Atlantic Health System, an integrated health care system setting standards for quality health care in New Jersey, Pennsylvania and the New York metropolitan area, and Mevion Medical Systems, the leading provider of compact single-room proton therapy systems, have announced Atlantic Health System’s plans to acquire and install a MEVION S250-FIT Proton Therapy System™* at the Carol G. Simon Cancer Center, located at Morristown Medical Center in New Jersey. The proton system is scheduled to be installed in 2025, and once in use will usher in a new era of cutting-edge radiation oncology services.
Proton therapy is an advanced form of radiation therapy that targets tumors more precisely compared to conventional photon therapy, thus minimizing damage to surrounding healthy tissue and critical organs such as the brainstem, heart, and lungs. A recent randomized clinical trial demonstrated that proton therapy achieved similar survival rates to traditional radiation therapy, but with fewer side effects in the treatment of head and neck cancers, meaning less malnutrition and feeding tube dependence for patients. The MEVION S250-FIT system further enhances these benefits with its industry-leading features. HYPERSCAN® Pencil Beam Scanning for Intensity Modulated Proton Therapy (IMPT) with a proton MLC, ensures precise delivery of proton therapy, minimizing damage to healthy tissue. Upright patient positioning and a large bore diagnostic CT from Leo Cancer Care allow for real-time image guidance and adaptive therapy.
Along with the tremendous benefits for patients, this collaboration signifies a major achievement, as Atlantic Health System is set to become one of the world’s pioneers in transforming a conventional LINAC vault to install the FIT proton therapy system. The FIT Proton Therapy System is the first and only full proton therapy system that can be seamlessly installed in an existing LINAC vault, significantly reducing the size, cost, and complexity of proton therapy.
“Introducing proton therapy is a transformative step in advancing state-of-the-art cancer services for our patients,” said Trish O’Keefe, PhD, RN, Senior Vice President and Chief Nurse Executive, Atlantic Health System and President, Morristown Medical Center. “By providing our dedicated physicians, nurses and team members with the latest technologies, we continue to empower them to provide the highest-quality care to our patients, their families and our community.”
A survey of 1,025 consumers conducted by remote patient monitoring company Vivalink Inc. found that 84% of respondents would be willing to participate in hospital-at-home monitoring if it allowed them to leave the hospital earlier. Further, of those who had participated in a hospital-at-home program, 84% reported a positive experience.
Consumer openness to remote monitoring could suggest a way to control rapidly rising health care costs. Hospital spending in the U.S. rose 10% in 2023, to $4.8 trillion, the U.S. Centers for Medicare and Medicaid Services recently reported, increasing interest in less expensive options such as remote monitoring of patients and hospital-at-home (HaH) programs.
One challenge to expansion of HaH initiatives is the pending expiration in December of the Acute Hospital Care at Home program implemented during the COVID-19 pandemic and extended under the Consolidated Appropriations Act of 2023. Hospitals granted an AHCAH waiver can provide inpatient-level care for Medicare beneficiaries.
Hospitals have flocked to create “virtual wards” that use remote monitoring systems to stay abreast of emerging issues in patients receiving care or recovering at home. As of April 2024, more than 320 hospitals in 133 health systems in 37 states had established hospital-at-home arrangements, and others are keen to follow suit but many have put plans on hold because of uncertainty about extension of the waiver.
“In the long run, HaH programs should achieve economies of scale through the use of lower-cost remote patient monitoring (RPM) technologies versus traditional, more expensive hospital bedside equipment,” Sam Liu, vice president of marketing at Vivalink, told BioWorld.
“A more permanent of long-term approval of the CMS waivers is key for ensuring access to these services,” Liu added. “Another primary factor is to provide patient- and clinican-ready technology solutions designed to reduce the hurdles to adoption and increase ease of use. Vivalink is directly involved in this aspect with our Acute RPM solution.”
“Consumers are increasingly driving the trend towards receiving care in the comfort of their own homes. This shift, accelerated by the COVID pandemic, underscores the importance of providing flexible and convenient health care solutions that meet patients’ evolving needs,” said Jiang Li, CEO of Vivalink. “At Vivalink, we are committed to the development of advanced digital healthcare solutions in order to improve access and efficiency of the health care system for all.”
The survey found that more than three-quarters of respondents would trust their health care provider’s recommendations whether to stay in the hospital or use remote monitoring systems at home.
Of those who had participated in home-based programs, slighly fewer half said the remote patient monitoring devices were easy to use. Notably, the 16% who were not keen to leave the hospital said that difficulty using the devices was a primary concern.
Age was a key factor in concerns with technology and lack of awareness of home monitoring options. Respondents over the age of 70 were less likely to be familiar with HaH programs, with 42% of this age group saying they had heard of or participated in a hospital-at-home program compared to 77% of those in their 40s.
Rural respondents were also less aware of HaH programs, with just 25% saying they had heard of them vs. 71% of urban residents. Rural respondents, however, were almost twice as interested in completely remote primary care (36%) than their urban counterparts (19%), perhaps because the shuttering of many rural hospitals and a shortage of physicians has increased the distance these patients must travel to receive care.
In addition, respondents who used hospitals the most were the most receptive to HaH programs. Of those who had had three or more hospitalizations in the last year, 95% were willing to participate in home-based programs compared to 62% of those who had two or fewer hospitalizations. The frequently hospitalized group was also more likely to trust in their physicians’ recommendations as to site of care (95%) compared to 78% for those hospitalized twice or less often.
Cardiac issues were the most likely to be monitored at home (46%), followed by cancer treatment and neurological disorders (38% each). More than 30% of respondents who had participated in HaH programs were being monitored for diabetes, respiratory disorders or infectious diseases.
For patients, hospital-at-home programs offer shorter in-patient stays with consequently lower bills, reduced readmission rates and reduced risk of hospital-acquired infections and overall better clinical outcomes as well as more comfort and eased access to familiar settings and family, according to the Agency for Healthcare Research and Quality.
For hospitals, the models reduce overhead expenses, allow continued care for more patients with lower staff commitment and reduced infrastructure costs, particularly during peak utilization periods. Johns Hopkins Medicine estimated that HaH programs saved 19% to 30% compared to standard in-patient care.
WASHINGTON – Sens. Chuck Grassley (R-Iowa) and Ron Wyden (D-Ore.), former and current chairmen, respectively, of the Senate Finance Committee, are leading a bipartisan push to ensure proper implementation of their law to break up anti-competitive practices in the U.S. organ transplant system. Grassley and Wyden, co-authors of the Securing the U.S. Organ Procurement and Transplantation Network Act, are joined by the law’s original cosponsors, Sens. Ben Cardin (D-Md.), Todd Young (R-Ind.), Elizabeth Warren (D-Mass.) and Jerry Moran (R-Kan.).
In a letter to Dianne LaPointe Rudow, President of the Organ Procurement and Transplantation Network (OPTN) Board of Directors, the senators reiterated Congress’s legislative intent to ensure the OPTN carries out the law’s necessary reforms. The lawmakers specifically noted:
Read the full letter HERE.
Background
The OPTN, which is responsible for collecting organs from donors and matching donations to patients nationwide, has been run by the same inadequate contractor since its founding 40 years ago. Grassley and Wyden’s Securing the OPTN Network Act requires HHS’s Health Resources and Services Administration to expand OPTN’s contracting process for the first time in its existence, in order to ensure only the most competent contractors operate the organ transplant system.
Grassley and Wyden also wrote to HRSA last month to share their recommendations on the law’s implementation.
WASHINGTON – Sens. Chuck Grassley (R-Iowa) and Ron Wyden (D-Ore.), former and current chairmen, respectively, of the Senate Finance Committee, are leading a bipartisan push to ensure proper implementation of their law to break up anti-competitive practices in the U.S. organ transplant system.
Families USA is leading a new lobbying push for Senate action on site neutral payment reforms, pressing Finance Committee Chair Ron Wyden to follow through on an issue House Republicans addressed in their transparency bill.
Why it matters: Changing how Medicare pays hospitals for outpatient care is a tough sell in the Senate, so pressure from a key consumer group is important to keeping the issue alive.
Driving the news: Families USA and a range of groups including AFSCME are calling on Wyden and Finance ranking member Mike Crapo to hold a hearing before the August recess on health care affordability and hospital costs.
What they’re saying: Wyden told Axios on Tuesday he is “not up on the letter” from the groups. Speaking about site neutral in general, he said: “I’ve had lots of people talking to me about it. I’ve got to get more input with respect to the rural areas.”
Our thought bubble: A Finance hearing is highly unlikely before the August recess, but the real hope is to keep the issue on the table for a year-end health care package.
Between the lines: The letter calls for two policies that already passed the House as part of its bipartisan transparency bill.
The intrigue: Besides Wyden’s worries about rural areas, Senate Majority Leader Chuck Schumer, an ally of New York hospitals, also has concerns with both policies, as we previously reported.
The bottom line: Even these relatively small steps on hospital costs face major hurdles in the Senate amid hospital industry opposition.
President Joe Biden’s administration will formally propose a rule to bar medical debt from individual credit reports Tuesday, a move that would prevent major health care bills from negatively impacting borrowing.
Vice President Kamala Harris and Consumer Financial Protection Bureau Director Rohit Chopra will announce the measure, a person familiar with the plan said, speaking on condition of anonymity to discuss the move before it is made public. ABC News first reported the proposal.
The move is the latest effort from the administration to help lower costs for consumers ahead of November’s election rematch between Biden and Republican Donald Trump, in which inflation will be a key issue.
The proposal has been percolating for months. The CFPB said last year it was working on the change. At the time, the agency was also looking to stop lenders from considering such debts in an application and curb certain repayment practices.
The exact parameters of the proposed rule and when it would take effect are unclear. Chopra told ABC it could take effect in 2025, potentially making its enactment dependent on the election.
Three major credit-reporting agencies — TransUnion, Equifax Inc. and Experian Plc — have already voluntarily removed certain existing medical debt from credit reports.
The U.S. Court of Appeals for the District of Columbia Circuit sided with the Health and Human Services Department in September. A group of 213 hospitals that filed the initial case in 2017 petitioned the Supreme Court in December to review that decision.
The American Hospital Association said in a statement it is pleased the Supreme Court agreed to consider the case.
“It is critical to hospitals and health systems that HHS interpret the DSH fraction consistently across the statute,” Chad Golder, AHA general counsel and secretary, said in the statement. “The agency’s longstanding failure to do so has cost hospitals more than a billion dollars each year, directly harming the hospitals that serve America’s most vulnerable patients. We look forward to the Supreme Court rectifying this legal error next term.”
An HHS spokesperson said the agency does not comment on ongoing litigation.
HHS claims those benefits are only for patients who receive cash Social Security payments during the month that they are in the hospital. Hospitals contend patients enrolled in Social Security should receive those benefits, regardless of whether they received payments during the month of their hospitalization.
In a decision issued in September, the appellate court disagreed with the hospitals, citing statute that “expressly defines the term ‘supplemental security income benefits under subchapter XVI’ as ‘a cash benefit.’”
At least $1.5 billion in annual Medicare DSH payments are at stake, the hospitals said in the petition for the Supreme Court to review the case. The plaintiff hospitals estimate that shortfall based on a 15% gap between Medicare DSH payments doled out from 2006 to 2020 and providers’ interpretation of the reimbursement calculation.
The case has wide-reaching implications for hospitals and patients, including payments tied to the 340B drug discount program, the AHA, Association of American Medical Colleges, America’s Essential Hospitals, Catholic Health Association, Federation of American Hospitals and National Rural Health Association wrote in a related brief filed in February.
The U.S. Supreme Court on Monday said it will review a lower-court’s decision that limits Medicare payments for hospitals that treat a disproportionate number of low-income patients.
Momentum is building on both sides of the Capitol to make comprehensive changes to the federal 340B drug discount program — though it’s unclear how much money the plans would save.
Why it matters: Surging sales over the past five years have put 340B on pace to become one of the largest federal drug programs, per Avalere. But it’s mired in litigation and competing state efforts to set rules of the road.
Driving the news: House Energy and Commerce members signaled interest in new transparency requirements and addressing provider consolidation during an oversight hearing on Tuesday, increasing the likelihood that policy changes could be rolled into a year-end health deal.
Across the Capitol, senators are still working on a 340B draft discussion bill that could define covered patients. It is expected to respond to the growing number of drugmakers that have restricted when providers can use 340B discounts at contract pharmacies.
Friction point: Hospital lobbyists are pushing back against the House bill, calling it a drug industry wish list and saying it would make many facilities ineligible for the program and create onerous compliance requirements.
What we’re watching: The level of interest pursuing reforms could hinge on how CBO scores the bills, Avalere noted. That could factor such variables as whether 340B discounts are putting upward pressure on launch prices for drugs.
Lawmakers on the House Energy and Commerce Oversight and Investigations Subcommittee on Tuesday probed ways to reform the controversial 340B program amid fears of pending litigation.
The hearing comes as efforts to reform the program gain steam on the Hill. The program mandates drugmakers sell outpatient drugs at discounts to hospitals, community health centers and many provider-based rural health clinics.
Republicans on the committee last week proposed a bill authorizing HHS to audit hospitals on how they use their 340B savings, redefining “patient” and establishing criteria for contract pharmacy arrangements. The American Hospital Association has opposed the legislation, arguing that it would limit hospital participation and create unworkable compliance rules. A bipartisan Senate working group has also recently floated a discussion draft to bolster transparency and to consider how to define what a “patient” in the program is.
Full committee ranking member Frank Pallone (D-N.J.) criticized Republicans during the hearing for not inviting drugmakers and HHS officials to testify.
“The Republicans did not have a single drug manufacturer here to talk about their part of the program. We will also not hear from the Health Resources and Services Administration, HRSA, about what the agency needs to oversee the program,” he said.
Witnesses included health policy experts as well as executives from health care systems and hospitals, the latter of which affirmed the value of the program to patients, often referring to it as a “lifeline.”
Here are takeaways from the hearing:
Some lawmakers worry that pending lawsuits challenging 340B requirements, including whether drugmakers can limit how many 340B pharmacies they ship to, could decide the future of the program before Congress does. A recent court decision on restricting pharmacies sided with drugmakers.
“I worry this entire program will continue to be legislated by the courts,” Rep. Scott Peters (D-Calif.) said. Other members also said recent court rulings have created uncertainty in the program and stripped HRSA of some of its oversight ability.
Some Republicans on the committee want hospitals to report how they’re using the savings from the 340B program — aligning those reporting requirements with those used by community health centers.
Anthony DiGiorgio, a neurosurgeon and professor at the Institute for Health Policy Studies at the University of California, San Francisco, told lawmakers there are “bad actors” among hospitals that don’t use 340B savings as intended by the program.
But some providers pushed back on the proposed requirements in the GOP bill.
Sue Veer, president and CEO of Carolina Health Centers, a community health system, was skeptical about applying the same reporting requirements for community health centers to all 340B entities.
“Dealing with a single entity-section solution doesn’t work,” she told Rep. Buddy Carter (R-Ga.), who co-introduced the legislative reforms.
She suggested transparency metrics that “outline the population served,” including their insurance status and poverty levels.
“Just uninsured patients is not adequate. It’s important to look at the overall profile of the patients that are served,” she said. She called the bill a “starting place.”
Matthew Perry, president and CEO of Genesis HealthCare System, also told Carter he wasn’t opposed to transparency but is “opposed to transparency that cherry-picks the type of information that completely distorts what 340B is designed to do.”
Democrats on the committee highlighted how 340B facilities in their districts use their savings to benefit patients and also asked providers who testified Tuesday how they’re using their savings. Veer replied to a question from subcommittee ranking member Kathy Castor (D-Fla.) by describing a home-visitation pediatric program her health centers operate.
“We’ve been able to really increase our access to all families [through the program] because of our contributions from 340B,” Veer said.
“And that’s due to the flexibility 340B provides,” Castor replied. “I appreciate your recommendations for some reforms, but you’re not recommending in any way we scale back the flexibility to determine the needs in the community.”
“No, I would not want to just scale back the flexibility, because every community is different,” Veer responded.
Republicans were more skeptical.
“There’s currently no requirement that 340B-covered entities pass savings onto patients,” Rep. John Joyce (R-Pa.) said, suggesting that participating hospitals are not offering drug discounts to patients, which Perry disagreed with.
Rep. Dan Crenshaw (R-Texas) asked whether specifying who is considered a patient in the program, or using a patient ID, can generate savings for patients who receive drugs through a 340B pharmacy. Some Republicans have argued that the current HRSA guidance on which patients can use the program is too overly broad.
Perry replied that his hospitals do track patients, but added that accidentally duplicating patients under a new tracking method might lead to losses for the hospital.
Cyberattacks compromising the health information of millions of Americans are prompting Congress and the Biden administration to take action to better protect highly sensitive personal data that’s profitable for hackers.
Up to a third of Americans had their private health information exposed in the cyberattack on Change Healthcare in recent months. The breach is believed to be the largest in health care in US history and has cost parent company UnitedHealth Group Inc. up to $1.6 billion in profits this year.
Lawmakers and regulators have been scrambling in their response. In May, Senate lawmakers grilled UnitedHealth Group CEO Andrew Witty over the attack, pressing the embattled executive on why the company left so much health information vulnerable and what should be done to avoid a repeat. Shortly after, the White House said it was weighing standards for hospitals to better protect patient information.
Now, senators on both sides of the aisle are keeping an open line with Witty and weighing legislation to better protect health information. They’ve also upped the pressure on the Biden administration’s labor and health departments to take on a greater role in both preventing and responding to cyberattacks.
The Department of Labor didn’t immediately respond to a request for comment. However, a Health and Human Services Department spokesperson said the agency is considering issuing new enforceable cybersecurity standards for the health-care sector, a move that could face a backlash from hospitals.
Trade group American Hospital Association has been vocal in its opposition to mandatory cybersecurity requirements for hospitals. In a May interview, the AHA’s national adviser for cybersecurity and risk, John Riggi, said that should the government take regulatory action, “hospitals alone should not be singled out.”
“The government needs to do more on offense against the fundamental source of cyber risk, foreign hackers and ransomware gangs attacking health care, ” Riggi said. “That’s not hospitals’ job. That’s the US government’s job.”
The FBI said in a report that in 2023, the health-care and public health sector flagged the most ransomware attacks, with organizations having filed almost 250 complaints with the agency. That’s more than critical manufacturing, which flagged fewer than 220, and government facilities, the third-most hit sector in the report, which came in at 156.
The full extent of Change’s breach has yet to be determined. The company processes pharmacy requests and insurance claims for over 340,000 physicians and 60,000 pharmacies. The hack was discovered Feb. 21, and the company severed connections that distribute data and money across the health-care system, leading to a backlog of payments and claims.
Lawmakers are casting a wide net in their response. Some, like senators Ron Wyden (D-Ore.), who chairs the Senate Finance Committee before which Witty testified, and Bill Cassidy (R-La.), a member of that committee, are pushing for legislation to better protect critical health-care infrastructure.
Wyden said he’s working on proposing “minimum standards” for cybersecurity in health care. He said the details wouldn’t be revealed until later as part of legislation.
Wyden also called for the Federal Trade Commission and the Securities and Exchange Commission to investigate UnitedHealth to determine if laws were broken, Bloomberg News reported.
Cassidy said there’s two tracks for responding to Change: looking at what happened at the company, as well as examining the broader health industry.
Witty, Cassidy said, has remained available since the hearing to answer questions. Cassidy said one issue that’s been brought to his attention is that UnitedHealth was unable to do a full security analysis of Change before purchasing the company.
Cassidy said he is also concerned there are too many larger companies operating in the health-care space. “Should we have any organization that, if it goes down, everything else is affected?” he asked.
While he isn’t currently putting forth legislation, Cassidy said Congress should act. The lawmaker, who also is the top Republican on the Senate Health, Education, Labor and Pensions Committee, said if he becomes HELP chairman in the next Senate, cyber “will be a big priority.”
“It’s better that Congress take information from all stakeholders—as opposed to what inevitably is a narrower view of a particular administration,” Cassidy said.
The Biden administration is facing increasing pressure to take direct action on cyber safety.
Earlier this month, House Committee on Education and the Workforce Chairwoman Virginia Foxx (R-N.C.) wrote to the Department of Labor to ask what the Employee Benefits Security Administration is doing to investigate cyberattacks.
Foxx’s committee’s jurisdiction includes private employer health-care benefits. She wrote the committee is concerned about how the Employee Benefits Security Administration “is working to curb” risks for employer-sponsored benefit plans.
Her letter included a list of questions about the EBSA’s cybersecurity role, such as how many cybersecurity investigations the group has conducted since February 2021 and whether the agency has ever been “compromised by cybercriminals.” Foxx asked for responses by May 30.
“The Change Healthcare hack immediately affected workers’ and their families’ access to health care. Prescriptions could not be filled. Health care claims and payments were halted. Pharmacies, military hospitals, and clinics attempted workarounds to mitigate disruptions,” Foxx wrote.
In a March statement, the HHS said it was in regular contact with UnitedHealth leadership and others to ensure the effectiveness of the company’s response.
Days later, the HHS and DOL published a letter to health care leaders saying the agencies urge UnitedHealth, insurance companies, and other payers to take actions, though they stopped short of enforcement.
The HHS in May said that hospitals can require UnitedHealth notify patients if their data was compromised in the February attack.
The department is considering enforceable actions informed by voluntary performance goals for health sector groups released in January, according to an agency spokesperson.
Among those goals are things like reducing email security risks, adding multifactor authentication, and setting security requirements for outside vendors.
The HHS spokesperson declined to provide additional information on enforcement specifics, including who in the agency would be responsible.
Greg Garcia, executive director for cybersecurity of the Health Sector Coordinating Council, an advisory group that works with the government, said enforcement is “a difficult thing to do,” but would make a difference in improving health sector cybersecurity.
Garcia said a federal rule —which implements standards under the Health Insurance Portability and Accountability Act—currently requires health providers to have incident response plans, and that it’s enforced by the HHS Office for Civil Rights. In the event of cyber incidents, the HHS “depends on intel from industry, law enforcement,” and others, Garcia said, though “the interagency process and its information sharing protocols with industry are always a work in progress.”
An HHS spokesperson noted that the civil rights office investigates complaints filed with the group and conducts compliance reviews. Investigations may result in civil fines. The spokesperson also said the office submitted requests for Congress to increase the amount of fines it can impose in a calendar year, with the goal being to promote HIPAA compliance to protect sensitive patient data.
Still, Garcia noted the Change attack was due to problems with “basic cyber hygiene”—a lack of multifactor authentication—and that “no amount of cyber security controls will totally prevent cyberattacks.”
Cybersecurity is a “collective responsibility” that health providers can’t shoulder alone and the government does have a role to play, said Garcia, who has worked with the HHS on cybersecurity matters. Congress could help by giving the HHS and other agencies broad authority to fund or oversee better incentives for the private sector, he said.
He added that third party service providers are also responsible. “Change Healthcare is a third party service provider, and they screwed up and the fallout impacts their customers existentially,” Garcia said.
Under its 2025 fiscal year budget request, the HHS would create a $1.3 billion Medicare incentive program for encouraging hospitals to take up cybersecurity practices. The department noted there was a 95% increase in large breaches reported to the agency from 2018 to 2022.
The AHA’s Riggi said any minimum standard placed on hospitals alone wouldn’t solve health-care sector cybersecurity risks. Focusing solely on hospitals wouldn’t have prevented the Change attack, Riggi said.
“We need to secure the entire health-care system,” he said.
As of May 9, 2024
We’re trying out something new: a handy cheat sheet for some of the big-ticket policy items that could find a home in must-pass legislation.
Why it matters: The biggest deals will likely come after the election, but the coming weeks will reveal a lot about what will command lawmakers’ attention.
Watch for updates throughout the year — and let us know if we’ve missed anything big or how we can make this feature more helpful to you.
Site-neutral payment policies
PBM overhauls
Hospital price transparency
$35 insulin beyond Medicare
China biotech crackdown
Drug pricing patent reforms
The issue: Preventing tactics like “product hopping” and “patent thickets” that sponsors say drug companies use to delay competition from cheaper generic drugs.
A MATTER OF DOLLARS AND CENTS — Congress appears poised to keep eased Medicare telehealth rules in place with at least another temporary extension, but members are concerned about costs and unintended consequences.
Loosened virtual-care rules for Medicare and commercial markets expire at the end of 2024, and lawmakers are setting the stage for a possible temporary or permanent extension of the regulations to preserve expanded access. The House Ways and Means and Senate Finance committees have met recently to consider expanded telehealth rules.
In a House Energy and Commerce Health Subcommittee hearing Wednesday, Democrats and Republicans indicated support for maintaining expanded telehealth payment for older adults but raised a number of issues:
Cost: The cost to extend the eased rules is a major concern for lawmakers. A key question is whether virtual visits would be reimbursed at the same rate as in-person care.
“Making these authorities permanent is likely to cost much more than a short-term extension, and we want to make sure that whatever we move out of committee is paid for,” Health Subcommittee Chair Brett Guthrie (R-Ky.) said.
But, generally, lawmakers seemed willing to accept higher costs to expand access to virtual care. Full committee ranking member Cathy McMorris Rodgers (R-Wash.) acknowledged that extending the rules would be a “significant investment” but said that “we can’t afford to go backwards.”
Harvard researcher Ateev Mehrotra told lawmakers that expanded telehealth is associated with a “modest” increase in spending but also improved outcomes, particularly in mental health.
Trickle-down impact: Lawmakers want to ensure that changes to virtual care policy don’t hinder access to in-person care.
Rodgers said she wants to ensure patients decide whether they get in-person or virtual care. Witnesses and lawmakers noted that some patients may prefer in-person care.
Full committee ranking member Frank Pallone (D-N.J.) said he doesn’t want telehealth to be used to undermine consumer protections like network adequacy standards.
“We also need to ensure that we are not further fragmenting care and that telehealth is being used in a way that facilitates coordination,” Pallone said.
Industry ‘gaming’: Health Subcommittee ranking member Anna Eshoo (D-Calif.) raised concerns about the industry “gaming” virtual care to make it into a “cash cow.”
What’s next: The Medicare Payment Advisory Commission meets today on telehealth in Medicare.
It’s an uphill climb and requires overcoming opposition from the powerful hospital industry and hesitation by its allies in Congress, including Senate Majority Leader Chuck Schumer. But insurers, employers, unions and consumer groups are eyeing a possible year-end package as a vehicle for a policy that could save taxpayers billions.
The proposals, which fall under a policy known as site-neutral payments, would mean hospitals are paid the same amount for the same service, regardless of whether it’s provided in a hospital outpatient setting or at an independent physician’s office.
Though there was bipartisan interest, a deal could not be reached in part because of the efforts from hospitals, which stand to lose billions of dollars over the next decade and warned members that the cuts would be devastating to care, particularly in rural communities.
Proponents of the policy plan to spend the next several months countering that argument by telling Congress that the status quo has consumers paying the price.
Better Solutions for Healthcare, a coalition of insurers and employers, is mobilizing employers — “folks who own dry cleaners and grocery stories and work in service industry gigs” — to meet with lawmakers in their districts and share “stories about how, as employers, their employees are negatively impacted by higher hospital costs,” said Adam Buckalew, a Republican lobbyist working on behalf of the organization.
One insurance lobbyist granted anonymity to talk about the strategy said that part of the plan is to approach lawmakers from rural areas, including House Ways and Means Chair Jason Smith (R-Mo.) and Senate Finance ranking member Mike Crapo (R-Idaho), to argue that the changes won’t be as damaging to constituents as opponents claim.
“That’s a key component of any kind of educational effort — put the facts out there on the scope and scale of the impact that these changes would have,” the lobbyist said.
Although advocates hope they can eventually push broad site-neutral payment reforms, they’re focused on narrower policies that were tucked into a larger bill that passed the House last year in a 320-71 vote.
One policy would apply to physician-administered drugs in Medicare that are provided at hospital-owned outpatient departments located away from the facility, while a second would require those outpatient departments to use a “unique identifier” that’s different from the hospital’s for claims and services.
The two items would save the federal government roughly $4 billion over 10 years, according to the nonpartisan Congressional Budget Office. It’s a sum hospitals claim would be devastating, even if some of it were used to offset future payment cuts for facilities that treat a large number of low-income patients.
Congress had tried to include the two site-neutral provisions among other health policy riders in both government funding packages that passed this month. But the riders all dropped out of the funding legislation amid disagreements about the scope of some of the other health provisions and the size of the spending bills overall.
“The outcome of recent government funding negotiations has made it clear that members of Congress have serious concerns about policies that would undermine patient access to hospital care, especially at a time when providers are facing unprecedented pressures,” said Charlene MacDonald, the executive vice president of public affairs at the Federation of American Hospitals.
LOWER COSTS?
Those who criticize hospitals — including Arnold Ventures, a research and advocacy organization funded by billionaire John Arnold, the left-of-center nonprofit Families USA and its Consumers First coalition — argue that the two provisions would lower costs for patients.
“The hospital industry has been out there with misinformation about how this would hurt them … We want to be the counterbalance to the industry who want to keep the status quo,” said Jane Sheehan, the deputy senior director of federal relations at Families USA. “Under the status quo, patients and consumers are suffering.”
A study funded by Arnold Ventures found that off-campus hospital outpatient departments in rural areas make up 7 percent of Medicare spending, and argued the site-neutral reforms would have a relatively small impact on them. Many rural hospitals would be exempted from the policies, the report said.
“These are targeted solutions, I don’t think the intent is to come in with a sledgehammer and smash these facilities,” said Sheehan.
The American Hospital Association called the study “misleading at best,” and claimed that rural hospitals would lose $272 million in revenue over the course of a decade from the proposals.
Proponents are also up against Schumer, a New York Democrat, who is closely aligned with hospitals in his state. House Energy and Commerce Chair Cathy McMorris Rodgers (R-Wash.) told POLITICO that Schumer objected to the “unique identifier” provision in the most recent spending package.
But lobbyists hope he could be swayed by extracting deals on other policies he wants — such as cracking down on how drugmakers use the patent system to maintain exclusivity on treatments. They point to his 2015 vote supporting the last site neutral effort that passed in Congress as reason to believe he is open to reforms.
“I could see a scenario where Schumer eventually signs off on the limited site neutrality policy, if there’s a lot of Democratic priorities included. But it has to be a very big package,” said a Democratic health care lobbyist granted anonymity to talk about client issues.
Schumer’s office didn’t respond to a request for comment.
END-OF-YEAR STRATEGY
The most likely timing for any larger package with those kinds of tradeoffs would be an end-of-the-year deal during the lame duck session.
Lawmakers have kicked many high-priority health care extenders to Dec. 31, including pandemic-era telehealth waivers and community health center funding. Buckalew said the to-do list creates more momentum behind the site-neutral policies and “forces a broader negotiation in the health care space.”
While many lobbyists and congressional staffers say the package of health policy riders fell out of funding bills for reasons other than the hospital-targeted provisions — giving them hope that they could find their way into a year-end package — they’re not taking any chances, working to get some members who are close with hospitals or concerned about impacts to rural facilities on board.
Meanwhile, those working to keep the issue alive are also encouraging its congressional supporters — including Rodgers in the House and Sens. Maggie Hassan (D-N.H.) and Mike Braun (R-ind.) — to continue pushing the policies.
When people see policies that are “impacting their wallets, impacting their ability to get the care they need when they need it, they get activated — they get energized by these issues. Spread the word to the public. Congress has the power to push back on this and that does resonate,” Sheehan said.
Pandemic preparedness advocates found things to like in the latest minibus, but also some worrying cuts.
Why it matters: While most of the country (and much of Congress) has moved on from pandemics, advocates are trying to maintain readiness while a reauthorization of the Pandemic and All-Hazards Preparedness Act remains stalled.
What’s inside: The Labor-HHS portion of the six-bill package unveiled today has some small funding increases:
The Biomedical Advanced Research and Development Authority, which works with industry on developing vaccines and treatments, would get a $65 million increase.
The Strategic National Stockpile is in line for a $15 million increase.
$10 million goes toward strengthening the public health supply chain to manufacture key supplies in the United States.
Yes, but: Republicans touted the way the package claws back $4.3 billion in “unnecessary” COVID-19 funding.
There is some uncertainty about where those cuts will fall, but potential targets include activities like genomic sequencing and contact tracing.
What they’re saying: “It’s very good and important to see areas where pandemic preparedness budgets and programs were strengthened, including an increase in BARDA’s budget,” said Tom Inglesby, director of the Johns Hopkins Center for Health Security.
He also touted funding for “rapid development of medical countermeasures against viral families with pandemic potential.”
But he warned about potential damage from the cuts, acknowledging it’s still unclear exactly how they will play out.
While most of the country (and much of Congress) has moved on from pandemics, advocates are trying to maintain readiness while a reauthorization of the Pandemic and All-Hazards Preparedness Act remains stalled.
Why it matters: It punts bipartisan provisions that health committees in both chambers have worked on for months to a lame duck session.
What they’re saying: “Republicans do not want the appropriations bills to become an omnibus and there was no opportunity for Democrats to include a health package on this vehicle, regardless of the contents of this package,” said a leadership aide briefed on the negotiations.
Yes, but: A complicating factor for reviving the deal is Senate Majority Leader Chuck Schumer’s objections to a provision that would require hospital outpatient departments to have unique Medicare identifier numbers. It would generate savings on what critics call “dishonest billing” by hospitals.
What’s next: Bill text for the appropriations funding deal could be released as soon as tomorrow.
Health care riders addressing PBM reforms and hospital transparency are due to be left out of the next government funding bill after congressional leadership quashed a committee-led effort to add them to the package, sources said.
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