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News

03/18/24 8:14 AM EDT

Scoop: Health riders left out of minibus

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.

Cyberattack Paralyzes the Largest U.S. Health Care Payment System

March 5, 2024 5:27 pm

The hacking shut down the nation’s biggest health care payment system, causing financial chaos that affected a broad spectrum ranging from large hospitals to single-doctor practices.

“This is worse than when Covid hit because even though we didn’t get paid for a while then either, at least we knew there was going to be a fix,” said Molly Fulton, who runs five urgent care centers around Columbus, Ohio.

An urgent care chain in Ohio may be forced to stop paying rent and other bills to cover salaries. In Florida, a cancer center is racing to find money for chemotherapy drugs to avoid delaying critical treatments for its patients. And in Pennsylvania, a primary care doctor is slashing expenses and pooling all of her cash — including her personal bank stash — in the hopes of staying afloat for the next two months.

These are just a few examples of the severe cash squeeze facing medical care providers — from large hospital networks to the smallest of clinics — in the aftermath of a cyberattack two weeks ago that paralyzed the largest U.S. billing and payment system in the country. The attack forced the shutdown of parts of the electronic system operated by Change Healthcare, a sizable unit of UnitedHealth Group, leaving hundreds, if not thousands, of providers without the ability to obtain insurance approval for services ranging from a drug prescription to a mastectomy — or to be paid for those services.

In recent days, the chaotic nature of this sprawling breakdown in daily, often invisible transactions led top lawmakers, powerful hospital industry executives and patient groups to pressure the U.S. government for relief. On Tuesday, the Health and Human Services Department announced that it would take steps to try to alleviate the financial pressures on some of those affected: Hospitals and doctors who receive Medicare reimbursements would mainly benefit from the new measures.

U.S. health officials said they would allow providers to apply to Medicare for accelerated payments, similar to the advanced funding made available during the pandemic, to tide them over. They also urged health insurers to waive or relax the much-criticized rules imposing prior authorization that have become impediments to receiving care. And they recommended that insurers offering private Medicare plans also supply advanced funding.

H.H.S. said it was trying to coordinate efforts to avoid disruptions, but it remained unclear whether these initial government efforts would bridge the gaps left by the still-offline mega-operations of Change Healthcare, which acts as a digital clearinghouse linking doctors, hospitals and pharmacies to insurers. It handles as many as one of every three patient records in the country.

The hospital industry was critical of the response, describing the measures as inadequate.

Beyond the news of the damage caused by another health care cyberattack, the shutdown of parts of Change Healthcare cast renewed attention on the consolidation of medical companies, doctors’ groups and other entities under UnitedHealth Group. The acquisition of Change by United in a $13 billion deal in 2022 was initially challenged by federal prosecutors but went through after the government lost its case.

So far, United has not provided any timetable for reconnecting this critical network. “Patient care is our top priority, and we have multiple workarounds to ensure people have access to the medications and the care they need,” United said in an update on its website.

But on March 1, a bitcoin address connected to the alleged hackers, a group known as AlphV or BlackCat, received a $22 million transaction that some security firms say was probably a ransom payment made by United to the group, according to a news article in Wired. United declined to comment, as did the security firm that initially spotted the payment.

Still, the prolonged effects of the attack have once again exposed the vast interconnected webs of electronic health information and the vulnerability of patient data. Change handles some 15 billion transactions a year.

The shutdown of some of Change’s operations has severed its digital role connecting providers with insurers in submitting bills and receiving payments. That has delayed tens of millions of dollars in insurance payments to providers. Pharmacies were initially unable to fill many patients’ medications because they could not verify their insurance, and providers have amassed large sums of unpaid claims in the two weeks since the cyberattack occurred.

“It absolutely highlights the fragility of our health care system,” said Ryan S. Higgins, a lawyer for McDermott Will & Emery who advises health care organizations on cybersecurity. The same entity that was said to be responsible for the cyberattack on Colonial Pipeline, a pipeline from Texas to New York that carried 45 percent of the East Coast’s fuel supplies, in 2021 is thought to be behind the Change assault. “They have historically targeted critical infrastructure,” he said.

In the initial days after the attack on Feb. 21, pharmacies were the first to struggle with filling prescriptions when they could not verify a person’s insurance coverage. In some cases, patients could not get medicine or vaccinations unless they paid in cash. But they have apparently resolved these snags by turning to other companies or developing workarounds.

“Almost two weeks in now, the operational crisis is done and is pretty much over,” said Patrick Berryman, a senior vice president for the National Community Pharmacists Association.

But with the shutdown growing longer, doctors, hospitals and other providers are wrestling with paying expenses because the steady revenue streams from private insurers, Medicare and Medicaid are simply not flowing in.

Arlington Urgent Care, a chain of five urgent care centers around Columbus, Ohio, has about $650,000 in unpaid insurance reimbursements. Worried about cash, the chain’s owners are weighing how to pay bills — including rent and other expenses. They’ve taken lines of credit from banks and used their personal savings to set aside enough money to pay employees for about two months, said Molly Fulton, the chief operating officer.

“This is worse than when Covid hit because even though we didn’t get paid for a while then either, at least we knew there was going to be a fix,” Ms. Fulton said. “Here, there is just no end in sight. I have no idea when Change is going to come back up.”

Diana Holmes, a therapist in Attleboro, Mass., has been unable to submit roughly $4,000 in claims for her work since Feb. 21. “It’s not like we have reserves,” she said.

The hospital industry has labeled the infiltration of Change “the most significant cyberattack on the U.S. health care system in American history,” and urged the federal government and United to provide emergency funding. The American Hospital Association, a trade group, has been sharply critical of United’s efforts so far and the latest initiative that offered a loan program.

“It falls far short of plugging the gaping holes in funding,” Richard J. Pollack, the trade group’s president, said on Monday in a letter to Dirk McMahon, the president of United.

“We need real solutions — not programs that sound good when they are announced but are fundamentally inadequate when you read the fine print,” Mr. Pollack said.

The loan program has not been well received out in the country.

Diana Holmes, a therapist in Attleboro, Mass., received an offer from Optum to lend her $20 a week when she says she has been unable to submit roughly $4,000 in claims for her work since Feb. 21. “It’s not like we have reserves,” she said.

She says there has been virtually no communication from Change or the main insurer for her patients, Blue Cross of Massachusetts. “It’s just been maddening,” she said. She has been forced to find a new payment clearinghouse with an upfront fee and a year’s contract. “You’ve had to pivot quickly with no information,” she said.

Blue Cross said it was working with providers to find different workarounds.

Florida Cancer Specialists and Research Institute in Gainesville resorted to new contracts with two competing clearinghouses because it spends $300 million a month on chemotherapy and other drugs for patients whose treatments cannot be delayed.

“We don’t have that sort of money sitting around in a bank,” said Dr. Lucio Gordan, the institute’s president. “We’re not sure how we’re going to retrieve or collect the double expenses we’re going to have by having multiple clearinghouses.”

Dr. Christine Meyer, who owns and operates a primary care practice with 20 clinicians in Exton, Pa., west of Philadelphia, has piled “hundreds and hundreds” of pages of Medicare claims in a FedEx box and sent them to the agency. Dr. Meyer said she was weighing how to conserve cash by cutting expenses, such as possibly reducing the supply of vaccines the clinic has on hand. She said if she pulled together all of her cash and her line of credit, her practice could survive for about two and a half months.

Through Optum’s temporary funding assistance program, Dr. Meyer said she received a loan of $4,000, compared with the roughly half-million dollars she typically submits through Change. “That is less than 1 percent of my monthly claims and, adding insult to injury, the notice came with this big red font that said, you have to pay all of this back when this is resolved,” Dr. Meyer said. “It is all a joke.”

The hospital industry has been pushing Medicare officials and lawmakers to address the situation by freeing up cash to hospitals. Senator Chuck Schumer, Democrat of New York and the chamber’s majority leader, wrote a letter on Friday, urging federal health officials to make accelerated payments available. “The longer this disruption persists, the more difficult it will be for hospitals to continue to provide comprehensive health care services to patients,” he said.

In a statement, Senator Schumer said he was pleased by the H.H.S. announcement because it “will get cash flowing to providers as our health care system continues to reel from this cyberattack.” He added, “The work cannot stop until all affected providers have sufficient financial stability to weather this storm and continue serving their patients.”

News

03/05/24 5:27 PM EDT

Cyberattack Paralyzes the Largest U.S. Health Care Payment System

New York Times

The hacking shut down the nation’s biggest health care payment system, causing financial chaos that affected a broad spectrum ranging from large hospitals to single-doctor practices.

CMS offers help for doctors and hospitals affected by Change outage

March 5, 2024 2:26 pm

The Centers for Medicare and Medicaid Services on Tuesday said it will consider granting accelerated Medicare payments to affected doctors and hospitals on an individual basis, similar to a program that doled out $100 billion during the Covid-19 pandemic.

It’s one of several ways the agency will try to help doctors and hospitals devastated by the Change Healthcare cyber attack and comes a day after Senate Majority Leader Chuck Schumer called for accelerated payment approval.

Hospitals and physicians have complained of trouble receiving payments and, in some cases, of having little cash on hand because of the attack on UnitedHealthcare subsidiary Change Healthcare on Feb. 21, which runs the payment and processing systems for scores of health systems.

HHS did not return a request for comment on how much money is available for accelerated payments. The agency gave generous terms for repayments of accelerated payments for those affected by Covid-19, but it remains unclear if those same terms would apply for this round of funding.

CMS has also instructed independent Medicare contractors that process claims to expedite any provider’s request to change to a new processing platform.

The agency is also calling for Medicare Advantage and Medicaid-managed care plans to relax requirements for prior authorization, which requires doctors to get insurer approval before performing certain services or prescribing drugs. The outage has affected the ability of doctors and hospitals to submit such requests.

In addition, CMS is calling for independent Medicare contractors to make sure they can receive paper claims.

“While we recognize that electronic billing is preferable for everyone, the [contractors] must accept paper submissions if a provider needs to file claims in that method,” the agency said.

News

03/05/24 2:26 PM EDT

CMS offers help for doctors and hospitals affected by Change outage

Politico Pro

Earmark battle emerges as late threat to spending bill

March 5, 2024 10:38 am

A package of six bills that needs to pass by Friday to avoid a partial government shutdown is drawing intense fire from conservatives in both chambers who are zeroing in on more than 6,000 earmarks buried in the package.

The spending package was initially expected to pass easily but now faces a rocky path in the Senate, where it’s become a political football in the ongoing battle between the GOP leadership and Trump-aligned conservatives.

If conservatives drag out the process, they could force a short shutdown over the weekend.

Senate conservatives are trying to elevate the package in the race to replace outgoing Senate Republican Leader Mitch McConnell (Ky.) — putting McConnell’s top deputy, Senate GOP Whip John Thune (S.D.), in a tough spot.

Thune is locked in a competitive race with Sen. John Cornyn (R-Texas) to become the next Senate Republican leader.

If Thune helps push the bill across the finish line, it could hurt his support among Senate conservatives — a key swing bloc, GOP aides and strategists warn.

Cornyn has made a concerted effort to outflank Thune on the right by courting Senate conservatives, according to GOP senators familiar with his behind-the-scenes maneuvers.

“John Cornyn and John Thune are going to be watched very closely how they handle this package. If one votes against it and one votes for it, that’s going to show a big difference and that could move enough votes to make a difference in the race to become Republican leader,” said Brian Darling, a Republican strategist and former Senate aide.

“The pressure on John Cornyn and John Thune is to be much more conservative going forward before the [leadership] election to make sure they don’t generate opposition from conservatives in the caucus who don’t want to see business as usual,” he said.

Getting the bill passed without Thune’s help will be a heavy lift given the whip’s central role in running GOP floor operations.

Thune has requested $116 million worth of earmarks in the spending package, which covers energy and water development, and the departments of the Interior and Transportation and Urban Development, according a list of projects compiled by his office.

He asked for $12 million to expand a water treatment plant in Clay County, South Dakota, and $30 million to address housing supply needs in Butte, Lawrence, Meade, Pennington and other South Dakota counties.

In November, the Senate overwhelmingly passed a minibus appropriations package with three of the six pending bills by an 82-15 vote, with Thune and Cornyn both voting for it.

The political environment within the Senate GOP conference has changed substantially since then.

Former President Trump has won a string of presidential primary contests and now appears to be the inevitable GOP nominee for president, and McConnell — Trump’s chief opponent in the party — last week announced his retirement from leadership at year’s end.

Senate conservatives are trying to take advantage of Trump’s growing power and McConnell’s receding influence by raising their voices and putting pressure on McConnell’s likely successors, Thune and Cornyn, to bend to their will.

That’s what happened last month, when Senate conservatives raised an uproar over the bipartisan border security bill that Sen. James Lankford (R-Okla.) negotiated with McConnell’s blessing.

They raised enough of a fuss that McConnell’s leadership team abandoned the border security compromise one by one, starting with National Republican Senatorial Committee Chair Steve Daines (Mont.). Senate Republican Conference Chair John Barrasso (Wyo.) and Cornyn then followed suit.

McConnell and Thune ended up voting against the border security deal even though they initially supported it as the best chance to reform the nation’s asylum laws for the foreseeable future.

Senate conservatives led by Sen. Mike Lee (R-Utah), the chair of the Senate Republican Steering Committee, and Sen. Rick Scott (R-Fla.) have trained their sights on the spending package that will come to the floor this week.

It would fund the departments of Agriculture, Commerce, Energy, Interior, Transportation, and Housing and Urban Development, among others.

Lee wrote on social media that “no Republican should vote for this bill” and ticked off what he saw as its major policy failures, noting it would not prohibit taxpayer funding from being used to prosecute a presidential candidate or being spent on “mail-order chemical abortion drugs” or being used to set up red flag laws to restrict gun ownership.

Scott’s staff counted more than 6,000 earmarks in the bill, a tally confirmed by the nonpartisan research group Taxpayers for Common Sense.

News

03/05/24 10:38 AM EDT

Earmark battle emerges as late threat to spending bill

The Hill

Scoop: Congress eyes narrow health package

February 26, 2024 4:34 pm

Only a handful of health care provisions that mostly extend existing programs are likely to catch a ride on the next government funding package as the prospect of a shutdown looms, sources say.

Why it matters: While there is not a final deal and the outlook could still change, a skinny package would be a disappointment for advocates looking to address drug or hospital costs.

What we’re hearing: Sources say that the health care package for the March 8 government funding deadline as of now will likely not include PBM reforms, price transparency measures or any site neutral Medicare payment policies for hospitals.

It will almost exclusively focus on items with pressing deadlines, like community health center funding, reversing Medicaid DSH payment cuts to hospitals serving low-income patients, and partial relief for a Medicare pay cut for doctors that took effect Jan. 1.
Punting virtually everything else that’s in play would set up another health care package for a lame duck session.

Between the lines: One of the complications for including PBM measures has been an array of competing priorities across both chambers, including, as we wrote previously, disagreements between the House and Sen. Bill Cassidy over whether provisions would apply to the commercial market, as in the HELP Committee’s legislation, not just Medicare.

Even a modest site-neutral measure was widely seen as perhaps the hardest piece to get included, in the face of strong hospital opposition.
Democrats have been pushing for higher community health center funding, and it is unclear what the final number will be. The House in December passed a 10% bump, to $4.4 billion per year.
There have also been discussions about PAHPA and the SUPPORT Act being included in any rider package, but the details of what that could look like are not yet clear.

The big picture: It’s also unclear exactly what legislative vehicle the health care riders could be attached to.

It was expected that text for the first set of four appropriations bills with a March 1 deadline would be released over the weekend, but that hasn’t happened.
One of the main obstacles is that the House Freedom Caucus is insisting on including certain policy riders that are non-starters for Democrats.
Those include some poison pill provisions such as prohibiting federal funds from going to gender-affirming care, Planned Parenthood and the Pentagon program that provides funds for people seeking an abortion to travel across state lines.
Speaker Mike Johnson has such a slim House majority that he has to decide whether he will work with Democrats on a bipartisan funding deal with no policy riders, or side with the Freedom Caucus, which would likely result in a shutdown.
There’s also been talk that another continuing resolution could be in the works, which could extend the health programs at existing funding levels.

What we’re watching: Friday is the first deadline for government funding to run out for programs covered by the fiscal 2024 Agriculture-FDA, Energy-Water, Military Construction-VA and Transportation-HUD spending bills.

News

02/26/24 4:34 PM EDT

Scoop: Congress eyes narrow health package

Axios

Only a handful of health care provisions that mostly extend existing programs are likely to catch a ride on the next government funding package as the prospect of a shutdown looms, sources say.

Site-Neutral Proponents Float Rural Exemption As Hospitals Flag Risks

February 15, 2024 4:18 pm

New talk about potentially ameliorating the hit to rural hospitals by adding rural exemptions to controversial site-neutral hospital policies is adding a wrinkle to the ongoing negotiations process. The hospital lobby is continuing its stern opposition to all site-neutral provisions, but some experts said the reforms are proving popular among voters, especially if an exception for rural hospitals is worked into the current provisions. Rural health lobbyists said they’d support such a tweak.

Stakeholders and congressional staffers remain unclear about the status and structure of hospital reform provisions that might be included in a bicameral health package as the countdown to Congress’ March 8 continuing resolution continues. The savings from hospital site-neutral provisions are entwined with a set of other extenders, including a so-called doc fix and a delay to the Medicaid Disproportionate Share Hospital cuts — and the ongoing lack of clarity about site-neutral complicates stakeholders’ lobbying for finite payment offsets elsewhere.

Mark Miller, executive vice president of health care at Arnold Ventures and former executive director of the Medicare Payment Advisory Commission, told Inside Health Policy hospitals aren’t likely to back site-neutral exemptions for rural hospitals even though they’ve raised concerns about how the reforms could harm rural hospitals’ payments.

“If the [American Hospital Association] and the Congress — and we have said this in our discussions with Congress — if you’re concerned about rural hospitals, exempt them. And this is the direct statement I would say to AHA: If you really care about rural hospitals, then exempt them from the policy. But they’re not going to do that,” Miller said. “They want to argue that they’re protecting rural hospitals, but if they just took a position and said, ‘exempt them from the policy,’ that’s protecting them, so why don’t they say that?”

Miller criticized several elements of the ongoing hospital lobbying to keep site-neutral provisions out of any compromise legislation, including a recent letter from the American Hospital Association urging Congress to nix site-neutral reforms and stave off cuts to Disproportionate Share (DSH) hospitals.

“They just kind of smear all of it together, and they say ‘you’re cutting the hospitals’ — But of course, what’s being affected . . . is the off-campus purchased stuff, which is usually a physician office,” Miller said. “We would say this is rolling back price increases imposed on the beneficiary and the taxpayer who went to their physician office. That’s where we think the money is coming from, and, we would argue, is an unethical price increase.”

Miller says prices go up as much as 300% when a hospital acquires a physician practice and argues the reduction in payment to off-campus outpatient payments is just bringing costs back to where they were before they were acquired. AHA’s letter “clouds the issue” by framing the provisions as cuts to hospitals, he added.

“All they’re doing is hiding behind the rural hospitals — the rural hospitals aren’t doing this much,” Miller said. “This is being executed by the large hospital systems who’ve bought beds and are now [doing] horizontal consolidation and are now engaged in vertical integration or consolidation by buying physician practices.”

Alexa McKinley, director of government affairs and policy for the National Rural Health Association, said NRHA generally doesn’t support site-neutral reforms because of the distinct impact they’ll have on rural hospitals compared to urban and suburban hospitals.

The volume of patients at rural off-campus provider-based departments are often the only point of access to care in some communities and are more convenient or closer than going to a hospital, which is why they’re often high volume and thus able to stay afloat, albeit on thin margins, McKinley said.

If rural off-campus departments are paid less because of the reforms, it’d ultimately threaten rural providers’ ability to keep their doors open, which would threaten access to care for rural patients by extension.

But if site-neutral reforms do move forward, NRHA would support a carve-out for all rural hospitals, McKinley said. NRHA has also called on CMS to consider exempting rural hospitals with less than 100 beds, Medicare-dependent hospitals, low-volume hospitals, and rural referral centers from current site neutral caps in the same way that sole community hospitals are exempt.

Miller took a similar approach.

“We don’t think all hospitals are well off. We think there ‘have’ hospitals and ‘have not’ hospitals. And this kind of opaque cross-subsidization where they’re hitting the beneficiary and the taxpayer is not the way we should solve that problem,” Miller said. “That problem should be out in the open — we should identify the dollars and direct the dollars to the hospitals that need them.”

When asked whether AHA would support language exempting rural hospitals from any site-neutral provisions, Jason Kleinman, director of federal relations at AHA, raised ongoing concerns for the stability of rural hospitals.

“Rural hospitals are experiencing unprecedented challenges right now that have forced 148 rural hospitals to close or convert to another type of provider since 2010,” Kleinman said in an email. “Temporarily not cutting these hospitals is not a solution to addressing these problems. In fact, it’s a gimmick and still puts access to care at risk.”

Instead, Kleinman said AHA’s looking to work with Congress on its rural hospital advocacy agenda which focuses on improving accountability for commercial insurers’ reimbursements to hospitals, improving flexible payment options, beefing up the workforce and protecting the 340B program.

AHA previously raised concerns that the rural hospitals facing impacts from the Lower Costs, More Transparency Act would face $272 million in cuts over a decade. Those same hospitals already experience a -16.4% Medicare outpatient margin and a -12.1% overall Medicare margin, AHA said in a Feb. 7 memo, meaning site-neutral reforms could drive them even further into the red.

But Miller pointed to research conducted by the Actuarial Research Corporation indicating around 2% of off-campus spending could be affected by site-neutral provisions and added that AHA’s math comes to less than 1% of total savings that’d come from implementing the provisions — dollars that could then be reinvested in the system.

For starters, Congress could take the savings from site-neutral reforms and put it toward rate hikes for rural hospitals, Miller said, either through the current payment system or using a supplemental set of payments to safety net hospitals. Miller also pointed to MedPAC’s recent work on reorganizing disproportionate share and charity care hospital payments as a means of improving support for vulnerable hospitals.

“I think their fundamental argument is, ‘We’re just trying to get money from anywhere, and we’re doing the right thing.’ And I think our fundamental argument is, ‘If we want the right thing — supporting vulnerable, rural, safety net hospitals, — this should all be transparent,” Miller said. “Where’s the money coming from? Who’s it going to?”

If site-neutral policies aren’t included in a future package, it leaves lots up in the air, namely a set of health extenders that need to be paid for — including DSH cut delays. But Kleinman shut down the idea of using site-neutral payfors for other programs, citing the harm it would do to Medicare beneficiaries.

“The AHA opposes the site-neutral cuts in the legislation and we don’t support permanent hospital Medicare cuts to be used for other programs. Congress has long opposed cutting Medicare and seniors’ access to care to pay for other non-Medicare spending,” Kleinman said in an email. “Gimmicks that temporarily carve out groups are just that, gimmicks. We remain opposed to the cuts as they will lower quality of care and access to hospital-based care, period.”

But around three-quarters of voters support limiting facility fees and about eight in 10 voters support requiring providers to disclose facility fees up front to patients, according to a December poll from the United States of Care conducted in partnership with Morning Consult. That’s around 70% of Republicans polled and 79% of Democrats polled, the polling data say.

Over 75% of those polled, including 73% of Republicans and 78% of Democrats, would support banning facility fees for services conducted in off-campus facilities, according to the poll.

Lisa Hunter, senior director for policy and external affairs at USofCare, pointed out most of the impact of those reforms would fall on larger, corporate hospitals.

“Our ideal is for site-neutral payments to prevail without exemptions so that policymakers can target those savings and reinvest them in the rural health infrastructure. Still, if rural hospitals need to be exempt to make progress on this issue, we understand,” Hunter said in an email. “We know from our listening research that people in rural communities overwhelmingly support transparency and fair billing provisions.”

News

02/15/24 4:18 PM EDT

Site-Neutral Proponents Float Rural Exemption As Hospitals Flag Risks

Inside Health Policy

Jefferson Health lost $48.7 million in first half of fiscal 2024. That’s a big improvement from last year.

February 15, 2024 4:14 pm

Jefferson, the Philadelphia region’s largest health by number of hospitals, is aiming to break even in the full fiscal year.

Torresdale Hospital in Northeast Philadelphia is among the 17 hospitals owned by Thomas Jefferson University. — *owned Thomas Jefferson University.*

Thomas Jefferson University and Jefferson Health’s loss in the first half of fiscal 2024 was sharply lower than last year, thanks in part to a large decline in expenses for contract labor and strong demand for inpatient services, according to a financial report released Wednesday.

Jefferson, the biggest health system in the Philadelphia region by number of hospitals, posted a $48.7 million operating loss in the six months ended Dec. 31, down from $83.4 million the year before. Its revenue was $4.8 billion, up 4% from $4.6 billion.

“Jefferson is on a steady path toward continued financial health,” Jefferson’s chief financial officer John Mordach said in an interview.

Jefferson’s goal for the full fiscal year, which ends in June, is to get close to break-even — as it did in October, November, and December. To meet its annual goal, Jefferson has to make enough in profits through June to erase its losses in the fiscal year’s first six months.

Signs of financial progress

One sign of financial progress for Jefferson: So far, it is not reporting unusual items that boost results in the current fiscal year.

Last year, Jefferson’s loss would have been even bigger had it not benefited from business sales, including $25 million from the sale of an interest in Delaware Valley Accountable Care Organization, and $24 million in COVID-related government aid.

This year, Jefferson changed how it accounts for property depreciation, but provided no financial details on one-time gains in its financial report to bondholders.

The improved results also reflect unspecified savings from job cuts in July. On Dec. 31, Jefferson had the equivalent of 35,525 full-time employees, down 2% from 36,355 on June 30. It was not clear how much of that reduction was from layoffs. Also on the labor front, Jefferson’s spending on contract labor, mostly nurses, fell by $31 million, to about half of last year’s level.

Lehigh Valley Health System, which Jefferson has a tentative agreement to acquire, also released financial results Wednesday. If that deal is completed, it will create a 30-hospital system that stretches from Scranton into South Jersey.

Lehigh Valley reported a $37 million operating loss on $2.1 billion in revenue in the six months ended Dec. 31, compared to a $32 million loss on $2 billion in revenue the year before. The nonprofit based in Allentown said it cut 475 full-time-equivalent jobs last fall, some from layoffs, some from eliminating vacant jobs. The organization employs 20,000.

News

02/15/24 4:14 PM EDT

Jefferson Health lost $48.7 million in first half of fiscal 2024. That’s a big improvement from last year.

inquirer.com

Jefferson, the Philadelphia region’s largest health by number of hospitals, is aiming to break even in the full fiscal year. Thomas Jefferson University and Jefferson Health’s loss in the first half of fiscal 2024 was sharply lower than last year, thanks in part to a large decline in expenses for contract labor and strong demand for inpatient services, according to a financial report released Wednesday.

Third Way Pushes For Charity Care Law Amid Hospital Extender Turmoil

February 15, 2024 4:03 pm

Third Way is calling on Congress to pass a national charity care law that would rein in hospitals’ debt collection practices, establish minimum requirements for charity care, and simplify how charity care is provided as part of a new report released Tuesday (Feb. 13). The center-left think tank points to data showing non-profit hospitals’ tax breaks have outpaced their charity care, echoing findings by the Senate health committee in late 2023 that hospitals call misleading.

Health committee Chair Bernie Sanders (I-VT) in mid-October recommended Congress and the IRS take several steps to crack down on non-profit hospitals’ charity care practices after a committee report indicated several of the largest tax-exempt hospital systems were only putting a fraction of their revenues back into charity care. But the American Hospital Association and America’s Essential Hospitals each pushed back in their own reports, raising questions about how Congress will handle transparency and oversight for non-profit hospitals moving forward.

Sanders in October said he planned to hold a hearing on non-profit hospitals in the coming months, though his office did not respond by press time on whether there are any further plans in the works.

The Third Way report comes amid a tumultuous time for hospitals, which are grappling with how to keep site-neutral provisions included in the House-passed Lower Costs, More Transparency Act out of a compromise package in the countdown to the end of the continuing resolution in early March. Tied to that issue is the matter of Disproportionate Share Hospital (DSH) cuts, which haven’t yet been averted by lawmakers as questions about payfors remain unresolved.

For its part, Third Way is calling on Congress to improve its oversight of non-profit hospitals by passing legislation with three components: modernize the requirements for charity care, simplify how patients receive charity care, and expand restrictions on aggressive debt collection tactics.

Third Way recommends establishing a standard for charity care, a recommendation that was included in a 2023 report from the Senate health committee. As part of the standard, nonprofit hospitals would offer charity care to individuals at a sliding scale based on income up to 400% of the federal poverty line.

Third Way’s recommendation is based on a similar requirement in Washington state, but a future policy could also be modeled after a Texas-based version requiring nonprofit hospitals to provide minimally the total amount of their tax exclusions in charity care.

Hospitals should also be required to streamline how patients apply for and receive financial aid, with more onus on the hospitals to help patients with their eligibility, Third Way says.

Hospitals should outline financial assistance policies to patients in writing and verbally before being discharged, and provide that information on every bill, the group adds, and should also be responsible for notifying patients of their eligibility for charity care based on federal income data the government should make available to hospitals with patients’ permission.

Policymakers should also block nonprofit hospitals from “engaging in extraordinary collection practices, specifically lawsuits and wage garnishment,” the report says.

Third Way says that non-profit hospitals received $28.1 billion in tax breaks — around $14.4 billion in federal exemptions and $13.7 billion in state and local breaks — in 2020. Around half of the nation’s 6,000 hospitals are private nonprofits, the report says.

But non-profit hospitals provided less charity care than for-profit hospitals and government hospitals in the last several years, Third Way’s report says.

“While charity care is not the only type of community benefit nonprofit hospitals may provide, it is the most effective method for ensuring patients have access to affordable care,” Third Way says. “Over time, the tax benefits for these hospitals have grown from $19.4 billion in 2011 to $28.1 billion in 2020, a 45% increase. Despite this trend, a study shows no accompanying growth in charity care. The vast majority (86%) of nonprofit hospitals did not provide more charity care than the value of their tax exemption.”

Third Way raised concerns that a lack of oversight from the Internal Revenue Service means hospitals aren’t required to hit a minimum level of charity care provided to maintain their tax-exempt status, and a convoluted application process for aid often deters patients from seeking financial assistance.

As a result, a higher number of patients grapple with medical debt where they’d otherwise be eligible for aid. Third Way says around half of nonprofit hospital systems billed low-income patients that should’ve qualified for charity care in 2019, and around 40% of patients had medical debt in 2023.

“With inadequate accountability for serving their community, nonprofit hospitals need a clear standard for the tax benefits they receive,” Third Way says in its report.

The American Hospital Association and the Federation of American Hospitals issued their own responses to the Senate’s October report, and Melinda Hatton, AHA’s general counsel and secretary, said in a late November blog post that hospitals’ charity care increased over the last three years, along with their expenses.

Median charity care spending for all hospitals grew by 13% between 2021 and 2022 alone, in line with a 17.5% cost growth during the same time period, Hatton said.

“It’s basic math: When the denominator (expenses) increases as much as it has over the past three years, but the numerator (charity care) does not increase as much, then of course the overall proportion will look different,” Hatton writes. — Bridget Early (bearly@iwpnews.com)

News

02/15/24 4:03 PM EDT

Third Way Pushes For Charity Care Law Amid Hospital Extender Turmoil

Inside Health Policy

Press Releases Pascrell Announces $3.1 Million for St. Joseph’s Hospital

February 13, 2024 4:33 pm

Congressman Bill Pascrell, Jr. (D-NJ-09) announced today that the Federal Emergency Management Agency (FEMA) has awarded $3,125,845.45 to St. Joseph’s Regional Medical Center. As the COVID-19 pandemic swept through New Jersey, St. Joseph’s implemented emergency protective measures to combat the spread of the virus. The federal award announced today will reimburse the hospital for expenses related to these measures, including the purchase of personal protective equipment (PPE) and other lifesaving resources. Congressman Pascrell had worked with the hospital and agency to ensure delivery of this funding.

“While our brave healthcare workers continue to respond to COVID-19, we must ensure that efforts to protect individuals who are at risk of contracting COVID-19 continue to receive federal support,” said Congressman Pascrell, a former Paterson mayor and former member of the House Ways and Means Subcommittee on Health. “This grant sought by my office will directly assist the patients, medical professionals, and staff at St. Joseph’s by covering the costs they incurred as the pandemic was at its peak. Federal funding is essential to the health of our community, and I will continue to work with FEMA and other federal agencies to deliver funding like this for our cities and towns.”

“We are grateful to Congressman Pascrell for securing this critical funding. He continues to fight to help ensure that our frontline team members are able to provide high-quality, groundbreaking care to residents throughout northern New Jersey,” said Dustin M. Riccio, MD, President and CEO of St. Joseph’s Health. “St. Joseph’s was at ground zero of the COVID-19 pandemic and we met the challenge head-on with a team of talented, compassionate and courageous clinical and support personnel. They cared for patients during what can only be called an unprecedented national healthcare emergency and showed their commitment to the community they serve, while placing their own health at risk. The funding awarded to St. Joseph’s Health will bolster our response to emerging healthcare needs while enabling us to better serve patients and help keep our communities safe.”

Throughout the pandemic, Congressman Pascrell maintained constant contact with federal agencies to ensure North Jersey received every federal dollar needed to combat COVID-19 while supporting residents and easing the financial strain that so many working New Jerseyans faced.

News

02/13/24 4:33 PM EDT

Press Releases Pascrell Announces $3.1 Million for St. Joseph’s Hospital

U.S. Rep. Bil Pascrell, Jr.

Site-Neutral Provisions Remain In Limbo As CR Clock Ticks

February 13, 2024 11:56 am

Stakeholders and congressional staffers remain unclear about the status and structure of hospital reform provisions that might be included in a bicameral health package as the countdown to Congress’ March 8 continuing resolution begins in earnest. The savings from hospital site-neutral provisions are entwined with a set of other extenders, including a so-called doc fix and a delay to the Medicaid Disproportionate Share Hospital cuts — and the ongoing lack of clarity about site-neutral complicates stakeholders’ lobbying for finite payment offsets elsewhere.

Existing health care extenders were temporarily extended at current funding levels — while others were left to expire — under the latest short-term continuing resolution (CR) stretching from mid-January through March 8 as lawmakers continue to hash out fiscal 2024 spending bills.

A significant part of the turmoil stems from uncertainty over what site-neutral provisions an eventual compromise package might contain.

The uncertainty leaves other policies, such as the doc fix and DSH cut delays, up in the air. Hospitals are vying for a tranche of non-earmarked funding transferred to the Medicare Improvement fund in late December to help delay DSH cuts — the same funding physicians have already staked a claim on as part of their efforts to stave off 2024 Medicare physician pay cuts, but which has rapidly become the focus of intense lobbying as the fate of site-neutral offsets throws other extenders into limbo.

Mark Miller, executive vice president of health care at Arnold Ventures and former executive director of the Medicare Payment Advisory Commission, said he anticipates that lawmakers will opt for a time-limited, smaller fix for DSH cuts and the sequester given the ongoing pressure from hospitals to avoid site-neutral requirements.

“I think the dynamic is this: The hospitals are very convinced they’re going to get DSH one way or the other, and so they’re opposing the site-neutral because they believe that the Congress will forestall the DSH cuts using some other mechanism,” Miller said. “It’s certainly not going to take the problem off the table, so I wouldn’t imagine that the physicians would be happy about it. But if the hospitals walked away with DSH cuts averted, no site-neutral, no NPI, no pricing obligations, they would clearly see that as a victory.”

Site-neutral debate

The House’s Lower Costs, More Transparency Act contained site-neutral provisions to Medicare for drug administration, while the Senate health committee’s Primary Care and Health Workforce Act would limit facility fees for certain services for patients with commercial insurance.

There’s some baseline overlap between the Senate and House packages, specifically a billing requirement to establish unique National Provider Identifiers, but the Senate package includes those billing requirements in the commercial market, whereas the House package would establish that requirement under Medicare.

The Congressional Budget Office on Tuesday (Feb. 6) issued a cost estimate for the Senate health committee’s Primary Care and Health Workforce Act with about $7.7 billion in estimated savings from hospital reforms under Title III of the package.

But a lobbyist noted that the Senate Finance Committee hasn’t formally weighed in this year on site-neutral reforms under Medicare — Finance Chair Ron Wyden (D-OR) said during a November markup that he wanted more time to work through the technical aspects of site-neutral reforms.

With weeks remaining until the continuing resolution expires on March 8, the lobbyist said that policymakers are mostly still unclear on the final direction of any health legislation, including whether site-neutral reforms will even make it into the package. It’s likely a solid set of provisions, as well as offsets, will begin to materialize during the week of Feb. 26, after the Senate returns from recess, the lobbyist said.

But other stakeholders feel differently. A staffer told Inside Health Policy on Wednesday (Feb. 7) that site-neutral provisions are expected to survive lawmakers’ ongoing talks despite the tumult.

A second congressional staffer on Tuesday (Feb. 6) said lawmakers were surprised by the strength of the support for site-neutral reforms from stakeholders across the health care sector, including insurers and doctors’ groups. The staffer told IHP that hospitals are putting considerable pressure on lawmakers to keep site-neutral out of the equation, but that eliminating the immense savings generated by those provisions would take a major bargaining chip off the table for negotiators.

The second staffer also said some lawmakers are skeptical about an argument from hospitals that site-neutral provisions would disproportionately harm rural hospitals.

The American Hospital Association in late January released a report noting that site-neutral funding cuts would have a direct impact on the level of care and services available to patients in rural and underserved communities, as hospital outpatient departments have stepped in to fill gaps in care that were otherwise causing access issues.

About 36% of outpatient visits in rural areas were to a hospital outpatient department between 2019 and 2021, AHA says, including about 40% of dually eligible beneficiaries.

AHA also doubled down on the ongoing threat to rural hospitals in a recent blog.

But Darbin Wofford, a health policy advisor for Third Way, said the House’s site-neutral provisions would have a minimal impact on rural hospitals.

“Site-neutral provisions only would apply to hospital outpatient departments located separately of the hospital campus,” Wofford said in an email. “Just 7% of Medicare’s total off-campus outpatient spending occurs in rural areas, and with exemption of Critical Access Hospitals, just 2% of rural facilities would see any effects.”

The House package’s site-neutral provisions also exempt Critical Access Hospitals, which account for over 60% of all rural hospitals, Wofford added — plus, Congress could include additional exceptions for the rural hospitals that aren’t already exempt if there are still outstanding concerns.

Future reforms

The first staffer said that any limited reforms that get looped into a health package ahead of March 8 would be a solid foot in the door for additional hospital oversight, an effort some senators are already beginning to push for.

During a November Senate Finance Committee markup of the Better Mental Health Care, Lower-Cost Drugs, and Extenders Act, Sen. Maggie Hassan (D-NH) introduced and withdrew an amendment to include the SITE Act in the package, which would establish site-neutral payments for drug administration services under Medicare, eliminate facility fees, and set up an NPI.

The SITE Act, which is cosponsored by Sens. Joe Kennedy (R-LA) and Mike Braun (R-IN), could lead to upwards of $100 billion in savings over the next decade, the first staffer said.

Hassan said during that markup that she was withdrawing her amendment as both Wyden and Ranking Republican Mike Crapo (ID) pledged to work more on the issue.

One element of the SITE Act, a provision combatting a loophole in the site-neutral policies of the Bipartisan Budget Act of 2015, would end grandfathering for existing and mid-build off-campus facilities — a priority that’s been especially pressing for stakeholders.

Arnold Ventures’ Miller said that the SITE Act would effectively end off-campus grandfathering, putting an end to what Wofford described as “a massive loophole.”

“Congress passed site-neutral payments in 2015, but those requirements only applied to newly built hospital clinics,” Wofford said. “There is a massive loophole that includes grandfathered-in clinics, and physician practices bought up by hospitals, creating an incentive for hospital takeovers.”

The SITE Act would result in more savings for taxpayers and beneficiaries, and potentially allow Congress to devote some of the dollars saved to other objectives, like higher payments for safety net hospitals, workforce aid and mental health, Miller pointed out. But there’s no scenario where the SITE Act would get picked up for the March 8 process, and there’s nothing in the Lower Costs, More Transparency Act that would remove grandfathering either, Miller said. —Bridget Early (bearly@iwpnews.com)

News

02/13/24 11:56 AM EDT

Site-Neutral Provisions Remain In Limbo As CR Clock Ticks

insidehealthpolicy.com

Stakeholders and congressional staffers remain unclear about the status and structure of hospital reform provisions that might be included in a bicameral health package as the countdown to Congress’ March 8 continuing resolution begins in earnest. The savings from hospital site-neutral provisions are entwined with a set of other extenders, including a so-called doc fix and a delay to the Medicaid Disproportionate Share Hospital cuts — and the ongoing lack of clarity about site-neutral complicates stakeholders’ lobbying for finite payment offsets elsewhere

News

02/13/24 11:54 AM EDT

Hospitals are fighting a Medicare payment fix that would save tax dollars

npr.org

In the battle to control health care costs, hospitals are deploying their political power to protect their bottom lines.

Organ Transplant Groups Push HHS on Decertification Process

February 13, 2024 11:51 am

The nonprofit groups that solicit, retrieve, and transport human organs for transplantation say the Biden administration should issue long-awaited guidance on how a revamped decertification process for the groups will unfold in 2026.

Nearly three-fourths of organ procurement organizations (OPOs) were either failing in their responsibilities or under-performing, the Centers for Medicare & Medicaid Services reported in 2023. This includes 24 OPOs—42%—that were operating at the lowest-performing “tier 3” level.

If these OPOs fail to improve their performance in 2024, they could face decertification from the federal organ transplant program in 2026, “presenting a real risk of systemic disruption,” the Association of Organ Procurement Organizations said Thursday.

“If nearly half of the country’s OPOs close in 2026, as is presently forecasted, hundreds of thousands of Americans currently registered on the transplant wait list, and those yet to be referred for transplant, are at risk of experiencing serious disruptions in care,” the association said in a statement. Yet “CMS has yet to share a plan for how a transition after vast de-certification would unfold.”

More than 40 members of Congress expressed similar concerns to the CMS in November 2023.

In a January response to the letter to each of the congressional co-signers, CMS Administrator Chiquita Brooks-LaSure said the agency is developing a proposed rule on the standards to evaluate and recertify OPOs.

“CMS is reviewing our OPO competition and de-certification processes, and any changes would be made through future rulemaking. We expect that any revisions will continue to hold OPOs responsible for improved performance,” Brooks-LaSure’s letter said.

‘Considerable Uncertainty’

The association was not satisfied by the response.

“There is considerable uncertainty around how this new re-certification process will work and numerous unanswered questions,” the group’s release said. “Our members are seeking clarity on the ground rule for competition; the process by which proactive mergers can take place, and how OPOs that want to acquire de-certified OPOs can do so; and, perhaps most importantly, what the process looks like for an OPO faced with de-certification.”

The nation’s organ procurement organizations identify potential organ donors, request consent from donor families if there’s no documentation, procure organs, and work to identify potential transplant recipients. They also help ensure that organs are delivered to transplant hospitals.

But in recent years, they’ve faced persistent criticism for questionable spending practices, poor performance, and not making enough organs available for transplant.

In their release, the AOPO said the non-utilization rate of kidneys reached a record high of 28% last year. “Last year, more than 8,500 kidneys that were recovered by OPOs and offered to transplant centers for patients in need were ultimately declined and unused,” it said.

This issue is highly concerning “because of its consequences for patients,” the group said. “Non-utilization leads to the unnecessary deaths of thousands of transplant patients each year who placed trust in our donation and transplant system to save their lives.”

The nation’s OPOs are assessed mainly on their organ donation rates and organ transplantation rates. But after an organ is recovered, an OPO has little to no control over whether it is actually used for transplantation. So the “transplant rate” reflects a transplant center’s decision, not OPO performance, but it still significantly affects an OPO’s ranking.

“The nation’s organ donation system is on the verge of collapse as nearly half of the nonprofits responsible for recovering organs nationwide are at risk of decertification by CMS, with no plan for transition,” Colleen McCarthy, the association’s president, said in a statement to Bloomberg Law.

“We urge CMS to immediately provide a detailed plan for ensuring America’s transplant patients will experience no disruptions should the agency dissolve 42% of organ procurement organizations,” she said.

News

02/13/24 11:51 AM EDT

Organ Transplant Groups Push HHS on Decertification Process

bgov.com

News

02/13/24 11:49 AM EDT

Rubio, Carper introduce Bill to free up hospital beds for high-need patients

Senator Marco Rubio (R-FL)

The hospital-at-home program has been essential in helping hospitals free up beds and staff for patients in need of greater care. However, the current hospital-at-home program only covers acute patients, not observation status patients.

Plan to merge 2 South Jersey hospitals this year could be a ‘game changer,’ mayor says

February 12, 2024 1:09 pm

A proposed alliance of two New Jersey healthcare companies maintains broad support a year after the institutions announced intentions to merge.

Cape Regional Health System formalized its decision in late 2022 with Cooper University Health Care, citing a need to affiliate with a more robust company for financial support to provide better services to the Jersey Cape.

The company operates Cape Regional Medical Center, Cape May County’s lone hospital, which is accessible by either the Garden State Parkway or Route 9.

A public hearing on the unionization was held on Feb. 5 at the Reeds at Shelter Haven in Stone Harbor. A panel from the New Jersey Attorney General’s Office heard public comments under the Community Healthcare Assets Protection Act, a state law passed in 2000 governing hospital transactions.

Those who spoke at the meeting said their support for the deal remains while it awaits regulatory approvals.

Cooper, a $2 billion not-for-profit enterprise, features a 635-bed hospital, a children’s hospital, the MD Anderson Cancer Center and Cooper Medical School of Rowan University.

Chris Leusner, mayor of Middle Township, where the hospital is located in its Cape May Court House section, said the two joining forces gives local patients access to care for which they would have had to otherwise travel long distances.

“Cape Regional is a first-class organization that cares about community, and I get very excited when I think about them merging and partnering with another excellent institution and organization Cooper Health System,” said Leusner, a first-term mayor who previously served as the township’s police chief “The number of specialized physicians and a new cancer center in our community will be a game changer for our residents. I think about my parents who have traveled within the last 12 months for specialized care to Cooper.”

Company officials said in 2022 the approval process could stretch into this year. State officials said they were giving commenters a week to provide their remarks.

Besides its hospital, the company manages a network of three urgent care facilities and employs more than 60 primary care physicians.

Cooper said previously the envisioned healthcare system created by the pair would tally about $2.2 billion in annual revenue while operating two hospitals with more than 900 licensed beds, more than 900 employed physicians in three practicing groups, 130 ambulatory locations in eight counties and six urgent care centers.

Cape Regional Medical Center first opened in 1950 as Burdette Tomlin Memorial Hospital. It has been known by its current name since 2006.

The deal follows a trend of smaller healthcare companies and independent hospitals merging into larger institutions.

Earlier this month, Saint Peter’s Healthcare System in New Brunswick, operator of one of New Jersey’s last remaining independent hospitals, announced a partnership with Atlantic Health System.

Joanne Carrocino, president of Cape Regional Health System, told the panel her company particularly felt a need to appeal to Cooper because of financial pressures.

“I don’t think anyone would argue that these are extremely challenging times to be in healthcare, especially for an independent community hospital, like Cape Regional,” Carrocino said. “All hospitals throughout the country are facing tremendous pressures, including significant physician and staff shortages, continued expense, inflation and increased competition from both traditional and non-traditional healthcare providers.”

News

02/12/24 1:09 PM EDT

Plan to merge 2 South Jersey hospitals this year could be a ‘game changer,’ mayor says

NJ.COM

A proposed alliance of two New Jersey healthcare companies maintains broad support a year after the institutions announced intentions to merge.

Senate weighs AI health care regulations

February 9, 2024 9:16 am

HOW TO REGULATE AI? The Senate Finance Committee took its first crack Thursday at examining the regulation of artificial intelligence in health care, focusing on payment policies, responsible use and accountability.

“This committee has a responsibility to ensure there are guardrails in place to protect patients, particularly in Medicare and Medicaid, and I do not believe that current laws go far enough to achieve that goal,” Chair Ron Wyden (D-Ore.) said, touting his legislation that would mandate companies assess the impacts of automated decisionmaking and require reporting to the FTC.

Ranking member Mike Crapo (R-Idaho) struck a more cautious tone, saying Congress needs to learn more about the technology before legislating.

“One-size-fits-all, overly rigid, and unduly bureaucratic laws and regulations risk stifling life-saving advances and becoming outdated before they are even codified,” Crapo said.

Here are three of Ben’s takeaways from the hearing:

Who’s paying? Lawmakers and witnesses from tech groups and universities were interested in reimbursement for AI tools. Crapo said Medicare coverage needs to keep pace with AI to avoid “access gaps” widening. Sen. Bob Menendez (D-N.J.) probed witnesses about Medicare coverage gaps.

Peter Shen, head of digital and automation for North America at Siemens Healthineers, called for a “more predictable” reimbursement strategy from CMS. Mark Sendak of the Duke Institute for Health Innovation suggested there be incentive payments like Congress did with electronic health records in a 2009 law.

Advocacy group the AI Healthcare Coalition called for a permanent Medicare payment pathway for AI in a statement for the record.

Care denials in the crosshairs: Lawmakers on both sides of the aisle were wary of AI being used to deny care en masse.

Wyden suggested that HHS might have a future role in overseeing algorithms used in processes like prior authorization. Crapo said that improper denials or delays in care “warrant government scrutiny.”

A cost-saver? Both Democrats and Republicans were optimistic that AI could help reduce costs as Congress looks to rein in rising spending.

“Perhaps we’ll actually be able to bend the proverbial cost curve down in health care. We’ve tried seemingly everything else in Washington,” Sen. Todd Young (R-Ind.) said.

News

02/09/24 9:16 AM EDT

Senate weighs AI health care regulations

Politico Pro

The Senate Finance Committee took its first crack Thursday at examining the regulation of artificial intelligence in health care, focusing on payment policies, responsible use and accountability.

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‘Considerable Uncertainty’

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