Washington Watch
Carter L. Alleman, J.D.
EHR Hardship Exception Bill Introduced
U.S. Representative Tom Price (R-GA) introduced H.R. 3940, the Meaningful Use Hardship Relief Act of 2015, which would allow for a blanket hardship exception for providers unable to meet the 2015 stage two meaningful use reporting requirements for electronic health record systems (EHR). The American College of Osteopathic Surgeons sent a letter of support for support H.R. 3940 because it responds to barriers created by the Centers for Medicare & Medicaid Services (CMS) with its late release of new or altered stage two requirements for the Medicare Electronic Health Record Incentive Program.
By releasing the new standards on October 6, CMS left providers with fewer than the 90 days required to report on meaningful use (MU) in 2015. Providers who are unable to meet the requirements for an EHR reporting period in 2015 for reasons related to the timing of the publication of the final rule may apply for a hardship exception under the "extreme and uncontrollable" circumstances category. Each hardship exception application will be reviewed on a case-by-case basis. Those who fail to meet the MU requirements in 2015 face a 2 percent penalty on their Medicare Part B billings.
New Ways and Means Health Subcommittee Chair
U.S. Representative Pat Tiberi (R-OH) was named the new chair of the Ways and Means Health Subcommittee. Representative Tiberi will be taking over an expanded subcommittee with the addition of two new members, one from each party.
Delays to Hip and Knee Bundles
The GOP Doctors Caucus is drafting a letter to Speaker Paul Ryan to ask for end-of-year legislation that would delay the bundled payments program for hip and knee surgeries. The lawmakers say CMS did not "seriously [consider] the negative consequences of this rule and its effect on patient access, choice, and quality," and that "we believe further delay is not only prudent, but necessary to ensure patient care is not impaired."
Possible Ban on Drug Ads
At the interim meeting of the American Medical Association, new policy was enacted calling for the end of drug advertisements. The policy is focused at stopping the rise of prescription drug prices. The United States and New Zealand are the only countries that allow direct-to-consumer advertising on drugs. The market research firm, Kantar Media, estimates that spending on prescription drug advertising have increased by 30 percent in the last two years to $4.5 billion. The policy also marks the start of new advocacy into the transparency of drug prices.
New Network Adequacy Model
The National Association of Insurance Commissioners (NAIC) approved the model state law on network adequacy that it has been working on for more than a year, making it available for state legislatures to consider next year. The model law also includes language protecting consumers from surprise medical bills from out-of-network providers working at in-network facilities. The model state legislation will allow telemedicine to be used to meet adequacy standards for health plans’ provider networks. Under the model legislation NAIC approved at its national meeting in Washington, D.C. health plans may use telemedicine to pipe in doctors from outside a geographic region. States must adopt the legislation for it to become effective; legislatures can do that as soon as next year
ACOS staff has not yet reviewed the final model act, however from earlier conversation, the model act puts more of the burden on the doctors to declare if they are out-of-network prior to providing care.
Major Insurer Possibly Leaving Exchanges
UnitedHealth, the country's largest health insurer is working to scale back its exchange business after cutting earnings projections today because of losses on individual plans sold through the Patient Protection and Affordable Care Act marketplaces. UnitedHealth is projecting losses of $275 million on the company's exchange business in 2016. In addition, the Minnesota-based insurer is reducing its marketing efforts for exchange plans and reevaluating its participation for 2017.
This comes at a time when health insurance companies are signaling a desire to start mergers. UnitedHealth has been tied with to a potential merger with Aetna. Aetna confirmed its continued participation in the exchanges in the future. The interesting part of this is Aetna is currently in the process of acquiring Humana, if both mergers occur this would shrink the entire insurance market to three companies. State insurance commissioners have jurisdiction to review the insurance mergers and are being called upon by the Department of Justice to closely review these mergers.