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This Week in Health Care Reform: September 28th, 2018

Congress unveils a massive opioid legislative package; a new survey highlights the growing reach of value-based payment arrangements; air ambulance operators find themselves the target of increased oversight; and, drugmakers exploit shortages to inflate prices.

Week in Review

Final Opioid Bill: Late Tuesday evening, negotiators from the House and Senate announced that they’d struck a broad, bipartisan agreement on a legislative package targeting the opioid epidemic.  Capping off months of policymaking efforts, the final 660-page bill takes a wide variety of actions in seeking to combat the crisis.  While the measure is seen by many as largely a step in the right direction, others are quick to call out for more sustained funding.  And, missing from the final package, provisions better aligning outdated privacy protections for mental and physical health records, including those concerning substance use disorders (SUD).  As has been written about here, failure to include those updates, experts and stakeholders have maintained, needlessly complicates insurers’ and providers’ ability to coordinate more effective, whole-health SUD treatments for patients.  (Thanks to the hundreds of Health Action Network members who wrote in to their lawmakers, urging them to include these provisions in the final package.)  In terms of immediate next steps, the House passed the final bill this afternoon before heading out of town until after the midterms, while the Senate has yet to indicate when it will take up the package.

Value-Based Payments: Nearly half of all physicians in the country now report compensation tied to value-based metrics, furthering our health care system’s gradual transition away from traditional volume-based, fee-for-service care delivery.  In its new biennial survey, The Physicians Foundation found that 47 percent of respondents had some portion of their reimbursement linked to value-based payment arrangements – up from the 42 percent that reported similar arrangements back in 2016.  However, more than half of the doctors polled aren’t convinced that value-based payments will lead to improved quality or reduced costs.  While the report didn’t cite specific reasons why, at least one-in-10 physicians said they weren’t sure if they were paid on value.

Air Ambulance Scrutiny: Consumers finding themselves on the wrong side of air emergency service bills may soon find some relief, as lawmakers turn their attention to reining in these astronomical charges.  At issue, the exorbitant air ambulance bills faced by patients after being airlifted to a hospital.  In fact, a recent report discovered that the median charges from these air ambulance operators doubled between 2010 and 2014, from about $15,000 per trip to $30,000.  Stakeholders, for their part, have worked to find agreeable solutions that benefit consumers.  In the meantime, with the Senate mulling changes to air ambulance regulations through its upcoming Federal Aviation Administration reauthorization bill, policymakers have reached out to the Administration – specifically, the Department of Transportation – urging for greater oversight and support for consumer complaints

Rx Price Inflation:
In examining the prices of dosages and formulas for medicines that went into short supply a couple of years ago, researchers uncovered an alarming trend that only adds fuel to the fire already raging over escalating drug prices.  The study, published in the Annals of Internal Medicine, show that prices for those drugs increased at roughly twice their usual rate after shortages developed.  Practically speaking, the study quantified a phenomenon that had long been observed by providers and health systems: mysterious jumps in the prices of vital medicines that coincided with those drugs becoming harder to find.  The implication only served to further what had long been suspected, namely, that pharmaceutical companies have long sought to reap additional profits when urgently needed medicines became scarce.      

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For those not following along – or, those just in need of a refresher – the health insurance tax (HIT) threatens to raise costs for hard-working families, small business owners, and seniors enrolled in Medicaid and Medicare Advantage plans.  Lawmakers, having recognized the onerous burden the HIT places on some of their most vulnerable constituents, have taken steps to provide relief, including suspension of the tax in 2019.  This summer, the House continued those efforts, passing a broad health care package that included a further delay of the HIT through 2021.  Senate lawmakers have proposed a bill of their own suspending the HIT into 2020, which they are expected to take up after November’s midterm elections.

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