May 13, 2019

President Calls on Congress To Fix Surprise Billing; Providers, Insurers Clash
In a White House press conference last week, President Trump detailed key principles to tackle surprise medical bills and called on Congress to move legislation.  The Administration is looking to address situations where patients receive unexpected medical bills – first, when a patient goes to an out-of-network emergency room for care, and second, when having elective surgery at an in-network facility a patient receives an unexpected bill from an out-of-network doctor, such as an anesthesiologist or radiologist. Surprise medical billing has been an issue of a lot of debate in Congress with a bipartisan working group led by Sen. Bill Cassidy (R-LA) and Maggie Hassan (D-NH) working on legislation for the past several months. Health Committee Chairman Lamar Alexander (R-TN) said he would have legislation ready for action this summer. Click here for the President’s remarks and here for the set of principles put forward by the White House.

  • Hospitals, physician and insurers are already clashing over the policy details, with the key question, “who will pay?” Click here.
  • HHS Secretary Alex Azar echoed the President’s sentiments saying American’s have the right to health care price transparency, click here.
  • Officials at HHS are indicating that a proposal to allow patients to compare healthcare prices on their smartphones is coming but not anytime soon, click here.

Employer Health Plans Pay Hospitals 241% More than Medicare
Large price discrepancies exist between what private health plans pay for hospital services and what Medicare pays. RAND Corporation researchers used data from three sources — self-insured employers, state-based all-payer claims databases, and health plans — to assess $13 billion in hospital spending in terms of hospital price levels, variation, and trends from 2015 through 2017 in 25 states.

  • Relative prices varied twofold among states. Some states (Michigan, Pennsylvania, New York, and Kentucky) had relative prices in the range of 150 to 200 percent of Medicare rates;
  • other states (Colorado, Montana, Wisconsin, Maine, Wyoming, and Indiana) had relative prices in the range of 250 to 300-plus percent of Medicare rates.
  • Relative prices increased rapidly from 2015 to 2017 in Colorado and Indiana, but they fell over the same period in Michigan.
  • Among hospital systems, prices varied nearly threefold, ranging from 150 percent of Medicare rates at the low end to 350 to 400-plus percent at the high end.

“Hospitals charge higher prices to private payers and employers because they can,” said Elizabeth Mitchell, president and CEO of the Pacific Business Group on Health. “But evidence shows that efficient hospitals can provide high quality care at Medicare rates without cost shifting.” Click here for the RAND study. Click here for more from Forbes.  Click here for the response from the American Hospital Association.

Rural Hospitals Continue To Fight for Survival
In the past decade, emergency room visits to America’s more than 2,000 rural hospitals increased by more than 60 percent, even as those hospitals began to collapse under doctor shortages and historically low operating margins. Rureal hospitals treat patients that are on average six years older and 40 percent poorer than those in urban hospitals, which means rural hospitals have suffered disproportionately from government cuts to Medicaid and Medicare reimbursement rates. They also treat a higher percentage of uninsured patients, resulting in unpaid bills and rising debts. A record 46 percent of rural hospitals lost money last year. More than 400 are classified by health officials as being at “high risk of imminent failure.” Hundreds more have cut services or turned over control to outside ownership groups in an attempt to stave off closure. Click here to read about the pending closure of one such hospital in rural Oklahoma.

Court Once Again Finds For the Hospitals on 340B, But Remedy Will be Slow in Coming
A Federal Court last week ruled for the second time against the CMS 28.5 percent cut in payments for drugs that are bought under the 340B drug discount program, this time for the extension of the cuts in the 2019 outpatient payment rule. In the ruling filed last Monday, Judge Rudolph Contreras of the U.S. District Court for the District of Columbia said the payment cut HHS put into effect for 2018 and 2019 was unlawful. However, the judge told CMS it must remedy the situation and required a status report be submitted to the judge by August 5. To read the ruling, click here.

House Passes Bill to Overturn Administration ACA Waivers, Protect Patients with Pre-Existing Conditions
The House passed legislation last week that would block the Administration guidance that allows states to work around key ACA provisions through waivers for health plans that do not meet benefits standards. The bill (H.R. 986) passed mainly along party lines and is being touted by Democrats as a reversal of the health policies that many believe would remove protections for people with pre-existing conditions. The Protecting Americans with Preexisting Conditions Act of 2019 is expected to die in the Republican held Senate and the President vowed to veto the measure if it made it to his desk. Click here to view the legislation.

  • According to Kaiser Family Foundation analysis, insurers on the individual market will pay a record total of about $800 million in rebates to enrollees due to setting premiums too high last year, click here.
  • A new survey of people with employer-sponsored health plans shows that six out of 10 skipped or postponed medical care and/or stopped taking prescription drugs due to costs, click here.

44 States File Suit Against Drug Companies for Conspiring To Inflate Prices
Leading drug companies including Teva, Pfizer, Novartis and Mylan conspired to inflate the prices of generic drugs by as much as 1,000 percent, according to a far-reaching lawsuit filed on Friday by 44 states. The industrywide scheme affected the prices of more than 100 generic drugs, according to the complaint, including lamivudine-zidovudine, which treats H.I.V.; budesonide, an asthma medication; fenofibrate, which treats high cholesterol; amphetamine-dextroamphetamine for A.D.H.D.; oral antibiotics; blood thinners; cancer drugs; contraceptives; and antidepressants. Click here for the NYTimes report.

HHS Releases Final Rule Requiring Drug Companies to Publish Prices in Advertisements
In 6o days, pharmaceutical manufacturers will be required to disclose prices in television commercials despite the push back from the industry claiming the policy could lead to “sticker shock,” which will cause patients, nervous about costs, to go off their medications. HHS Secretary Alex Azar however, referred to the new requirement as “the single most significant step any administration has taken” toward price transparency. For the HHS fact sheet, click here, and for the final rule, click here.

  • The House is set to vote on a bill (comprised of seven bills) to tackle drug prices, click here to review the legislation.
  • According to a recent report by the Pew Charitable Trusts, Maine’s legislature has big plans to bring down drug costs, click here.

More Doctors Work for Hospitals Than Private Practice
More American physicians are employees of a hospital system than are in their own private practice, according to a new AMA survey. In 1973, 75.8 percent of doctors were in an independent practice, today 45.9 percent are independent and 47.4 percent are hospital employees. The survey also showed that younger physicians and women physicians are less likely to be owners. In 2018, 25.5 percent of physicians under the age of 40 were owners as compared to 54.3 percent among physicians age 55 and older. Additionally, 34-percent of women physicians were owners compared to 52.1 percent of men. Click here for the AMA survey results.

CBO Finds President’s Proposed 2020 Budget Would Significantly Reduce Health Spending
The CBO, Congress’ non-partisan number crunchers, released estimates last week of the President’s entire budget proposal including the proposals affecting health programs. CBO estimated that the federal deficit under the President’s budget proposal would increase from $896 billion in 2019 to $966 billion in 2020 if fully adopted. Additionally, the actuaries found that the federal debt held by the public would increase from 78 percent of GDP in 2019 to 87 percent in 2029 under the plan. However, CBO estimates that health care spending would be reduced by $1.5 trillion, mainly because of a proposal to repeal certain provisions of the Affordable Care Act and instead provide block grants to states. To view the estimate, click here.

Administration Proposes Changes To Federal Poverty Measures
The White House Office of Management and Budget has posted a request in the Federal Register seeking comments on a proposed change to an index used to gauge inflation for a U.S. poverty measure. The proposed change in the poverty calculation would fit with other steps taken by the Administration to reduce access to federal welfare programs. The changes under consideration would impact federal programs such as the school lunch program and Head Start, as well as tax credits on the ACA individual market and could change eligibility standards for Medicaid enrollment. Click here for the proposal in the Federal Register.

Hepatitis A on the Rise by as Much as 500% in Some States
In a report recently released by the CDC, since 2015, Hepatitis A infections have risen in the United States by 294%. In 10 states including Washington, D.C., this rate reached a 500% increase. While the most common type of viral Hepatitis worldwide, it is preventable with a vaccine, unlike with Hepatitis C. This rise of infection is largely attributed to injectable drug use and the sharing of needles among the homeless. The Advisory Committee on Immunization Practices recommends routine vaccinations for adults at increased risk, including men who have sex with men and people who are homeless or use drugs. For the CDC report, click here.

ACOs Have a 30 Percent Drop Rate from the Medicare Shared Savings Program
With the Medicare Shared Savings Program redesign begining in July, officials at CMS hope that it will stem the tide of ACOs dropping out of the program. Data published by Health Affairs shows that ACOs drop out of the program at a rate of 30 percent. This number decreased dramatically once an ACO completes its first contract, typically 4 years into MSSP. The redesign hopes to help retain more ACOs and attain that benchmark, as well as increase higher benchmarks per capita. For the research published in Health Affairs, click here.

Congress Wants Nationwide Access to CAR-T Treatment
Similar bi-partisan letters from both the House and Senate last week call for CMS to make its nationwide Medicare coverage decision for the new cancer treatment CAR-T. CMS proposed a nationwide coverage plan for the nearly $500,000 treatments that would require the therapy be offered under “coverage with evidence development,” patients would have to be in a CMS-approved registry or clinical study, and agree to be monitored for two years after treatment in order to receive coverage. Both the House and Senate raised concerns in their letters that the proposed collection of clinical data may be repetitive and overly burdensome as this information is already being collected as part of an international blood and marrow transplant registry. Signatories want assurance from CMS that the final coverage decision will be flexible enough to allow for coverage of additional uses of CAR-T as they are approved by the FDA. Click here for the Senate letter, and here for the House letter.

Rural Areas Have HIgher BMI Rates than Urban Areas
A recent study published in Nature reported that Body Mass Index rates were higher for the first time in rural areas compared with urban areas. The study found “contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017—and more than 80% in some low- and middle-income regions—was due to increases in BMI in rural areas.” This is a trend that the study found globally from data collected from 112 million adults across 200 countries in 2017.  It is thought to be reflective of other social determinants of health that correlate with obesity, such as lower education and income, higher price of healthy foods, and less access to and use of public transit. For the full study click here.

Record Measles Outbreak Continues
As of last week, the U.S. Centers for Disease Control and Prevention had reported 764 cases of measles in 23 states, the worst outbreak in the United States since 1994. The outbreak continues to correlate strongly with unvaccinated communities, prompting many states to evaluate legislation to remove any nonmedical reason, such as personal or religious exemptions to vaccinations, amidst anti-vaccination group protest. Currently most states allow such exemptions; however, seven are considering removing them. For the latest on the outbreak from the CDC, click here.

Over Half of Pregnancy-Related Deaths Are Preventable
In a new report, the CDC analyzed maternal morbidity and mortality statistics to find that 60 percent of pregnancy-related deaths in the U.S. are preventable. Every year, about 700 women in the U.S. die due to pregnancy-related complications, with leading causes being cardiovascular disease and hemorrhage. African American women were reported to die at a rate three times higher than that of white women, highlighting one of the largest racial disparities in women’s health. These deaths were deemed preventable with improved access to, and delivery of, quality care, especially for women of color. Click here to read the report.

Global Alcohol Consumption Rates Increase
According to an article published in the Lancet, the percentage of alcohol consumption is increasing around the world. Research from Canada and Germany looked at the percentages of people that didn’t drink and the number of people who were binge drinkers, among other markers, to analyze drinking trends. The study showed that between 1990 and 2017, the number of people that abstained from alcohol use decreased and the number of people that binge drink increased. To read the full study, click here.

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