HealthCare Roundtable e-News – May 6, 2020


COVID-19 Update Follow-Up

I’d like to thank everyone who participated in last week’s COVID-19 Zoom conference. As we know, these are challenging times and everyone is working hard to maintain efficient and responsive organizations. If there’s anything we can do to support you during this time, please let me know.

Please click here for a copy of Andrew’s final presentation.

Stay healthy!

Tom Lussier



Remdesivir’s ICER Value Estimate Catalyzes Conversations on Pandemic Drug Prices

As biopharmaceutical companies ramp up the testing and production of vaccines and treatments for COVID-19, many discussions are now popping up regarding the question of setting drug prices for pandemic products. Among the most promising drugs to come from the crisis is the COVID-19 treatment drug Remdesivir, created from the labs of Gilead Sciences, and according to the Institute for Clinical and Economic Review, its patient value is in the neighborhood of $4,500 for each patient. (InsideHealthPolicy)

Since Remdesivir became one of the first drugs throughout the crisis to show promise in treating COVID-19 patients, the FDA has opted to fast track the drug. Remdesivir has since been a catalyst for conversations surrounding the costs of drugs that will treat, track, and prevent the disease.

Daniel O’Day, CEO of Gilead, said in its first-quarter call last week that “the tone is different in Washington,” that lawmakers’ attitudes already are changing around drug price controls, particularly as the need for COVID-19 drugs and vaccines increases. On Eli Lilly’s first-quarter call, CEO David Ricks said the biopharma industry has a “once in a generation opportunity to reset” its reputation.

Meanwhile, CMS announced last week that it would reveal details in the coming weeks on how the agency plans to lower seniors’ insulin costs. The White House budget officials are also currently reviewing a proposal with drug-pay policies in Part D and Medicare Advantage.

CMS Organizes Independent Commission Supporting Nursing Home COVID-19 Response

CMS confirmed last week that it is organizing an independent commission to assess the response of nursing homes to COVID-19 as the virus continues to wreak havoc on facilities across the country. The announcement was made the same day that FEMA confirmed it will be delivering “care packages” containing personal protective equipment to 15,000 nursing homes nationwide.

The commission, which includes resident advocates, family members, nursing home experts, infection control professionals, as well as state and local authorities, will look to provide recommendations and best practices on how to improve care delivery for nursing home residents, how to strengthen rapid and effective identification of COVID-19 and mitigate its spread, as well as strategies to improve compliance with infection control policies. (InsideHealthPolicy)

Mark Parkinson, AHCA president and CEO, said “We look forward to working with this Commission to identify ways that the public and private sectors can support the needs of our health care heroes and ensure they have the additional resources needed to stem the tide of this pandemic among our residents,” in a statement last week.

Some in Washington are asserting that more oversight is needed for nursing homes across the country. Randi Seigel, a partner with Manatt, Phelps & Phillips, said she sees the commission as both an oversight effort for nursing homes, but also as an attempt to better support nursing homes. Senate Finance Committee Chair Chuck Grassley (R-Iowa), who has been a strong proponent for better oversight of nursing homes, recently held outbreaks in nursing homes up as evidence that more federal oversight is needed. (InsideHealthPolicy)

White House Reviewing 2021 and 2022 Final Rule for MA, Part D

Last week, the White House Office of Management and Budget began its review of final 2021 and 2022 regulatory changes to Medicare Advantage and Part D. While a call letter is usually released alongside Medicare Advantage and Part D rate notices, CMS said that it opted for a rule instead in order to codify certain policy changes. The agency had finalized 2021 rate increases back at the beginning of April this year.

The proposed rule was expected to lead to $4.4 billion in savings over 10 years. Changes to the star ratings programs and other initiatives contributed to the savings, and CMS suggested that some of the savings would be “passed onto beneficiaries in the form of increased benefit offerings and reduced premiums or cost sharing.” The most recent interim final rule includes changes to the 2021 star ratings program intended to address the disruption to data collection and plan performance in 2020 posed by the COVID-19 crisis.

CMS noted that most of the star ratings measures for Medicare Advantage are based on data from the Healthcare Effectiveness Data and Information Set (HEDIS) and Consumer Assessment of Healthcare Providers and Systems (CAHPS). The interim final rule will eliminate the requirement for submission of 2020 CAHPS survey data and delays collection of the HEDIS survey. (InsideHealthPolicy)

Medical-Debt Collection Still on the Rise During COVID-19 Crisis

While the coronavirus crisis rages on and continues to impact millions, hospitals have been front and center as news reports detail the heroic acts of front line workers during this time. But despite these acts of good and heroism, debt-collection operations at hospitals continue to reach out to thousands across the country, targeting many individuals who have recently lost their healthcare or had to file for unemployment. Many of these individuals have been on the receiving end of payment notices and lawsuits for previously unpaid bills in the thousands.

In the last decade, the number of lawsuits over debt-collection has skyrocketed. Back in 2008, The Baltimore Sun reported that Johns Hopkins and other local Maryland nonprofit hospitals had filed more than 32,000 debt-collection suits over the past five years, winning at least $100 million in judgments. In 2019, a coalition released a report finding that Hopkins had launched 2,400 lawsuits in Maryland courts since 2009 against patients with unpaid bills, increasing from 20 in 2009 to a peak of 535 in 2016. (ProPublica)

In many cities during the crisis, trends show that the lawsuits are being brought mostly against the demographic that has been shown to be most vulnerable in the pandemic: lower-income African Americans with underlying health conditions. Cecilia Behgam, an AFL-CIO researcher, said that these groups “are people who are already disproportionately feeling the impact of the epidemic.” Many who have been laid off or no longer have access to healthcare are opting to use their government stimulus checks-if they’ve received it-on the necessities; paying rent, gas, electricity, and food.