09 Sep September 9, 2019

Physician Groups Continue to Lobby Against Provisions in Surprise Billing Legislation
Various congressional committees will turn their attention this week to surprise billing legislation as physician groups have stepped up lobbying efforts against the current surprise billing bills that passed out of Senate and House committees earlier in the summer. The doctor groups argue that relying only on rate setting, as the current Senate legislation does, will take away physicians’ leverage in price negotiations and eventually lead to hospital closures, and that adding an arbitration backstop can alleviate those concerns. The House Energy & Commerce Committee approved surprise billing legislation that includes both a benchmark payment and an arbitration backstop; however, many health care groups have concerns with various aspects of the bill. In addition to in-person lobbying efforts, the American College of Emergency Physicians outlined their concerns in a letter to the Senate Health Committee stating that a benchmark payment could negatively impact smaller emergency physician practices. Another letter from 10 physician groups to the House Ways and Means Committee details ideas for a surprise billing package that the Committee is reportedly working on. To read the ACEP letter, click here and here for the group letter.

• The group Doctor Patient Unity is mounting a direct mail campaign in addition to the ongoing TV advertisements that it has been running for the past few weeks calling out the legislation as government price fixing, click here.
• State Insurance Commissioners sent a letter to the Senate Health Committee urging protections against surprise billing by air ambulance providers in the Senate’s surprise billing package, click here.

MedPAC Refining Redesign of Post-Acute Payment Policy
The Medicare Payment Advisory Commission is moving forward on its redesign of post-acute payment policy, with an emphasis on measuring value and providing performance bonuses. MedPAC’s uniform, value-based payment proposal would apply to the four settings that provide post-acute care: nursing homes, in-home care, inpatient rehabilitation facilities, and long-term acute care hospitals.  MedPAC commissioners met last week in Washington to review the status of its redesign plans.  Commissioners will likely complete their proposal to Congress in the spring. Click here to see the Commission’s slide presentation.

• At least one commissioner, a health system executive, lamented the overall lack of progress on reigning-in the growth of Medicare spending.  Click here for the report.
• MedPAC also discussed whether CMS should seek authority from Congress to expand its durable medical equipment competitive bidding program — potentially even beyond DME — because the commission views the program as a success. Click here for the slide presentation.
• MedPAC is also considering ways indirect medical education payments could be reallocated so that IME adjustments would apply to both inpatient and outpatient care. To review MedPAC’s complete September agenda and corresponding presentations, click here.

Speaker Pelosi’s Plots a More Middle Ground Approach on Reforming Federal Rx Policies
Former Obama and Clinton Administration health care officials have reviewed and endorsed the approach House Speaker Nancy Pelosi is likely to reveal this month in House Democrats’ proposal to reform federal pharmaceutical policies.  The plan is in stark contrast to the direct government negotiation policies that are the preference of the more progressive members of the Democrat Caucus. The former officials argue that Pelosi’s arbitration approach will encourage settlements between the government and drug companies and would not hurt innovation because the fallback for failed negotiation is not “an arbitrarily low price dictated by the government.” Click here to read the full article. Click here for a review of the key elements of Pelosi’s drug reform plan.

• The pharmaceutical industry ranked dead last in Gallup’s survey of public opinion below oil and gas, big banks, and the federal government, click here.

At Least 5 Deaths Attributed To Vaping; CDC and FDA Issue Warnings
With disease and even death – possibly as many as five – caused from vaping e-cigarettes rapidly increasing, FDA and CDC officials in recent conference calls have notified states that severe lung illness linked to vaping has more than doubled to 450 possible cases in 33 states, including as many as five deaths. Investigators at FDA found an oil commonly available as a nutritional supplement and is used in topical skin treatments in cannabis vaping products in samples collected from patients who fell ill across the country. And while CDC officials will not confirm the chemical that is causing the severe lung illnesses, they believe that some “chemical” is involved and warned people against using vaping products in an advisory. Click herefor the CDC Advisory. Click here for more from the New York Times, and here for more from the Washington Post.

• Michigan is the first state to ban flavored e-cigarettes in crackdown on vaping, including both in-store and on-line sales and will apply to all flavors, including mint and menthol, click here.
• Key House committee chairman sent a letter last week to the FDA suggesting it should evaluate whether Juul is making “therapeutic claims” that may be violating the agency’s regulations, click here.
• A hospitalized teenager with severe lung damage from vaping has a message for his peers, click here.

HHS Awards $1.8 Billion To Battle Opiate Crisis
HHS has announced $1.8 billion will go to the states to continue the Trump Administration’s battle against the opiate crisis. The CDC will contribute more than $900 million for spreading resources on opioid misuse, overdose, and death, as well as collecting real-time data on opioid overdoses. The Substance Abuse and Mental Health Services Administration will award $932 million in response grants, which will allow states additional funding for prevention and treatment options. Opioid misuse, overdose, and death has decreased in recent years for the first time in more than 20 years. HHS hopes the additional funding and resources will continue this trend. For more from HHS, click here.

• A new study suggests prescription drug monitoring programs have a positive health impact as they lower opioid-related hospital and emergency department visits, click here.

New Mexico Hospital Sues Thousands of Patients who Struggle to Pay their Medical Bills
Former patients of the Carlsbad Medical Center are facing the burden of significant medical costs as the hospital is suing them for what is left of their bills after their insurance company has paid.  At least 3,000 patients have reportedly been sued by the hospital since 2015. Many of the defendants were caught off-guard upon receiving the summons, as they had never received an itemized list of costs they still owed.  Owing thousands of dollars, many cannot afford the payment in full and they were not given any options for payment plans until after the lawsuits were filed. Rising medical costs and surprise bills are a growing problem nationwide, causing many to drain their savings, as the hospital’s prolific use of lawsuits demonstrates. To read the full report from The New York Times, click here.

Federal Judge Approves $69 Billion Acquisition of Aetna by CVS
Months after the deal was initially approved by the Justice Department, U.S. District Judge Richard J. Leon signed off on the merger. The approval was contingent on concerns from the government and the public that the merger would cripple the competition. Judge Leon concluded that competition would remain even after the merger, making the deal one of public interest. The American Medical Association opposes the merger, reiterating the initial concerns of lacking competition and rising costs. To read the full report, click here. To read Judge Leon’s conclusion, click here.

Hospital-Funded Report Makes the Case for Consolidation
In a report funded by the American Hospital Association, research shows that hospital mergers can result in better care, enhanced quality, and lower costs. The analysis, conducted by Charles River Associates, comes on the heals of the reported 90 mergers in 2018 after 115 mergers in 2017 making hospitals the largest share of healthcare spending and, in many Congressional Districts, the largest employer. Click here for the report.  However, after the report was made public, the news media resurrected previous studies that emphasized the negative aspects of hospital mergers.  Click here and here.

• A new NIH study has found that hospital ED closures can adversely affect outcomes for heart attack patients at neighboring hospitals that are near or at full capacity, click here.
• New research from the National Bureau of Economic Research shows that patients are more likely to die following a rural hospital closure, whereas urban closures had no measurable impact on mortality, click here.

Senate Committee Chairman Calls for More Oversight of HHS Mental Health Grants
Senate Finance Committee Chairman Chuck Grassley (R-IA) has sent a letter to HHS Secretary Alex Azar calling for the Department to increase oversight of its mental health programs following a summer of deadly mass shootings. Grassley urged HHS to implement the recommendations suggested by the GAO and HHS IG to improve accountability of mental health grants. “I write with concern that the Department of Health and Human Services and its federal partners are not doing enough to coordinate and effectively target federal resources to the most effective behavioral health programs,” Grassley wrote, saying the matter was urgent following a series of recent deadly attacks. To read the letter, click here.

Senate Appropriators Urged to Allow for National Patient Identifiers
Health groups are urging Senate Appropriators to follow the House’s lead and remove the amendment that prohibits HHS from adopting a national unique patient identifier. The more than 50 health care organizations – that include physicians, hospitals, and insurers – state that the lack of an identifier has stifled innovation and poses serious patient safety risks. Click here for the letter.

ACA Reduced Racial and Ethnic Disparities in Insurance Coverage: Report
The expansion of Medicaid reduced racial and ethnic disparities in most states, according to the new report from the Commonwealth Fund. While all racial and ethnic groups saw a rise in health insurance coverage between 2013 and 2016, minorities below 139% of the national poverty line saw the greatest positive impact. Researchers found that the greatest contributing factor to this increase was the Medicaid expansion program. To read the full report from the Commonwealth Fund, click here. To read more about the Affordable Care Act’s Medicaid expansion program, click here.

• CMS awarded 34 organizations grants to help consumers shop for and enroll in health coverage. Funding would be provided to navigators in states with federally-facilitated health insurance exchanges, click here.

CMS Announces New Rule to Reduce Medicare, Medicaid, and CHIP Fraud by Providers
CMS has announced the final rule for the Program Integrity Enhancements to the Provider Enrollment Process, strengthening the agency’s ability to prevent fraud. The rule gives CMS the ability to bar providers that pose risk to the programs. If a health care provider is affiliated with another provider who has previously committed fraud, that provider can also be blocked. The new rule will be effective November 4, 2019. To read the press release from CMS, click here. To read the final rule from CMS, click here.

New CDC Report Shows Wide Gap Between States with Highest and Lowest Death Rates
The average age-adjusted death rate for the five states with the highest death rate is 49% higher than the age-adjusted death rate for the five states with the lowest death rate, according to a new CDC report.  The report also shows that the age-specific mortality rate for all five states with the highest rate is higher than all five states with the lowest rate. Additionally, mortality rates were higher for non-Hispanic black and non-Hispanic white populations in the states with the higher death rate. Conversely, the death rate for Hispanic populations is higher in the states with lower overall death rates.  To read the full report from the CDC, click here.

HRSA Announces Grants for Integrated Health Care Networks
The Health Resources and Services Administration has announced funding opportunities for nonprofit or public rural entity organizations in the Delta States under the Delta States Rural Development Network Grant Program. Alabama, Arkansas, Illinois, Kentucky, Louisiana, Mississippi, Missouri and Tennessee can apply through Dec. 5th for support for the development of integrated health care networks to address unmet local health care needs and prevalent health disparities in rural Delta communities. Funding will be available for up to 12 organizations. Click here for more.

New York Ends Religious Exemptions for Vaccines; Children Must be Vaccinated to Attend School
With new measles outbreaks across the state, New York became the fifth state to end religious exemptions for vaccines. Roughly 26,000 children in the state must have all recommended vaccines or cannot attend school. Some parents are making appointments for their children to get vaccinated while others are considering home school options or moving out of the state. Many parents are hesitant to introduce vaccines to their children because of the fear of autism, a connection widely disproved by a number of studies and professionals. To read more, click here.

Google Bans Ads for “Unproven or Experimental Medical Techniques”
Google has announced it will no longer accept ads for its sites that are for “unproven or experimental medical techniques,” including most stem cell therapy, cellular therapy and gene therapy. The Internet giant said it was taking the step after seeing “a rise in bad actors” trying to take advantage of patients by offering “untested, deceptive treatments.” The new position comes as stem cell clinics have grown into a sprawling direct-to-consumer industry after years of little enforcement by federal regulators.  Click here for the announcement from Google.

Discount Medical Care: Groupons for the Doctor?
Groupon, the well-known money-saving coupon service has made its presence known in the health care field. Providers have partnered with the company and other discount companies to offer coupons for medical services. Patients are using Groupons in an attempt to avoid the high costs of medical tests. Groupons have been used for various types of scans including CTs, mammograms and ultrasounds; deals tend to be used by people with an insurance gap. To read the full report, click here.

Plant Proteins Can Decrease Mortality 
Perhaps the new meat alternatives may be even better for your health than you thought. New research finds that a higher intake of plant protein leads to lower total mortality. The study followed 70,696 Japanese adults, aged 45-74 years. Additionally, the study found that substituting meat with plant protein was associated with a decreased risk for total, cardiovascular disease-related, and cancer-related mortality. To view the study, click here.