20 May May 20, 2019

Hospitals, Health Plans Targeted by Government in New Price Transparancy Push
The Trump administration has been working behind the scenes for months on a strategy to force greater price disclosure across much of the $3.5 trillion health-care industry, according to a new report in the Wall Street Journal. The push relies on existing administrative tools, according to people familiar with the discussions. Those include Labor Department powers under the law that sets minimum standards for private-industry health plans and current hospital-payment rules under Medicare. The administration is strongly interested in forcing insurers to publicize the negotiated rates they pay for services, the people said. The requirement could affect insurers providing coverage in the private-employer market, where about 158 million people get their health insurance. Click here for the report.

Surprise Billing Legislation on the Fast Track
Both the House and Senate have released legislation to tackle “Surprise Billing” practices. The House Energy and Commerce Committee released its proposal first that includes provisions that bars balanced billing for emergency services and requires providers to notify patients when there is a potential for out-of-network charges. Later in the week, a bi-partisan group of Senators released a separate bill that would specify times when out-of-network billing would not be allowed as well as sets up an independent dispute resolution process. Leaders in both chambers have stated their eagerness to move legislation quickly. Click here for a Strategic Health Care summary on the House bill, and here for the Senate version.

• The House Ways and Means Committee will hold a hearing on Surprise Billing on Tuesday, May 21st, entitled, “Protecting Patients from Surprise Medical Bills,” click here.
• The American Academy of Pathologists have offered up an approach on how to deal with surprise bills, click here.
• Georgetown University Health Policy Institute reviewed NY State’s surprise billing arbitration law and found that the law has successfully protected many consumers from major sources of surprise medical bills, click here.

Senate Committees Ready Drug Pricing Package, Will Include 340B Transparency
Multiple Senate Committees are working on legislation to curb the rising cost of drugs and all are expected to move swiftly with mark-ups as quickly as mid-June and plan to bring the legislation to the floor of the Senate for a vote prior to the August recess. Reports also suggest the recently introduced Surprise Billing legislation may be included in the package as well as 340B transparency policies, according to Sen. Bill Cassidy (R-LA) who spoke about the issues at an Alliance for Integrity and Reform of 340B meeting last week. Leadership’s goal is to keep the bills bi-partisan. As a start, following the HHS final rule requiring pharmaceutical manufacturers disclose pricing in TV advertisements, Senator Dick Durbin (D-IL) and Senate Finance Committee Chairman Chuck Grassley (R-IA) introduced a bi-partisan bill that would codify the regulation. Click here for the bill (S. 1437) information and here for some of the remarks at the AIR340B meeting.

• The House passed a bill last week that combined several bills to lower drug prices that were passed out of the Energy and Commerce Committee, H.R. 987, originally bi-partisan, included a provision that lost support of Republicans because it strengthens the individual insurance exchanges under the ACA, click here for the bills, here for the CBO cost estimate.
• Yet another pharmaceutical manufacturer financed report shows that the 340B program is growing but charity care at covered entities is shrinking, click here.
• HHS issued a regulation last week that it says will lower drug prices and reduce patient costs by opening up price negotiations for some pharmaceuticals as well as reversing a position that would have limited coverage of protected drug classes, click here.

More than Half of All Hospitals Get As and Bs in Latest Leapfrog Safety Report
Assigning letter grades to hospitals based on their patient safety performance, Leapfrog released it’s Hospital Safety Grades Report last week. From the more than 2,600 hospitals graded by the group, 32% earned an “A,” 26% earned a “B,” 36% earned a “C,” 6% a “D” and just under 1% an “F.” From all the hospitals graded twice a year, 41 have earned an “A” in every update. The grades are derived on an independent, nonprofit grading system that assigns letter grades to general, acute-care hospitals and is the nation’s only rating system focused entirely on errors, accidents, injuries and infections. To view the summary of the report, click here, and for the entire list of hospitals that were graded, click here.

300 House Members Sign-On to Letter to Delay DSH Cuts
Led by Reps. Eliot Engel (D-NY) and Pete Olson (R-TX), 300 House Members signed a letter to House Leadership urging them to proceed with legislation to delay – by an additional two years – the Medicaid Disproportionate Share Hospital Payment cuts which will go into effect on Oct.1. Medicaid DSH cuts were originally included in the ACA but have been repeatedly postponed by Congress. The current 2-year delay was enacted in February 2018. The $4 billion cut is scheduled to take effect in fiscal 2020, and will increase to $8 billion annually in each subsequent year through fiscal 2025. The letter states that the country’s hospitals “cannot sustain losses of this magnitude,” and “Until a more sustainable, permanent solution is reached, we ask that you work to delay these cuts for at least two fiscal years.” To view the full letter, click here.  Senate Finance Committee Chairman Chuck Grassley (R-IA) has repeatedly said it is time to fix the DSH payment program and no longer delay the scheduled cuts.

Hospitals Taking Action To Protect Patients from Cyber-Attacks
Hospitals are pushing medical-device makers to improve cyber defenses of their internet-connected infusion pumps, biopsy imaging tables and other health-care products as reports of attacks rise. Rattled by recent global cyberattacks, U.S. hospitals are conducting tests to detect weaknesses in specific devices, and asking manufacturers to reveal the proprietary software running the products in order to identify vulnerabilities. In some cases, hospitals have canceled orders and rejected bids for devices that lacked safety features. Credit-rating agency Moody’s Investors Service in February ranked hospitals as one of the sectors most vulnerable to cyberattacks. Click here for the report.

Legislation To Fix 3-Day-Stay Requirement Could Move Forward
In a speech before the Center for Medicare Advocacy’s Annual Summit, Rep. Joe Courtney (D-CT) was optimistic his re-introduced legislation that would count beneficiaries’ time spent under observation toward the three-day hospital stay required before Medicare covers nursing home care could actually move this Congress. Under current law, in order for Medicare to pay for a nursing home stay, a patient must first have a three-day inpatient stay, not including any time spent in the hospital as an outpatient under observation or the day a patient was discharged. Click here for more on his speech at the summit (scroll down to middle of the page).

FTC Commissioner Urges More Aggressible Policing of Health Care Mergers
In a speech to the Center for American Progress last week, Federal Trade Commissioner Rebecca Kelly Slaughter urged antitrust enforcers to be aggressive in policing mergers in the health care industry to keep costs down for consumers, even if it means a greater risk of losing cases. These remarks echo the calls among lawmakers and policy advocates who say antitrust officials at the FTC and the Justice Department need to get tougher on mergers across industries. The FTC regularly investigates mergers between health-care providers like hospitals and insurers. The commissioner also called private-equity acquisitions in health care a “really disturbing trend” in response to a question about leveraged buyouts in the industry. Click here to view the session.

United States Birth Rates Hit 32 Year Low
In a report recently released by the CDC, last year the birthrate in the United States dropped 2% from 2018, making 2018 the lowest number of births in a year since 1986. Contributing to this decrease is record fertility lows, as well as a drop in teenage pregnancies. This decrease of fertility and birth rate alike brings the United States more in line with other wealthy nations like Canada, England, and those of Western Europe. For the full report click here.  Click here for more analysis from the NYTimes.

New Liver Allocation Rules Goes into Place then Blocked; Transplant Centers in Conflict
On May 14th, U.S. District Judge Amy Totenberg denied to issue a temporary restraining order on the new Liver Allocation Policy that will change how livers are distributed for transplantation.  HHS lifted its pause on implementation and set about moving the new policy into effect immediately. The very next day, the Judge filed an order to pause implementation efforts until an appellate court can weigh in on the issue. “The court again finds itself thrust into maelstrom of this preliminary issue prior to the court of appeals having a chance to weigh in on the matter,” she wrote in the new ruling. In addition and in light of the new order, the United Network for Organ Sharing, which oversees organ distribution, asked for clarification from the judge as “the policy has already been implemented.”  For the latest ruling, click here.  Transplant centers across the country are now in open conflict.  Click here for the Washington Post report.  Click here for the news coverage from Atlanta.

Elder Care Homes Making Big Profits, Under Increasing Scruitiny
The growth of board-and-care homes in neighborhoods across the United States is tied to medical advances, enabling aging baby boomers to live longer despite debilitating illnesses. This has resulted in an increasing number of gravely ill people or their family members seeking an alternative to costly nursing home care. There were about 29,000 residential care communities nationwide and about 300,000 full-time caregivers in 2016, according to the most recent federal figures available. About two-thirds are smaller facilities with four to 25 residents, many with dementia. California leads the nation with more than 7,300 residential care facilities licensed by the state. Click here for the NYTimes report.

Pediatric End-of-Life Care: Where Do Children Go?
The New York Times this week sheds light on an underserved portion of our population here in the United States: dying children. Approximately 43,000 children a year have need of palliative care services with little choice as to where to go. Generally the answer to this is hospice care but most of these facilities are geared towards the elderly and terminally ill, not children. The article examines a few hospice programs that have come up with child-focused solutions but they are few and far between. For the full  article, click here.

HRSA Awards $24 Million in Rural Grants for Opioid Response
The Health Resources and Services Administration’s Federal Office of Rural Health Policy has announced $24 million in grants were awarded in the second round of Rural Communities Opioid Response Programs for organizations to develop plans to implement and sustain substance use disorder, including opioid use disorder, prevention, treatment, and recovery interventions. Recipients across 40 states will receive $200,000 each for one year to work to reduce morbidity and mortality in high-risk rural communities. Click here for more from HRSA.

FDA Warns Against Unauthorized Diabetes Management Devices
In a warning statement issued by the FDA, people with diabetes who use continuous glucose monitoring systems (CGMs), insulin pumps, or automated insulin dosing (AID) systems to manage their diabetes should be aware that use of devices not authorized for sale in the United States may be putting themselves at risk for serious injury or even death. Concerns over cost and availability have pushed patients to look for alternatives, but the FDA urges communication with patients’ healthcare providers to find a safer solution. For the warning statement from the FDA, click here.

African-American Women in the South More Likely to Die from Breast Cancer
That’s according to a new analysis by the Pew Charitable Trusts. The study shows that treatment advances have improved breast cancer survival rates among all U.S. women, but the disparity between white and black women has grown as black women are 40% more likely to die from the disease. Additionally, the highest disparity is in southern states.  For example, Louisiana and Mississippi have the highest racial disparities in breast cancer mortality with the excess death rate among black women at more than 60%. Alabama, Arkansas, Georgia, North Carolina, South Carolina and Tennessee all have excess death rates over 40%. To read more, click here.

“Fake” Social Media Is Negatively Impacting Healthy Living
The increase in social media fitness influencers are causing people to strive to achieve an unnatural or genetically impossible bodies. These influencers are often photoshopped or have had cosmetic surgery to maintain a flatter stomach and thinner legs, leading to unrealistic goals. When a woman’s body fat diminishes below 22% hormonal changes can cause negative health implications, such as reduced fertility, yet social media encourages women to have visible abdominal muscles (which are visible around 16-19% body fat). To read more about the implications of these harmful body images, click here.

Not Surprising, Highly Processed Foods Lead to Weight Gain
A recent NIH study suggests that ultra-processed diets cause excess calorie intake and subsequent weight gain. The study evaluated 20 adults with stable BMIs of about 27. The randomly selected participants were given an ultra-processed diet or unprocessed diet for the span of 2 weeks and then given an alternate diet for the following 2 weeks. The study found that energy, carbohydrate, and fat intake increased while protein intake decreased on the ultra-processed diet and the increase in energy intake correlated with weight gain. The study concluded that restricting ultra-processed diets may be used for obesity prevention and treatment. To read the full study, click here.