from AcademyHealth Blog at https://bit.ly/3w4Q6q9 on April 30, 2024 at 03:35PM
CMS pauses new data policy changes – Read on Washington’s April 2024 Advocacy Update
Appropriations Committees seeking outside witness testimony as they write their bills.
The House and Senate Appropriations Subcommittees on Labor and HHS have announced that they are accepting outside testimony for appropriations priorities. The House deadline is May 3 and more information can be found here. The Senate deadline is May 24 and more information can be found here. AcademyHealth’s CEO and President Aaron Carroll submitted his testimony in support of the Agency for Healthcare Research and Quality, and you can find it here and here.
CMS data policy access rule delayed as agency seeks more comments
On April 15, the Centers for Medicare and Medicaid Services announced that they will be postponing any changes to their data request and access policies until at least 2025 after initially announcing changes beginning on August 19, 2024. The delay in changes reflects the agency needing to review and be responsive to the comments that they continue to receive. Researchers can still respond to CMS until May 15, here.
White House released a rule to protect reproductive health privacy
The Biden Administration released a final rule, called the HIPAA Privacy Rule to Support Health Care Privacy, that prohibits the disclosure of a patient’s health information as it relates to reproductive health care. This new rule would prohibit entities covered by HIPAA, such as health care providers, health plans, and clearinghouses, from disclosing a patient’s protected health information to an investigation into a person seeking or obtaining lawful reproductive health care, including abortion. This is a reaction to states criminalizing abortion and reproductive health access in the wake of Dobbs.
Biden Administration finalizes nursing home staffing rules
The Biden Administration released a final rule that requires a registered nurse to be on-site in every skilled nursing facility for 24 hours a day, mandates enough staff to provide every resident with at least 3.5 hours of care daily, and strengthens rules for assessing the care needs of every resident. For a facility with 100 residents, it translates to a minimum of two or three registered nurses and at least 10 or 11 nurse aides per shift, as well as two additional staffers who could be nurses or aides per shift, according to the administration’s interpretation of its new formula. Set to phase in over the next few years, the mandate will replace the current standard that gives operators wide latitude on how to staff their facilities. An industry study estimated that nursing homes would need to hire at least 100,000 more workers to meet the mandates.
CBO looks into Medicare accountable care organizations
The Congressional Budget Office (CBO), the budget scorekeeper for Congress, released a report on Medicare Accountable Care Organizations: Past Performance and Future Directions. They found that certain types of ACOs are associated with greater savings, including ACOS led by independent physician groups, ACOs with a larger proportion of primary care providers (PCPs), and ACOs whose initial baseline spending was higher than the regional average. CBO noted that there are weak incentives for ACOs to reduce spending, a lack of the resources necessary for providers to participate in ACO models, and providers’ ability to selectively enter and exit the program on the basis of the financial benefits or losses they anticipate from participating as factors limiting savings.
HHS Inspector General finds that CMS fails to secure mental health parity in Medicaid
A report released March 25 by the Department of Health and Human Services’ Office of Inspector General found all eight selected states—Arizona, Illinois, Kansas, Mississippi, New Jersey, New York, South Carolina, and Texas—failed to comply with laws requiring Medicaid managed care plans ensure coverage for mental health and substance use disorder are no more restrictive than coverage for other medical or surgical benefits. The IG found that none of the states had implemented required parity provisions by the October 2017 compliance deadline. The IG called for CMS to improve its oversight by strengthening follow-up procedures and regular communication with states to verify parity analyses are conducted.
CMS requesting comments on how to improve Medicare Advantage data
The Centers for Medicare and Medicaid Services released a request for information (RFI) on all aspects of data related to the Medicare Advantage program. They are intersected in both data not currently collected as well as data that is collected, and have identified special interest in: data-related recommendations related to beneficiary access to care including provider directories and networks; prior authorization and utilization management, including denials of care and beneficiary experience with appeals processes as well as use and reliance on algorithms; cost and utilization of different supplemental benefits; all aspects of MA marketing and consumer decision-making; care quality and outcomes, including value-based care arrangements and health equity; healthy competition in the market, including the impact of mergers and acquisitions, high levels of enrollment concentration, and the effects of vertical integration, data topics related to Medicare Advantage prescription drug plans (MAPDs); and special populations such as individuals dually eligible for Medicare and Medicaid, individuals with end stage renal disease (ESRD), and other enrollees with complex conditions. Responses are due by May 29.
CDC released its public health data strategy for 2024
The Centers for Disease Control and Prevention (CDC) released their updated Public Health Data Strategy for 2024. This is a two-year plan intended to provide accountability for data, technology, policy and administrative actions necessary to meet public health data goals. New focus areas include developing and supporting the implementation of public health data standards and increasing use of more granular data and integrated visualizations, among other things.
FTC warns about tech advancements leading to health care price fixing
Federal Trade Commission Chairwoman Lina Khan said that algorithms can make it possible for companies to fix health prices without explicitly coordinating with one another, creating new challenges for regulators. By using the same algorithms to set prices, companies can effectively charge the same without explicitly colluding to set prices. Traditionally, the FTC has policed health care by challenging local or regional hospital mergers that have the potential to reduce competition and raise prices. Mergers of systems that don’t overlap geographically are increasing, she said. In addition, hospitals now often buy doctor practices, while pharmacy benefit managers start their own insurance companies or mail-order pharmacies — or vice versa — pursuing “vertical integration” that can hurt consumers, she said.
What we’re reading
Research published in Quantitative Science Studies by Deng et al looked at name discrimination when news reports on scientific papers. They found that researchers with non-Anglo names, especially those with East Asian and African names, are significantly less likely to be mentioned in news stories, and are more likely to be referred to by the authors’ institutions. News media plays a key role in disseminating research to the public, the prestige of research teams and their institutions, and affect public perception on who is doing notable and valuable work.
The Commonwealth Fund released their annual State Health Disparities Report. Racial and ethnic disparities in health, well-being, and life expectancy of historically been the norm in the US. The factors that drive these disparities are numerous, from racial poverty to pollution to lack of nutritious food sources. Massachusetts, Rhode Island, and Connecticut stand out for their relatively high performance for all racial and ethnic groups, yet, even so, these states have considerable disparities in access to care, the quality of care people receive, and health outcomes. Oklahoma, West Virginia, and Mississippi, perform poorly for all groups.
Some of the biggest contributors to health outcomes happen outside of the traditional health care system. These Social Determinants of Health (SDOH) are the context and conditions in the environment where people live, work, and exist that affects health outcomes and quality of life. NBCreported on the growing movement of doctors prescribing fruits and vegetables like medicine to improve patient health. These so-called produce prescription programs aim to combat heart problems and obesity-related diseases by either preparing free bundles of fruits and veggies for participants to pick up on a regular schedule, delivering fresh batches of produce to people’s homes or giving them money to buy produce. Study after study has found that participants in pilot programs saw significantly lower non-HDL cholesterol and lower blood sugar levels.
Substance abuse and opioid overdoses are devastating every community in this country. KFF Health News reported on how Huntington, West Virginia is faring during a “fourth wave” of opioids fueled by fentanyl and other synthetics in their community. From 2006 to 2014, 81 million painkiller pills were shipped to this city of 46,000 people. Drug overdoses are the third leading cause of death, following heart disease and cancer. A solution that the city is trying is the establishment of a Quick Response Team, which operates within 72 hours of an overdose by bringing a team consisting of a peer recovery coach, paramedic, police officer, and faith leader to visit the person who overdosed or their family. The city has seen ambulance calls to treat an overdose decrease by 40 percent since starting this team.
ChristinaT
Health Econ Bot 