23 Sep September 23, 2019

Surprise Billing Legislation on Slower Track; Swing State Voters Oppose 
Three different House committees are working on surprise billing legislation…a process that has significantly slowed action on producing a concensus bill. Last week, the House Education and Labor Committee postponed a vote on its surprise billing package mostly because committee members cannot agree on whether to go forward with a benchmark payment rate or an independent dispute resolution process, or to go with a simpler bill that would just not allow hospitals to send surprise medical bills to patients. Meanwhile the House Ways & Means Committee plans to soon release its own surprise billing legislation. The House Energy and Commerce Committee, which has already passed a bill, announced a bipartisan investigation into private equity firms that own physician staffing companies and are financing a campaign that favors physicians in the surprise billing debate.  Committee leaders sent letters to firms requesting information and documents pertaining to staffing and emergency transportation companies. Click here to see the letter. The Energy and Commerce-passed bill was scored by the Congressional Budget Office at a cost of $20.1 billion over 10-years because it also includes an extension of Medicare and Medicaid programs such as community health centers and health education. Click here for the CBO estimate.  In one of the most interesting developments, a leaked poll showed that swing state voters oppose surprise billing legislation. Click here.

• The American Hospital Association sent a letter to the Education and Labor Committee stating that providers and insurers should “be permitted to negotiate payment rates for services provided” rather than have rates set by government, click here.
• In another report slamming the health care industry, news outlet Axios says health care companies, including many not-for-proft health sytems, have continued to post record-level profits, hospitals alone had a combined net profit margin of 8.6-percent, click here.
• An HHS OIG report found that Medicare made improper payments of $1.9 million to providers for emergency ambulance transports to destinations other than hospitals or skilled nursing facilities. Medical transport services are seen as a large part of surprise billing issue, click here.

House Passes Bill to Avert Government Shutdown, Delay DSH Cuts, Extend Health Programs
The fiscal year ends at the end of the month and the House easily passed a measure by a vote of 301-123 that will continue funding the government through November 21st with the Senate expected to also pass the bill this week for President’s signature. The measure includes a provision to delay the reduction in the allotments for Medicaid disproportionate share hospitals which was set to go into effect on October 1st and cut $4 billion in funds. Additionally, the bill would continue to fund graduate medical education, community health centers, diabetes programs, and behavioral health clinics. The bill would also allow U.S. territories like Puerto Rico and the Virgin Islands to keep receiving maximum federal medical assistance, funding that had been running out. To view the bill, click here and for the Committee summary, click here.

• The Senate Appropriations Committee is developing its own versions of the spending bills for the next fiscal year, but so far, they do not include a long-term delay in the DSH funding cuts. The Labor-HHS bill included $93.4 billion in discretionary funding, click here for the committee summary and here for the bill.

Federal Judge Finds for Hospitals in HOPD Site Neutral Case
U.S. District Judge Rosemary Collyer has found that CMS had exceeded its authority and threw out a regulation that cut what Medicare pays for certain hospital outpatient department clinic visits, siding with hospitals that challenged HHS over the policy. The American Hospital Association, the Association of American Medical Colleges and three hospitals sued last year after the rule was finalized, and argued that the policy hurt their ability to care for the most vulnerable patients. Important to note, the Court did not grant the hospitals’ request for CMS to reimburse them for the cuts, but set a date of October 1st for a status report on whether additional briefings on a remedy are needed. CMS is expected to appeal the ruling. Click here to view the ruling.

House Speaker Unveils Drug Pricing Legislation
The long-awaited drug pricing proposal drafted by House Speaker Nancy Pelosi (D-CA) was released last week would allow HHS to negotiate prices with pharmaceutical manufacturers on as many as 250 of the highest cost brand-name drugs that do not have generic or biosimiliar competitors on the market and insulin must be included as one of the drugs to be negotiated. The maximum price negotiated for the drugs would be tied to the cost paid in other developed countries, where medicines often sell for less. The bill would place penalties on companies who refuse to participate and force them to pay rebates if they raise prices more than the inflation rate. The proposal would also implement a $2,000 out-of-pocket cap on costs for beneficiaries in Medicare Part D drug plans and reduce the amount the federal government pays in Part D and increase the costs borne by insurers and drug manufacturers. House Republicans were quick to criticize the plan saying that negotiating prices is akin to price controls and Senate Majority Leader Mitch McConnell (R-KY) declared the bill dead on arrival in the Senate. Click herefor the bill text and here for the summary.

• Rep. David Cicilline (D-RI) introduced a bill that would prohibit drug companies from engaging in “product hopping,” which involves switching patients from a drug whose patent is about to expire to a new product that companies have the exclusive right to sell, click here.
• A House Energy and Commerce Subcommittee held a hearing to examine how pharmaceutical companies are using anti-competitive strategies, such as product hopping and ever-greening, to increase profits, click here.
• According to the AARP, the growth of retail prices of over 750 brand name, generic, and specialty prescription drugs surpassed the rate of inflation in 2017 at a rate of 4.2-percent versus the rate of inflation tof 2.1-percent, click here.
• A House Energy and Commerce Health Subcommittee will have a hearing on Wednesday on legislation to lower the cost of drugs, most of the bills concentrate on allowing the government to negotiate rates, click here.
• AARP is taking on drug companies with an all out blitz aimed at lowering cost of pharmaceuticals, click here.

Reports of Vaping Illnesses Increase, Congress Takes Action, FDA Proposes Increased Oversight
According to the CDC and FDA, the number of people who have become sick as a result of a vaping-related lung illness has increased to 530 people nationwide with eight deaths linked to illness, leading to a criminal probe by the FDA into the supply chain of the products. Both the House and Senate are ramping up oversight and introducing legislation to combat the problem. Sen. Dick Durbin (D-IL), along with eight other Democratic senators, introduced legislation that would impose a federal tax on e-cigarettes for the first time and simultaneously raise taxes on other forms of tobacco. Sens. Mitt Romney (R-UT) and Jeff Merkley (D-MA) introduced a bill that would ban flavors other than tobacco, create new design standards for e-cigarettes, monitor health risks for the technology, apply existing tobacco taxes to e-cigarettes and urge HHS to run a campaign to educate Americans about any health risks of e-cigarettes. Reps. Tom Suozzi (D-NY) and Pete King (R-NY) released their own bill that would ban flavored e-cigarettes, tax those still on the market, and triple federal taxes on other types of tobacco. Also last week, the FDA proposed a rule to allow e-cigarette products to be sold only after they have shown they can be marketed in a way that protects public health. Click here for more on the Durbin bill, here for the Romney bill, here for the Suozzi bill, and here for the FDA rule.

• Teen e-cigarette use has doubled in the past two years, with a quarter of high school seniors and a fifth of 10th graders now reporting they used nicotine vapes in the past month, according to the National Institute on Drug Abuse, click here.
• The CDC has launched its emergency operations center to coordinate the investigation into hundreds of cases of severe lung illnesses linked to e-cigarette use, click here.
• Walmart announced last week that it intends to end sales of e-cigarettes and vaping products in all of its U.S. stores, click here.
• A House Investigations Subcommittee announced a hearing on Wednesday on the public health risks of e-cigarettes, click here.
• Another House committee scheduled a hearing on Tuesday to examine the outbreak of vaping lung illness and the CDC’s urgent warning, click here.

House Committee To Investigate How States are Utilizing Opioid Funds
The House Energy and Commerce Committee began a bipartisan investigation into how states are using federal funds to respond to the opioid crisis through treatment and recovery efforts. Specifically, they asked the Governors of Florida, Indiana, Kentucky, Maine, Maryland, Massachusetts, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, Tennessee, West Virginia, and Wisconsin the following:

• How much federal funding for opioid use disorder prevention, treatment, and recovery has each state received since 2016?
• What challenges, if any, exist in deploying federal funds to local communities in an expedited manner?
• How do states determine which local government entities receive federal grant funding.
• Do federally appropriated funds to address the opioid crisis provide states with the flexibility to focus on the hardest hit regions or localities?
• What additional resources would be most helpful?

Governors are asked to send their responses by October 18th. To view the letters (at the bottom of the press release), click here.

Providers, Insurers Battle Over Highly Concentrated, Non-Competitive Markets
The American Medical Association has released a report that shows an estimated 73 million Americans with commercial health insurance live in highly concentrated markets and face limited choices as competition has decreased over four years: a situation that can have negative consequences for patients who rely on commercial health insurance. AMA points to insurance consolidation, such as Anthem-Cigna and Aetna-Humana, as a major impact on the commercial markets. America’s Health Insurance Plans hit back pointing to a study from the Health Care Cost Institute that found 72-percent of hospital metro markets were highly concentrated, which have been linked to the rising cost of hospital care Click here for the AMA study, and here for the HCCI study.

• A new report from the Robert Wood Johnson Foundation found that ACA marketplaces are stabilizing with more insurers filling gaps, there are 13-percent fewer markets with only one insurer, click here.

Tennessee Unveils New Plan to Cap Medicaid and Convert to Block-Grants
Tennessee has unveiled its first-in-the-nation proposal to cap federal funding for its Medicaid program and phase out the open-ended entitlement in exchange for new flexibility. Strongly supported by conservatives, the plan could trigger similar plans from other conservative-leaning states, contingent on federal approval. The new plan will shake up approaches to Medicaid that have been used for years. The plan would mean that the government would pay the state a lump-sum every year and would give the state free reign, as federal rules about who must be included would no longer be applicable. Tennessee argues that this would allow them to run the program more efficiently. To learn more, click here.

• A University of Michigan law professor challenges the legality of Tennessee’s proposal for block grants into its Medicaid program, click here.

Model Approved to Boost Stroke Care at Rural Hospitals
CMS’ Physician-Focused Payment Model Technical Advisory Committee (PTAC) voted to support ACCESS Telemedicine, a model that aims to improve neurological emergency services and access to appropriate care in rural areas by using telemedicine to allow physicians to consult neurological specialists better  equipped to handle those cases. The ACCESS model would help decrease the amount of unnecessary transfers to tertiary hospitals. In addition to the committee voting unanimously in favor of ACCESS, they recommended to further develop the proposal rather than implement the model as written in a vote of 9-2. To read  more on ACCESS, click here.

Multiple Readmissions for Dialysis Patients Leads to Lower Outcomes
According to a recent study by the Agency for Healthcare Research and Quality, patients who received dialysis and were hospitalized multiple times had a higher risk of poor outcomes than those who were not hospitalized or were only hospitalized once. The study found that nearly one in five patients in the first year of dialysis were admitted to a hospital and then were readmitted within 30 days of discharge. These patients were at a substantially higher risk of another hospitalization or death and a lower likelihood of kidney transplantation than other dialysis patients. The researchers concluded that looking at strategies to prevent readmission among dialysis patients may improve outcomes. To read the study, click here.

• The Comprehensive End-Stage Renal Disease Care Model, a specialized accountable care model targeting end-stage renal disease patients, delivered promising results during its first two years of implementation, according to a new analysis. Click here.

Millions of Patient Medical Imaging Records are Unprotected 
The imaging records for millions of patients are left unprotected, some of which pull up PHI with a simple query in the database, according to a new media investigation. ProPublica reports identifying 187 computer servers that have unprotected medical scans, including X-rays, MRIs, and CTs of over 5 million Americans as well as millions of other patients internationally. The majority of these accessible records came from independent medical centers rather than large hospitals, which tended to implement security protections on patient scans. Click here to read the full report.

Senate Passes Legislation to Expand Autism Programs
The Senate has passed legislation that would that would authorize about $370 million annually through fiscal 2024 for research, education and intervention programs for individuals with autism spectrum disorder. The legislation (H.R. 1058), that already passed the House, heads to the President for his signature. Among other benefits, it allows program participants to receive assistance throughout their lives, not just in childhood. Click here for the bill.

HHS Awards Over $85 Million to Expand Access to Oral Health
HHS has announced that it will award more than $85 million to nearly 300 health centers to improve oral health. HHS said health centers are imperative to giving patients access to the care that they need, and oral health is a critical part of that. Each center will receive up to $300,000 to update facilities, add equipment, or for other necessities. Health centers have seen a 13% increase in dental patients in recent years. In 2018, health centers funded by HRSA supplied more than 16.5 million dental visits. To read the full report from HHS, click here. To see the list of award recipients, click here.

Study: Medicare ACO’s Have Saved $1 Billion
Since its participation in Medicare Shared Savings Program, accountable care organizations have saved $1 billion. The report from Innovaccer states: “The adoption of value-based care models is expected to account for 59 percent of healthcare payments by 2020, as the healthcare industry uses value-based care to address these high-cost utilizers.” 9 of the 53 parameters ACOs cover were found to be critical including emergency room visits, long-term care hospital discharges, use of imaging for low back pain, and others. Researchers believe that ACOs are the ideal model to follow for the future of health care. To read the full report, click here.

• Nine organizations wrote to CMS administrator Seema Verma to “expeditiously pay” for participation in Advanced Alternative Payment Models, click here.

Few Physicians Ask Patients about 5 Key Social Determinates of Health: Study
According to a new study published in JAMA, few physician practices and hospitals ask patients about five key social determinates of health. Food insecurity, housing instability, utility needs, transportation needs, and interpersonal violence are key aspects to a patient’s overall health outcomes. However, according to the study, with responses from over 2,000 practices and over 700 hospitals, only 24.4% of hospitals and 15.6% of private practices screen for all five determinates. Interpersonal violence is most screened for, while utility needs is least screened. To read the full study, click here.

• A new report from the GAO shows mixed-results from states surveyed about coordinating patient care and addressing social determinates of health, click here.

Generic Zantac Maker Stops Distribution
One manufacturer of generic ranitidine (Zantac), Novartis’s Sandoz unit, has reportedly decided to halt distribution of the antacid drug until a contamination issue is resolved. The FDA says some lots of ranitidine, a histamine H2 inhibitor, were found to contain small amounts of N-nitrosodimethylamine (NDMA), considered to be a human carcinogen. NDMA is a member of the nitrosamine family of chemicals also found to have contaminated some angiotensin receptor blocker drugs, sparking an uproar that still hasn’t died down. Click here for details.

New Combo Pill Could Prevent Heart Attacks
A new, daily pill that combines four different medications has recently been tested in the United States. The year-long study observed 300 individuals, ages 45-75, at a health center in Mobile, Alabama, half of whom took the combo pill, while the other half continued their usual care. After a year, patients who had taken the combo pill had lowered their LDL levels and blood pressure. The study, funded by the American Heart Association and National Institutes of Health, wanted to find a successful and inexpensive treatment for conditions leading heart attacks and strokes, among low income adults. While the study shows promise, polypills are currently not available in the U.S. To read more, click here.

• A nutrition advocacy organization just released its most comprehensive and restrictive dietary recommendations to date. The guidelines focus on completely restricting any drinks that have added sugars, in favor of milk and water. To review the guidelines, click here.

Study: Teen Girls Who go to Bed Later are More Likely to Gain Weight
A new study funded by the National Institutes of Health conducted a study of teenage boys and girls measuring the difference in their “social jetlag” by estimating weeknight and weekend bedtimes and how that affects body composition, specifically fat. The findings concluded that teenage girls who have more social jetlag, or go to bed later in general, have a higher percentage of fat, whereas results for the boys were not statistically significant. Researchers suggest sticking to a bedtime to reduce social jetlag and therefore reduce the risk of obesity. Click here to read the full release from NIH.

HHS Releases Plan to Increase Youth Sports Participation
Health and Human Services has released The National Youth Sports Strategy, a plan to engage youth in physical activity regardless of external factors such as race, zipcode, and sex that could hinder their ability to do so. This strategy was created in response to President Trump’s Executive Order calling for more of America’s youth to participate in physical activity. It hopes to increase the public’s awareness about the importance and benefits of physical activity as well as recruiting volunteers for youth sports programs. To read the full HHS news release, click here.