HealthCare Roundtable e-News – May 20, 2021


Some House Democrats Signal Concerns with Pelosi’s Bipartisan Drug Pricing Bill

In a recent letter sent to House Speaker Nancy Pelosi (D-Calif.), a group of Democrats signaled their concerns that the House’s drug pricing legislation, known as H.R. 3, does not do enough to incorporate bipartisan measures. The bill, which has a provision that would allow the secretary of Health and Human Services to negotiate lower drug prices and cap prices based on prices paid in other countries, only received two Republican votes when it passed the House in 2019.

The letter states that lawmakers “must garner bipartisan, bicameral support, with buy-in from a majority of Americans and stakeholders in the public and private sectors…If this pandemic has taught us anything, it’s that we all, truly, must be in this together.”

H.R. 3 is opposed by many in the pharmaceutical industry over concerns that the bill could hurt drug companies’ ability to develop new drugs. Pelosi had been a significant proponent of the H.R. 3, which she and other advocates have been eyeing as a potential cost-saving measure to support President Biden’s infrastructure package.

Other critics of the bill include Reps. Scott Peters (D-Calif.) and Jake Auchincloss (D-Mass.), who co-led the effort to draft the letter to the Speaker and shared their beliefs that the bill does not do enough to protect patients. Matt Corridoni, a spokesman for Auchincloss, said that H.R. 3, “doesn’t materially lower their out of pocket costs and it prevents cures they need. This letter is starting a conversation about improving drug pricing reform.”

Lawmakers Clarify Surprise Billing Intentions, Arbitration in Letter to Biden Administration

Conflicting views of how the Biden administration should interpret components of surprise billing legislation are causing a rift amongst lawmakers as HHS prepares to implement the law. The No Surprise Act, which passed last year as part of a 2020 spending bill, prohibits the practice of balance billing patients more than in-network charges for services conducted in an outpatient setting or done by an out-of-network doctor in an in-network setting.

The last-minute inclusion of language stating that arbitrators cannot consider the provider’s billed charge, the usual or customary charge, or rates paid by Medicare, Medicaid, or other government programs, has been disputed. All stakeholders agree that Medicare charges cannot be considered, but many hold different views on whether the factors listed in the legislation should be considered equally, or whether Congress intended the qualifying payment (QPA) amount to be the primary consideration and the other factors to be used only in certain circumstances. Sens. Bill Cassidy (R-La.) and Maggie Hassan (D-NH), who had worked together over the last few years to pass legislation on surprise billing, penned a letter to the Biden administration last week that they had intended all the factors be given equal weight. (InsideHealthPolicy)

“The law’s arbitration framework is designed to ensure that neither payors nor providers have a financial incentive to remain out of network as a tool to establish leverage for contract negotiations,” Cassidy and Hassan said. “To achieve this balance, we wrote this law with the intent that arbiters give each arbitration factor equal weight and consideration.” Reps. Larry Bucshon (R-Ind.) and Raul Ruiz (D-Calif.) made a similar plea to HHS in a letter sent earlier this month, asking that the agency “refrain from issuing guidance or taking other action that would give preference to once factor over the other as it works to promulgate rules for the No Suprise Act.” (InsideHealthPolicy)

Latest National Health Spending Analysis Shows a Rebound in March Growth Rate

According to health research and consulting non-profit Altarum, overall spending on health in the U.S. has recovered so far in 2021. The organization’s May 2021 Health Sector Economic Indicators (HSEI) Brief analyzes data on the national health spending growth rate, health sector spending, prices, employment, and utilization, finding that economywide price growth outpaced the health sector in April, while the jobs market fell slightly.

The brief indicated a significant rebound in March, with national health spending coming out to be 12.5% higher than one year ago, reflecting the recovery from the drop in spending that began in March 2020. Net growth in national health spending rising 1.8% through March 2021 compared to January of last year.

The brief also reported that health care employment fell slightly in April 2021, down 4,100 jobs over the month, with more than 29,000 jobs during the first four months of 2021 compared to the end of 2020. Slight gains in jobs in ambulatory care settings were offset by continued losses in hospital and nursing and residential care jobs.

Senators Push Bill to Expand Telehealth Initiatives Post-Pandemic

As COVID-19 cases across the country continue to decline, local officials are reconsidering which policies that went into effect at the height of the pandemic will become permanent. U.S. Senators are pushing for continued telehealth services across states, where many rural communities in particular benefitted from the resource.

According to Sens. Susan Collins (R) and Angus King (I), the use of telehealth among Medicare beneficiaries skyrocketed in the past year. Both are eager to make COVID-19 telehealth flexibilities permanent post-pandemic by supporting a proposal called the Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2021, a bill which Collins says will enable her constituents to “continue to take advantage of remote home health care amid the COVID-19 public health emergency and beyond.”

Telehealth participation jumped at the beginning of the pandemic and has leveled off in recent months; however, according to a recent HIMSS Market Intelligence survey, nearly one in two respondents between the ages of 18 and 56 preferred seeing their primary care provider via video after the COVID-19 pandemic. In situations regarding the treatment of mental health, the numbers are even higher.

Connected Health Initiative Executive Director Morgan Reed and other advocates of the CONNECT Act have said that the reforms, “would enable Medicare beneficiaries to meaningfully access virtual care and come very close to our recommendation to adopt ‘any site at which the patient is located’ as a statutory originating site.”