventually spreading it across the United States. Click here for the Facebook press release.

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