New Rule Addresses RX Price Gaming in Government Programs

The Centers for Medicare & Medicaid Services (CMS) enacted a rule allowing more flexibility for state governments to create value-based drug purchasing agreements with pharmaceutical companies.

U.S. Ranks Tops in Science, Choice in World Health Care Index

“Previous rankings by other organizations have been biased by a political preference for government funding and government control. These rankings are more objective.”

Lawmakers Hold the Line on COBRA Subsidies

Government economic relief packages actively encourage business owners to fire employees, says Casey Mulligan, an economics professor at the University of Chicago and a former Council of Economic Advisers chief economist.

Court Levels Playing Field for Medicare Reimbursements

In a decision that promises to level the playing field between hospitals and physician offices when it comes to Medicare reimbursements, a federal appeals court ruled the U.S. Department of Health and Human Services (HHS) has the authority to implement a Trump administration rule providing for site-neutral payments. Crafted to address the Medicare reimbursement disparity between hospital-affiliated remote practices not located on hospital grounds, and independent physician practices, the HHS annual payment rule requires clinics to undergo a cut in their payments over the next two years to bring them into parity with reimbursements to physician offices. Currently, clinics are paid more than physician offices for providing the same Medicare services. The July 17 ruling by the U.S. District Court of Appeals for the District of Columbia reverses a lower-court decision stating HHS lacked the authority to mandate site-neutral payments. Hospitals Lose Argument The American Hospital Association (AHA) bitterly opposes site-neutral Medicare payments and spearheaded the lawsuit against the HHS rule. AHA argued the site-neutral payment cuts violated the federal statute governing the annual payment rule. The appeals court dismissed this claim, noting federal law gives HHS latitude in changing the payment formula. In addition, the government has the authority to control unnecessary increases in the volume of outpatient services, the court found. AHA also argued HHS’s change was not budget-neutral, a requirement under federal law. The court agreed with the Trump administration’s view that overall reimbursement for such payments would remain the same and the volume would simply shift toward physician offices. The court also rejected AHA’s argument that HHS’s decision to reduce payments to off-campus clinics violates the Bipartisan Budget Act of 2015. That statute gave HHS the power to cut payments to clinics created after the law went into effect but not to preexisting clinics. The court, however, determined the rule does not violate the intent of Congress because the cuts in payments reflect a shift in volume at remote hospital practices since enactment of the Bipartisan Budget Act. Closing ‘a Loophole’ The site-neutrality issue arises from the fact health care does not function as a true market, says Devon Herrick, a health economist and policy advisor to The Heartland Institute, which co-publishes Health Care News. “In competitive markets, prices can vary from one store to the next for a variety of reasons,” said Herrick. “These include competition and convenience. However, it makes little sense for taxpayers to pay more for physician visits just because a hospital has purchased physician practices. This is a loophole to raise reimbursements, not competition.” "It makes little sense for taxpayers to pay more for physician visits just because a hospital has purchased physician practices. This is a loophole to raise reimbursements, not competition.”

Petition Asks High Court to Get Medicaid Enrollees Back to Work

In its filing, the Department of Justice said the lower court’s decision “reflects a fundamental misreading of the statutory text and context.”

Free Market Health Care Reform Is Within Reach: Commentary

Rushing in with an all-encompassing Medicare for All plan, or its stepping stone, the so-called public option as a way to control costs invites more than trouble. This is socialized medicine. Quality, availability, and choice will disappear faster than a Soviet dissident.

Hospitals, Insurers Must Post Charges, Court Decides

Hospitals and insurers consider negotiated rates “trade secrets,” which they are reluctant to disclose. The plaintiffs also said the rule would undermine negotiations between providers and insurers.

Mask Mandates Worry Workers’ Comp Underwriters

Insurance underwriters are scrutinizing mask usage and whether it could lead to an increase in workers’ compensation claims. “Improper breathing while wearing surgical or cloth masks has been shown to create anxiety, headaches, increased heart rate, dizziness and fatigue,

COVID Treatment Costs Exceed $12,000 Per Patient

The average hospitalization bill for a COVID-19 patient is $12,489 and the total national cost for inpatient hospitalizations will range from $9.6 billion to $16.9 billion in 2020, a new study finds.

Lockdowns Are Making More Adults Suicidal, Vulnerable to Non-COVID Death, CDC Figures Show

“Quarantine policies during the COVID-19 pandemic have created a burden of social isolation, a burden which falls most heavily on patients of limited economic means, cognitive impairment, and chronic psychotic illness.”

Bill Gets Treatments to Sick Patients Faster

U.S. Senators introduced a bill that would create a provisional pathway to get treatments to patients faster, especially as patients facing life-threatening illnesses continue to hope for effective drugs to treat their conditions.

Researchers Examine T-Cell Immunity from COVID-19

Researchers suspect T-cells have such a large role in protecting the public from COVID -19  that herd immunity could be achieved at a 20 percent rate rather than the 60 to 80 percent assumed for other infectious diseases.

Governors under Fire for Exposing Nursing Home Patients to COVID-19

Michigan offered to nursing homes $5,000 for each recovering COVID-19 patient they accepted and now the U.S. Department of Justice has requested data from Michigan, New Jersey, New York, and Pennsylvania for actions that "may have resulted in deaths of elderly nursing home residents."

Trump Tackles Drug Prices

President Donald Trump signed four executive orders intended to lower drug prices and boost U.S. production of medicines and medical equipment.

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AnneMarie Schieber is a research fellow at The Heartland Institute and managing editor of Health Care News, Heartland's monthly newspaper for health care reform.