November 22, 2019
The Out-of-Pocket Health News Digest
Below you will find briefs about recent health policy news stories. Our hope is for students to have an information outlet at their fingertips to keep up-to-date with the most pressing news stories in health policy.
This compilation is produced by the HPSA Education Committee: Sharoni Bandyopadhyay, Matthew Dunn, Payton Watt and Courtney Zott.
CMS Finalizes Sweeping Hospital Price Transparency Requirements
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In a shock to the healthcare industry, CMS finalized a controversial hospital price transparency rule on November 15. Though the agency delayed implementation of the rule until January 1, 2021—a year after the initial proposed date—it added requirements for providers to publicize even more price information online.
 
Under the new regulations, hospitals will have to post five types of price information in two different formats, as follows:
 
In a machine-readable format for each item and service provided by the hospital (including employed physician services):
  • The gross charge as reflected in the chargemaster
  • The payer-specific negotiated charge
  • The minimum payer-specific negotiated charge out of all negotiated charges for that item or service (new from the proposed rule)
  • The maximum payer-specific negotiated charge out of all negotiated charges for that item or service (new from the proposed rule)
  • The discounted cash price the hospital will accept from uninsured patients or patients willing to pay without insurance (new from the proposed rule)
 
In a “consumer-friendly” manner for 300 “shoppable” services:
  • The payer-specific negotiated charge
  • The minimum payer-specific negotiated charge out of all negotiated charges for that service (new from the proposed rule)
  •  The maximum payer-specific negotiated charge out of all negotiated charges for that service (new from the proposed rule)
  • The discounted cash price the hospital will accept from uninsured patients or patients willing to pay without insurance (new from the proposed rule)
 
CMS’ theory behind the rule is that patients will be empowered to shop for the most affordable care, leading hospitals to lower their prices. However, opponents argue that the price information will be too complex for patients to understand, and the research on whether shopping leads to reduced care costs is mixed. That being said, there are studies (see here and here ) that show an association between transparency and slower price growth for another reason: hospital concern about image and reputation. 
 
In addition to the final rule, CMS issued a proposed rule that would also require insurers to publicize negotiated rates and provide online out-of-pocket estimates to enrollees.

Opponents disagree on the impact of requiring providers and payers to disclose secret negotiated rates, with some arguing that it would cause collusion among payers to reduce reimbursement and some arguing it would cause collusion among providers to demand increased reimbursement.

The American Hospital Association plans to sue along with other industry trade groups.
 
Sources: HHS.gov , CMS.gov
CDC Sounds Alarm on Antibiotic Resistance
On November 13, 2019, the CDC released a new report , raising alarms on the threat posed by antibiotic resistance. Antibiotics are prescribed to patients with bacterial infections, but this treatment no longer works if the bacteria evolve mechanisms to survive the drug. More than 2.8 million antibiotic-resistant infections occur in the United States every year. This results in 35,000 deaths per year, or 1 death every 15 minutes. The crisis is even worse on a global level, with low-income countries facing the most harm. According to an April 2019 U.N. report , by 2050 the global mortality from drug-resistant infections could reach 10 million deaths per year.

Human activities contribute to the proliferation of antibiotic resistance. In the U.S., many people take antibiotics inappropriately. This typically happens when physicians prescribe unnecessary antibiotics , or when patients save their prescribed dose and take the drugs at a later date. People also consume antibiotics without even knowing, because they are heavily used in animal agriculture. One study found that 70% of the types of antibiotics given to livestock are also used in medicine. The cumulative result is bacteria populations gain additional chances to become drug-resistant.

Experts agree that confronting this issue requires a multi-faceted approach. On the provider side, it is important for health facilities to follow infection-prevention protocols so harmful bacteria does not spread in the first place. Also, physicians should follow clinical guidelines for when to prescribe antibiotics. On the research side, there is a desperate need to create new treatments for bacterial infections. This includes developing new antibiotics, but some investigators see more potential in “bacteria-eating” viruses called bacteriophages. A major obstacle is that pharmaceutical companies are relatively uninterested in these research pursuits, because other areas of drug development are more profitable. Accordingly, the U.N. report argues that antibiotics should be treated as a public good, so governments can ensure their countries are investing in combating this crisis.  

Google and Ascension’s Controversial, and Perhaps Illegal, New Data Sharing Agreement
A whistleblower revealed that Google has obtained the private health information of 50 million Americans through its new data-sharing agreement with Ascension, the second largest health system in the nation. This new project, titled Project Nightingale , was hidden from the public, including the patients whose data was being shared and the physicians who treat them. Google defended this reveal in a blog post , citing that they intend to use this private health information (PHI), including name, date of birth, medical history and more, to create artificial intelligence algorithms and improve patient care. The HHS has launched a federal inquiry to learn about this cloud-based data sharing agreement and determine its legality. 

HIPAA (1996), the federal patient privacy law, is in desperate need of an upgrade and currently leaves patient data incredibly vulnerable in the current age of technology, constant data collection and easy exchange of private information. Google currently has data-sharing agreements with several health systems, including Cleveland Clinic, UChicago Medicine, Mayo Clinic, and more. Interestingly, data-sharing agreements differ with each health system; some health systems require anonymity, while others allow for all PHI to be accessible. However, efforts at anonymous data exchange prove to be difficult. In July, a former UChicago patient sued the health system for failing to properly de-identify PHI.

This is not Google’s first foray into the healthcare space, and they are certainly not the only tech giant that is striking data deals with healthcare organizations. Apple, Microsoft, IBM and Amazon are encroaching into the healthcare industry either through hospitals or technology. Earlier this month, Google announced that is is buying FitBit for $2.1 billion , giving them access to the health and wellness data of millions. All these acquisitions come with similar premise: use health data to provide high quality care. However, the promise of a more efficient healthcare system is not sufficient for patients who are concerned about the privacy of their medical data (and possibly their health-related internet searches, caloric intake, steps per day, and more). Consumers continue to call for urgent regulation both for patient privacy and technology.

Sources: STAT , The Atlantic
One-Liners
  • Flavored E-Cigarettes: Trump was originally in favor of placing a ban on flavored e-cigarettes in order to decrease vaping among youth, but has since reversed his position since his advisers warned him that the ban may result in voter fallout and now states that he needs to further study the topic before he takes action (NYTimes).
  • Health Education: South Dakota recently launched a health education campaign to address their high rates of meth use; their slogan of, “Meth. We’re On It.” and their new website, onmeth.com, has resulted in people not taking the issue seriously (CNN).
  • Global Health: UNICEF reports that despite advancements in global child health over the past decade, the most vulnerable children continue to have devastating outcomes; for example, children from the poorest households in low and middle-income countries are twice as likely to die from preventable causes before their fifth birthday compared to children from wealthier households (UNICEF).
  • Health Care Coverage: Tens of thousands of Americans on associate health plans, which are alternatives to Obamacare provided by the Trump administration, are about to lose their coverage because Democrats state that such plans are deceptively cheaper, but skimp on coverage. (The Washington Post).
  • Gun Violence: [Trigger Warning] As Republicans blocked Senator Chris Murphy’s gun control package that would require universal background checks for firearms, a school shooting in Santa Clarita, CA occurred, killing two (BuzzFeed News).