May 28, 2019

Senate Committee Tackles Health Care Costs with Major Reform Bill

The Senate Health Committee has released draft legislation that includes proposals on drug pricing, surprise billing, electronic health records and public health. The bill would set up an information exchange program for commercial insurers, strengthen incentives to improve cybersecurity practices, require a study of third-party health apps, and increase cost transparency, among other proposals aimed at lowering health costs. Not included in the current draft is the speculated 340B transparency language, although it  be could be added later as an amendment during markup in June. The bill does hit pharmacy benefit managers hard by prohibiting PBMs from engaging in spread pricing, or charging a health plan, patient or plan sponsor more for a drug than the PBM paid to acquire it. Additionally, PBMs would be required to pass on 100-percent of any rebates or discounts that they negotiate with drug companies to insurers. Also there are measures meant to tackle rising maternal mortality rates and target vaccine hesitancy amid the nation’s largest measles outbreak in 25 years. Click here for the draft legislation, here for the Committee summary, and here for the Committee’s release including additional explaining documents.

  • The White House could release an executive order as early as this week to compel the disclosure of health care prices, click here.
  • The New York Times takes a look at the cost of health care versus actual benefits patients receive in different parts of the country, click here.

House Committee Focuses on Surprise; No Conclusions Reached
The House Ways and Means Committee did its part in the ongoing development of policies to deal with medical surprise billing last week with a hearing that clearly identified the problem with no solution in sight. There was an overall consensus by both Republicans and Democrats that patients were being taken advantage of by high out-of-network provider charges and that surprise billing needed to end; however, there was no agreement on how to resolve the issues and how to get into the middle of the argument between insurers, hospitals, and doctors. Members and witnesses discussed recent state imposed solutions saying that even though some of the state policies have worked but, a federal policy solution is needed to truly alleviate the problem. Recent policies that increase price transparency were discussed as a way to inform patients, but there was no solution between the many industry groups or Congressional leaders on how to legislate on the overall issue. Click here to watch the hearing, here for the testimony of the American Medical Association, here for America’s Health Insurance Plans, here for the American Hospital Association, and here for the ERISA Industry Committee.

  • The American Hospital Association released a report this week showing that tax-exempt hospitals provided $95 billion in total benefits to their communities in 2016, click here.
  • Sen. Bill Cassidy’s (R-LA) STOP Surprise Medical Bills Act (S. 1531) is gaining momentum picking up even more bi-partisan co-sponsors this week for a total of 20 co-sponsors, click here for the legislation, here for the section-by-section, and here for the co-sponsor list.
  • Washington Post does a good job discussing all of the work going on with surprise billing in both the House and Senate, click here.
  • Click here for a good NYTimes report on surprise billing.

House Committees Solicit Feedback on Reforms of Medicare Part D Program
The Ways and Means Committee and Energy and Commerce Committee last week requested comments on draft legislation that would reform and improve the Medicare Part D program and establish an out-of-pocket cap for beneficiaries. Additionally, the draft would change the incentive structure for Part D plans to manage costs by reducing the government’s share of the catastrophic coverage from 80 percent to 20 percent over four years.  These proposals are much in line with the President’s FY 2019 and 2020 budgets and MedPAC recommended changes to the program. Click here for the draft and here for the solicitation for comments.

CBO Testifies that Medicare-for-All Will Give More Coverage But Will Lead to More Government Control
In another Medicare-for-All hearing last week, this time before the House Budget Committee, the non-partisan Congressional Budget Office testified that the proposed single-payer health care system would result in “many more” people with health insurance but would also be “potentially disruptive” and increase government control. CBO deputy director Mark Hadley stated in his testimony that while overall coverage would certainly increase, that because health care represents around one-sixth of the economy the proposed “changes could significantly affect the overall U.S. economy” and be “potentially disruptive.” Additionally, he testified that if more people gained coverage while payment rates to doctors and hospitals went down there could be a lack of supply of health care causing “increased wait times and problems with access to care.” Click here to view the hearing and here for Hadley’s written testimony. And for a more extensive synopsis of the hearing, click here.

Major Payment Cuts Loom in Medicaid Programs
Payment cuts are on the horizon October 1 for all disproportionate share hospitals, as mandated by the Affordable Care Act, to the tune of $4 billion in the first year and doubling to $8 billion in years following. However, a lesser known program is also due to expire at the end of the fiscal year leading to massive cuts for U.S. Territories who are funded under a different Medicaid structure than the states. U.S. territories’ Medicaid programs receive a fixed matching rate of federal funding, unlike the states, which have matching rates that can rise when poverty increases. If a territory exceeds that fixed cap, the territory is responsible for 100 percent of future costs. The ACA and a 2018 bipartisan budget law provided temporary additional funding to some of these areas, but much of it expires at the end of September. Add to the problem that many territories such as Puerto Rico and the Virgin Islands are still recovering from the after effects of Hurricanes Irma and Maria. For more on the issue, click here.

Counties with Medicaid Managed Care Increase by 11 Percent in 5 Years
According to a new study from the Robert Wood Johnson Foundation, the share of the population in a county with a Medicaid Managed Care Organization in the marketplace increased from 48% in 2015 to 57% in 2019…with a MMCO present in 952 counties now in 2019, compared to 542 counties in 2015. To see the full study click here.

New Legislation Combats Misinformation About Vaccines
Bipartisan legislation was introduced in the House last week – the VACCINES Act (H.R. 2862) – that would fund new CDC research and educational programs to combat vaccine hesitancy with an aim to increase immunization rates across the country. The bill was sponsored by Rep. Kim Schrier (D-WA), a doctor from the state where the current measles outbreak got started, along with Reps. Michael Burgess (R-TX), also a doctor, Eliot Engel (D-NY), Kurt Schrader (D-OR), Gus Bilirakis (R-FL) and Brett Guthrie (R-KY). The recently released draft on health care costs by the Senate HELP Committee (see above) includes an authorization for a national campaign to increase awareness, fight misinformation and disseminate evidence-based information about vaccines. It would also authorize grants for research and educational campaigns and boost disease outbreak response with grants to state and local public health departments to improve their data collection systems. The CDC has confirmed more than 880 cases of measles this year in 25 states. Most of the cases occurred when travelers from abroad brought the virus into communities of unvaccinated people. Click here for H.R. 2862, and here for more on the Senate bill section that includes vaccine related policies.

  • The California Senate passed a bill that gives public health officials, rather than physicians, the power to determine vaccine exemptions; the bill is a direct response to the increase in exemptions being sold by physicians, after non-medical exemptions were banned in California in 2016, click here.
  • State officials fighting measles outbreaks threaten to use rare ban to keep U.S. patients from boarding airplanes, click here.
  • Democratic Gov. Janet Mills on Friday signed into law a bill that eliminates religious and philosophical exemptions for vaccinations in Maine, which has one of the highest rates of non-medical vaccine exemptions in the nation, and health officials say the opt-out rates appear to be rising. Click here.

MIPS May Not have the Desired Results
The push for pay-for-performance for physicians, specifically through the Merit-based Incentive Payment System, may not actually have a significant reduction on hospital readmissions, according to a study just released by the Annals of Internal Medicine.  The study was based on Texas Medicare claims over two 47 month periods and compared 30-day readmission rates prior to the implementation of MIPS in 2015 to post implementation 30-day readmission rates. “Our finding of minimal variation in risk for readmission among PCPs calls into question any pay-for-performance program that aims to reduce readmissions and assumes variation by PCP,” the researchers wrote. The difference in the 30-day readmission rates? Only 1.1 percent. Read the study in its entirety, click here.

HHS Clarifies HIPAA Compliance for Business Associates
The HHS Office of Civil Rights has issued a new fact sheet that provides a clear compilation of all provisions through which a business associate can be held directly liable for compliance with certain requirements of the HIPAA Privacy, Security, Breach Notification, and Enforcement Rules (“HIPAA Rules”), in accordance with the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009. Click here for details.

More Women are Dying of Uterine Cancer
That National Cancer Institute just released a report with troubling findings. Women aged 30-70 in data sourced from 2018 have increasingly been diagnosed with aggressive and deadly uterine cancers. As the most common cancer and second deadliest gynecologic cancer in the U.S., the rise contrasts with the decrease of other cancers and scientists do not have a reason why. Comparatively, the CDC released a report revealing that death rates from cardiovascular cancer have dropped 19 percent between 1999 and 2017.  For the full report on uterine cancer, click here, and for the CDC cancer report, click here.

  • The American Cancer Society also published a new study revealing that Medicaid expansion has been tied to increased cancer screening, a 4-9 percent increase among states with Medicaid expansion, click here.

Colorado Caps Rising Insulin Prices; CDC Releases Drug Cost Strategies for Seniors Report
Over the last two decades, the cost of insulin rose over 700% across the board and Colorado has become the first state to set a price cap on insulin co-payments for its citizens on private insurance. The price ceiling has been set at $100, giving residents much needed relief from the $600-$900 a month cost. The legislation also holds Attorney General Phil Wiser accountable to investigate the price hikes on insulin. Gov. Jared Polis hopes that this will set the trend for other states to combat rising drug costs as federal legislation circles in congress. This news the same week the CDC releases a report revealing strategies that patients aged 65 and older use to reduce drug costs individually. The report revealing almost 5% do not take their medications as prescribed, and almost 18% requesting alternative or lower cost drugs. Click here for the local CBS Denver report, and here for the CDC report.

Wide Price Variations for Health Tests Costing Billions Too Much: UnitedHealthGroup
In a recently released report from UnitedHealth Group, they examined 7 groups of common minimally invasive outpatient diagnostic tests in 2017 paid for by their members. Across the seven groups this resulted in over 12.5 million tests run, and a variation in price on the same test. This variation ranged as small as twice the cost for the same test, up to twenty times the cost for the same test; an echocardiogram had a nine-fold increase for instance ranging as low as $210 and up to $1830. By eliminating such dramatic price variation and re-pricing everything that ranked above the 40th percentile down to the 40th percentile, there could have been a $18.5 billion [49-percent] savings in 2017. To read the report, click here.

New Artificial Intelligence May Become More Accurate Than Radiologists 
In a study done by software engineers at Google, artificial intelligence was able to read 6,716 lung CT scans with 94% accuracy as opposed to the current standing 30% rate of false negatives from chest CT scans. This positive achievement shows great promise, although it may not be ready to be implemented quite yet. AI software grows more intelligent the more data it takes in, and computers may be able to recognize subtle changes in a CT scan that human doctors cannot. AI still can make errors however, and the use of AI in the medical field raises concerns of cybersecurity and widespread misinformation that could potentially be spread from one single source. Click here for the study. Click here for a New York Times article.

Contact with Nature in Childhood Could Result in Better Mental Health as an Adult
A study of 3,600 people conducted in Barcelona found that adults who had been exposed to nature more often as a child had better mental health in adulthood. This comes at a time where more and more children are being raised in urban environments without easy access to nature. It underscores the importance of having safe and appealing parks in these urban communities, as well as the importance of getting children off screens and outside. Click here for the report.00?

Want to Live to 100?
As the number of centenarians rises in the U.S. so does the incidence of disease and lonliness.  But the upside includes seeing great-great grandchildren and witnessing history.  Click here for a review of the advantages and disadvantages from the WSJ.

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