Addressing Surprise Billing By Setting Payment Standards For Out-Of-Network Providers

A report from the Commonwealth Fund describes how seven states have adopted a payment standard for out-of-network bills based on different data sources: the Medicare fee schedule, which sets a reimbursement amount for each service; publicly available data from multiple insurers, like a state-run all-payer claims database; and insurers’ internal data on amounts they have agreed to reimburse in-network providers.

The report can be obtained at https://www.commonwealthfund.org/blog/2020/addressing-surprise-billing-setting-payment-standards-out-network-providers.

Friends of HRSA Sends FY 2021 Funding Request to Congressional Appropriators

ASAHP joined over 100 organizations in sending a letter to key Congressional appropriations as part of the Friends of HRSA coalition. The coalition letter requests $8.8 billion for discretionary HRSA programs in the FY 2021 Labor-HHS-ED-Related agencies appropriations bill. The coalition urged the appropriators to reject the $742 million in cuts that were proposed to HRSA’s discretionary budget in the President’s FY 2021 budget proposal, which was released earlier this month.

The letter may be accessed here.

Children Are At The Forefront Of U.S. Racial And Ethnic Change

Data from the Population Reference Bureau indicate that the population identifying with two or more races is projected to be the fastest-growing racial/ethnic group between 2010 and 2020, with a 36% increase. The Asian American population is projected to increase by 32%, followed by the Latino population (23%). The non-Hispanic white population is projected to increase by just 1%, with a net gain of 1.3 million individuals.

More data can be obtained at https://www.prb.org/children-are-at-the-forefront-of-u-s-racial-and-ethnic-change/.

House & Senate Labor, HHS, & Education Appropriations Subcommittees Held Hearings on FY21 HHS Budget

In the House hearing, Rep. Bustos described the physician to patient disparity between rural and urban areas in Illinois, yet the President’s budget cut health workforce programs by 50%. Secretary Azar highlighted the Department’s support for the National Health Service Corps. Other issues briefly discussed were the Department’s cuts to gun violence prevention research, cuts to Title X, and how the Department received consent from children to have their therapy sessions with ICE transmitted to DHS.

In the Senate hearing, Secretary Azar described the President’s healthcare agenda which includes the need for more physician assistants, nurse practitioners, and other health professionals. Subcommittee Ranking Member Murray, in her opening statement, disagreed with the budget’s proposal to cut nearly $800 million from “tuition assistance, loan forgiveness and training for several hundred thousand health professionals annually” and eliminate of the Social Service Block Grant and the Preschool Development Grants. Other issues briefly discussed were the Department’s liver allocation policy, surprise medical billing, drug pricing transparency, and the treatment of children held at the border.

Summaries for the hearings can be found here: House and Senate

National Health IT Priorities For Research: A Policy And Development Agenda

The Office of the National Coordinator for Health Information Technology (ONC) led the development of National Health IT Priorities for Research: A Policy and Development Agenda, which articulates a vision of a health IT infrastructure that supports alignment between the clinical and research ecosystems. The Agenda outlines nine priorities, including concrete steps  to achieve that vision and enable research to happen more quickly and effectively.

The Agenda can be obtained at https://www.healthit.gov/sites/default/files/page/2020-01/PolicyandDevelopmentAgenda.pdf.

Student Aid Alliance Sends FY 2021 Appropriations Request to Congress

The Student Aid Alliance, of which ASAHP is a member, sent a letter to the Congressional leaders of the Labor-HHS-Education Appropriations Subcommittee which outlines the Alliance’s FY 2021 appropriations funding level requests for student aid programs. The letter covers Pell Grants, campus-based aid, TRIO, GEAR UP, GAANN, and LEAP Grants.

The letter may be accessed here.  

Insights Into The 2020 Individual Insurance Market

A new report from McKinsey & Company examined trends in insurance providers participating in individual health care exchanges, and found that participation increased in 2019 compared to previous years. 

The report can be obtained at https://healthcare.mckinsey.com/sites/default/files/2020%20Individual%20Marketplace%20Infographic.pdf.

APTR Releases Newly Revised Clinical Prevention and Population Health Curriculum Framework

After 2 years of review and deliberation, the Association for Prevention Teaching and Research (APTR) has released its newly revised Clinical Prevention and Population Health Curriculum Framework. This effort was led by APTR’s Healthy People Curriculum Task Force (HPCTF). The Framework features

  • a new domain addressing mental and behavioral health,

  • greater emphasis on Social Determinants of Health (SDOH) and health equity,

  • improved, updated illustrative examples, and

  • 14 new or revised topic areas.

Academic and practice community comments are welcome. Click here for more information or to share feedback.

Hospital Strategies To Promote Patient And Community Health

A new issue brief from the American Hospital Association (AHA) describes how hospitals and health systems are leading initiatives to foster healthy behaviors and improve the health of individuals and communities.

The issue brief can be obtained at https://www.aha.org/system/files/media/file/2020/02/SDOH_HealthyBehaviors_IssueBrief.pdf.

Difficulty to Get Home Health Care With Medicare Payment Change

Experts say there are fewer incentives for agencies to deal with those who need extenive physical, occupational and speech therapy — and some are losing services. Previously, the more visits to a homebound patient, the higher payments. Now, Medicare payments are based on various factors: diagnosis, other medical conditions, level of impairment, timing of services, and hospital or rehab center referral.

Read more here.

Potential Fiscal, Credit Impact Of Medicaid Proposals

Recent regulatory actions from the Centers for Medicare and Medicaid Services (CMS) could have fiscal and credit repercussions for state governments and those reliant on state funding, particularly not-for-profit (NFP) healthcare providers, according to a recent commentary by Fitch Ratings. CMS issued regulatory notices to (1) allow states to transition to block grants or per capita cap grants for certain beneficiaries, effective immediately, and (2) the Medicaid Fiscal Accountability Regulation (MFAR) could upend how states finance their Medicaid costs.

The commentary can be obtained at https://www.fitchratings.com/site/pr/10110150.

Health Care Cost and Utilization Report

Health Care Cost Institute annual reports examine year-over-year and five-year cumulative trends in health care spending for individuals with employer-sponsored insurance, segmented by health care service category. This year’s report found that average annual health care spending for individuals with employer-sponsored insurance increased to an all-time high of $5,892 in 2018. From 2014 to 2018, spending grew 18.4%, and about three-quarters of the increase was due to growth in service prices. In 2018, there was a 1.8% uptick in the use of services.

The report can be obtained at https://healthcostinstitute.org/health-care-cost-and-utilization-report/annual-reports.

Problems Paying Medical Bills, 2018

Recent findings from the National Health Interview Survey indicate that an estimated 14.2% of U.S. residents said they or a family member had problems paying medical bills in 2018, down from 19.7% in 2011, according to a new report from the Centers for Disease Control and Prevention. The percentage of individuals in families having problems paying medical bills was higher among females (14.7%), children (16.2%), and non-Hispanic black persons (20.6%) compared with males, adults, and other racial and ethnic groups, respectively. Among persons under age 65, those who were uninsured were more likely than those with Medicaid or private coverage to have problems paying medical bills.

The report can be obtained at https://www.cdc.gov/nchs/data/databriefs/db357-h.pdf.

Medicaid Drives Growth In Federal Grants To States

According to a report from The Pew Charitable Trusts released in February 2020, states derive roughly one-third of their revenue from the federal government, funding that pays for health care, schools, roads, public safety, and other services. Since 2008, those grants have increased by 42 percent from $448 billion to $636 billion, adjusted for inflation, driven by rising Medicaid costs. 

The report can be obtained at https://www.pewtrusts.org/-/media/assets/2020/02/medicaiddrivesgrowthfederalgrantsstates.pdf.

CMS Administrator’s Remarks At AMA Conference

Today, CMS Administrator Seema Verma spoke at the American Medical Association National Advocacy Conference. Her presentation included remarks about health care cost containment, the Medicare Advantage Program, and prior authorization.

Her remarks can be obtained at https://www.cms.gov/newsroom/press-releases/speech-remarks-cms-administrator-seema-verma-american-medical-association-national-advocacy.

Trump Administration Releases FY 2021 Budget Request

Today, the Administration submitted to Congress the budget request for fiscal year 2021. A non-binding document, it specifies key priorities for the nation that involve prioritizing spending for programs that are a core function of the U.S. government.

The budget request can be obtained at https://www.whitehouse.gov/wp-content/uploads/2020/02/budget_fy21.pdf.

An Overview of The Budget and Economic Outlook: 2020 to 2030

The Congressional Budget Office (CBO) estimates that the federal budget deficit in 2020 will be $1.0 trillion, or 4.6% of gross domestic product (GDP). If current laws governing federal taxes and spending generally did not change, the projected gap between outlays and revenues would increase to 5.4% of GDP in 2030. Federal debt held by the public would rise over the coming decade, from 81% of GDP in 2020 to 98% of GDP in 2030.

A new slide presentation by CBO officials can be obtained at https://www.cbo.gov/system/files/2020-02/56108-CBO-presentation.pdf.

Call for Abstracts for Nexus Summit 2020

The 2020 Nexus Summit taking place August 23-26 at the Hyatt Regency Minneapolis is now calling for abstracts. The conference themes for this year include

  • Optimizing the interprofessional clinical learning environment and culture

  • Leadership and mentorship for IPE

  • Centering IPE around people/patients, families, caregivers, and communities

  • Evaluation, assessment and the use of informatics in IPE

Visit their website for more information and to submit an abstract once the submission portal opens on February 12.

Mortality In The United States, 2018

A new report from the National Center for Health Statistics (NCHS) presents final 2018 U.S. mortality data on deaths and death rates by demographic and medical characteristics. These data provide information on mortality patterns among U.S. residents by variables such as sex, age, race and Hispanic origin, and cause of death. Life expectancy estimates, 10 leading causes of death, age-specific death rates, and 10 leading causes of infant death were analyzed by comparing 2018 and 2017 final data.

The report can be obtained at https://www.cdc.gov/nchs/data/databriefs/db355-h.pdf.