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This Week in Health Care Reform: July 20th, 2018

The House prepares an important vote on legislation protecting millions of Americans from the potential of increased health care costs; Medicare Advantage savings and outcomes are shown to eclipse those achieved in traditional Medicare; separately, the Administration proposes billing changes for Medicare to allow for virtual visits; meanwhile, states continue to struggle with restrictive telemedicine policies.

Week in Review

HIT Vote: Next week, the House of Representatives is scheduled to vote on a broad health care package that includes, among other items, extending the moratorium on the health insurance tax (HIT) – which is suspended next year – for an additional two years through 2021.  This proposal builds on bipartisan legislation introduced earlier this year by Reps. Kristi Noem (R-South Dakota), Kyrsten Sinema (D-Arizona), and Ami Bera (D-California), the enactment of which, would provide relief from increased premiums to hard-working families, small business owners, and Medicare Part D beneficiaries, as well as enrollees in Medicare Advantage plans and Medicaid.  In fact, according to a study by management consulting firm Oliver Wyman, consumers could see lower premiums and cost savings totaling $570 on average in 2020 alone were the HIT to be further delayed.  Stakeholders have already mobilized, urging lawmakers to support these efforts.  We need our Health Action Network members to also reach out to their elected officials and urge them to support further delay of the HIT.  Be sure to take action today!

MA Results: As our health care system continues to reshape itself, operationalizing the shift from fee-for-service to value-based care, there’s arguably no better blueprint than that offered by the Medicare Advantage program.  Evidence abounds illustrating how consistently Medicare Advantage (MA) outperforms traditional Medicare.  A new study advances this narrative, highlighting the cost-effective care and better outcomes for beneficiaries with chronic conditions achieved by the program relative to fee-for-service Medicare.  In comparing the two, researchers from Avalere found that these MA enrollees had 23 percent fewer inpatient stays and 33 percent fewer emergency room visits than those enrolled in Medicare.  Further, inpatient spending was 17 percent lower in Medicare Advantage, while outpatient spending was 5 percent lower.  The study goes on to document how MA plans achieved these results by guiding beneficiaries to lower cost services and coordinated care.  In fact, MA was more likely than Medicare to spend on preventive services in order to prevent enrollees from developing more costly chronic diseases.

CMS Proposal:
Last week, CMS proposed overhauling Medicare billing standards for the first time since the 1990s to allow doctors to be paid for virtual visits.  Recognizing that access and transportation for the elderly and disabled population can often be a significant barrier to care, CMS’ proposal would pay doctors for their time when reaching out to beneficiaries via telephone or other telecommunications devices.  As a part of the proposal, physicians would also be paid for the time they spent reviewing videos or images sent by patients seeking care or a diagnosis.  The proposed billing change is a component piece of CMS’ commitment to modernize the Medicare program by leveraging technologies and digital health tools.

Digital Health:
Despite growing acknowledgment of the role that access to new technologies plays in the health of its communities, many states continue to wrestle with the realities of articulating telemedicine policies that ease existing restrictions governing its utilization.  Medicaid programs in particular – specifically, policies related to licensing, reimbursement, and standards of practice – find themselves struggling with how best to capitalize on the benefits of telemedicine.  In a recent survey, more than half of the states were identified as having either “restrictive” or “moderate” telemedicine policies in place across a wide range of categories, including: Coverage and reimbursement; eligible patient settings; and, service limitations.  Encouragingly, though, nearly every state Medicaid program provided coverage and reimbursement for live video conferencing.      

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On Tuesday, the Senate HELP Committee held a hearing to explore ways to reduce health care costs, specifically, through the elimination of excessive health care spending.  While lawmakers grappled with how new policies could potentially curb increasing costs, they were left with a handful of questions that are likely to drive the conversation propelling the larger shift to a health care system with value as its North Star – namely: Does the government need to standardize care for value-based models to work?  What is fraud and what is abuse?  And, who bears responsibility for social determinants of health?

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