More Than Two Million Surprise Bills Avoided During January-February 2022
This week, AHIP and Blue Cross Blue Shield Association released a survey and analysis of the No Surprises Act (NSA). The report found that the NSA prevented over two million potential surprise medical bills across all commercially insured patients in the first two months of 2022. If this trend continues, the report projects the NSA will prevent over 12 million surprise medical bills in 2022. On Thursday, Senator Patty Murray (D-WA), Chair of the Senate Committee on Health, Education, Labor, and Pensions (HELP), released a statement on the report. The NSA was signed into law as part of the Consolidated Appropriations Act of 2021 on Dec. 27, 2020. This legislation marks the first federal consumer protection from surprise medical billing.
FTC Sues to Block Hospital Acquisitions in New Jersey, Utah
This week, the Federal Trade Commission (FTC) blocked proposed acquisitions of healthcare groups in New Jersey and Utah. The FTC first authorized an administrative complaint and filed a suit in federal court to block the acquisition of Saint Peter’s Healthcare System by RWJBarnbas Health, one of the largest hospital systems in the state. The agency claims the deal would increase prices and reduce quality of care for patients by eliminating head-to-head competition. Specifically, the FTC stated the acquisition will harm inpatient general acute care services, which includes essential medical and surgical diagnostic and treatment services that require an overnight hospital stay. The FTC also authorized an administrative complaint and filed a lawsuit in federal court to prevent the proposed merger between HCA Healthcare and Steward Health Care System in Utah. Both organizations provide inpatient general acute care services. The agency claims the merger would eliminate the second and fourth largest healthcare systems in the Wasatch Front region, where approximately 80% of Utahans live.
The Centers for Medicare & Medicaid Services (CMS) released a report which recommended cost savings from Part B prescription drug spending be re-incorporated into the 2023 Part B premium determination. The Medicare Part B premium builds in a reserve to adequately finance the Supplementary Medical Insurance (SMI) Trust Fund to cover unexpected potential Medicare costs. CMS recommends that this budget surplus be reintegrated into 2023 Part B premium calculation, in order to deliver these savings back to Part B beneficiaries. Mid-year premium redetermination would be logistically infeasible, and CMS does not have sufficient authority to directly send premium refunds.
The Centers for Medicare & Medicaid Services (CMS) released a Behavioral Health Strategy Plan which outlines the goals of strengthening equity and quality in behavioral health care, improving access to substance use disorders prevention, treatment and recovery services, ensuring effective pain treatment and management, improving access to and quality of mental health care services, and utilizing data to inform effective actions and measure impact on behavioral health. This Strategy is designed to remove barriers to care and services, support a person’s emotional and mental well-being, and adopt a data-informed approach to evaluation of behavioral health programs.
The Centers for Medicare and Medicaid Service’s Office of Minority Health (CMS OMH) announced that they will be awarding 3 grants with a total value of nearly $1 million to researchers at minority-serving institutions (MSIs). The grant winners will be researchers who study and/or address health disparities along demographic divisions, including race or ethnicity, sexual orientation and gender status, socioeconomic class, disability status, or geographic divides. MSIs include Historically Black Colleges and Universities, Hispanic-Serving Institutions, Asian American and Native American Pacific Islander-Serving Institutions, and Tribal Colleges and Universities. The deadline to submit the application to CMS OMH is Thursday, July 28th, at 3pm ET. The application can be found here.
Senators Shelley Moore Capito (R-WV) and Tammy Baldwin (D-WI) reintroduced the Palliative Care and Hospice Education and Training Act. PCHETA aims to grow, enhance, and sustain the palliative and hospice care workforce to meet the needs of and improve care for Americans at the end of life. PCHETA does this by focusing on ensuring access and funding for education centers and teachers to expand interdisciplinary training in palliative and hospice care, investing in resources and information sharing with patients and families to be sure they’re informed about the benefits of palliative care, and directing NIH to expand palliative care research to advance clinical practice and improve care delivery.
The Senate Health, Education, Labor, and Pensions (HELP) committee released its versions of the FDA User Fee Reauthorization legislation, the FDA Safety and Landmark Advancement Act (FDASLA). The most recent version includes notable additions that put it in line with legislation the House Energy & Commerce Committee passed. The bill includes provisions aimed to shorten FDA’s decision-making around whether certain generic drugs may be automatically substituted at the pharmacy for brand name drugs they reference, reforms to accelerated approval, and a number of other provisions around cosmetics and dietary supplement oversight, and the regulation of laboratory developed tests. The provisions to speed up therapeutic equivalence would require FDA to determine whether generic drugs approved via section 505(b)(2) drugs are therapeutically equivalent to reference products. A shorter timeline for determining therapeutic equivalence could potentially save consumers some money at the pharmacy counter.
Representing the members of the American Medical Association (AMA), Physician James Madara published a letter to Secretary Becerra of the US Department of Health and Human Services calling for reform of the unsustainable Medicare payment system. Over the past two decades, physician payment rates have declined by 20% in inflation-adjusted dollars. Growth in key contributors to the Medicare Economic Index as well as budget neutrality adjustments threaten to widen this gap. More than 100 provider groups and state medical associations have signed on to show their support for systemic physician payment reform goals, such as ensuring financial stability with a baseline positive annual update reflecting inflation, revising budget neutrality requirements to allow for spending growth, and safeguarding access to quality care by advancing health equity and protecting practices.
The Federal Trade Commission and the Department of Justice announced that they will hold a two-day meeting starting June 14, 2022 to explore new ways to enforce the antitrust laws affecting the pharmaceutical industry. An FTC spokesperson said the commission is interested in exploring PBMs regardless of whether PBM policy is a prominent topic at the two-day event. On the first day, FTC Commissioner Rebecca Kelly Slaughter will deliver a keynote address, followed by plenary sessions on market concentration in the pharmaceutical sector and merger remedies. The second day will feature sessions on drug industry mergers and how conduct by drug companies affects merger analyses. State attorneys general, Canada’s Competition Bureau, the European Commission Directorate General for Competition, and the U.K.’s Competition and Market Authority will take part in the event. This event comes on the heels of the FTC’s request for information surrounding PBM tactics in the pharmaceutical industry and recent inquiries by Congress on PBM and drug pricing issues writ large.
The U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), released The Blueprint For Change, a national framework to improve care for children in the U.S. who currently have a special health care need. The Blueprint for Change is organized around four critical areas: health equity, family and child well-being and quality of life, access to services, and financing of services. The guiding principles to ensure this are making sure that all services and supports are designed and implemented to reduce health disparities and make it easy for families and professionals to navigate when, where, and how they need them. HHS wants to make sure that service sectors increase the ability of CYSHCN to access services by addressing administrative processes that hinder access and that health care and other related services for CYSHCN and families are financed and paid for in ways that best support their needs.