A budget hawk’s Medicare targets

The ideas and innovators shaping health care

Apr 05, 2023 View in browser   By Ben Leonard, Ruth Reader and Erin Schumaker FOLLOW THE MONEY MedPAC's Mathews has the knife out for at-home care and telehealth fees | Courtesy of the Medicare Payment Advisory Commission Telehealth and at-home care are burgeoning health care industries. James Mathews, the executive director of the Medicare Payment Advisory Commission, says Congress may be paying too much for them. MedPAC advises lawmakers and in its March report to Congress said slashing payments to firms caring for Medicare patients in their homes could save $10 billion over five years without impeding access to care. The commission is also investigating whether telehealth payments set during the pandemic are too high, given the country’s return to normalcy. Ben caught up with Mathews for some straight talk on bringing Medicare costs down. This interview has been edited for length and clarity.  Why are you proposing cuts to home health care reimbursements? The financial performance of the home health sector under Medicare has been extremely robust, even in light of the pandemic. The financial performance increased between 2020 and 2021. While home health can be valuable when it is used appropriately, Medicare is paying too much. Why do you think the length of telehealth visits should be reviewed?  There is almost a universal sense that it takes less time to provide a visit via telehealth than in person. There’s this disconnect between the distribution of services that Medicare is being billed for and the potential time that is actually taken for clinicians to provide those services. How do you see the future of Medicare reimbursement for telehealth?  Telehealth is a genie that’s going to be very hard to put back in the bottle. It may not be necessary to do that if some fundamental questions about the effect of telehealth on access to care, outcomes and quality and impact on Medicare spending are answered. Permanent decisions about telehealth expansions should be made on the basis of data that reflects a more steady state with respect to the pandemic. We would feel more comfortable using data from 2022 or 2023.   STEP INSIDE THE WEST WING: What's really happening in West Wing offices? Find out who's up, who's down, and who really has the president’s ear in our West Wing Playbook newsletter, the insider's guide to the Biden White House and Cabinet. For buzzy nuggets and details that you won't find anywhere else, subscribe today.     WELCOME TO FUTURE PULSE Lanai, Hawaii | Ben Leonard This is where we explore the ideas and innovators shaping health care. Vasectomies spiked 30 percent in the months following the Supreme Court decision last year ending the constitutional right to an abortion, according to new data from Komodo Health. In states with abortion trigger laws, that rise was even steeper — up 39 percent versus the same period in 2021. Share any thoughts, news, tips and feedback with Ben Leonard at bleonard@politico.com, Ruth Reader at rreader@politico.com, Carmen Paun at cpaun@politico.com or Erin Schumaker at eschumaker@politico.com. Send tips securely through SecureDrop, Signal, Telegram or WhatsApp. Today on our Pulse Check podcast, your host Ben talks with Krista Mahr about a National Institutes of Health study on the effects of long Covid and what the researchers say the federal government should do to help those with the lingering condition. Listen to today’s Pulse Check podcast THE REGULATORS "We’re seeing people go in and type symptoms, put in information and that information is being disclosed in a way that’s inconsistent with HIPAA and being used to potentially track people, and that is a problem." HHS Office for Civil Rights Director Melanie Fontes Rainer HHS is coming after health care firms that share sensitive health data they’ve collected by tracking customers’ clicks online. In December, the Department of Health and Human Services said that commonly used web-tracking tools violate HIPAA, the federal health privacy law, if they disclose protected patient data. The agency directed health care organizations that collect patient data to ensure their contractors and vendors don’t share it with third parties. Health care providers use trackers on their websites for a variety of reasons. They record visitors’ clicks and what they type to improve user experience. They also collect and share visitors’ data with online advertising platforms to better promote health services. Crackdown: HHS has launched multiple investigations, Melanie Fontes Rainer, the director of HHS’ Office for Civil Rights, said at the International Association of Privacy Professionals’ summit in Washington, calling the web-tracking practices “problematic” and “widespread.” Industry scramble: Some health care organizations, including the telehealth firm Cerebral, New York-Presbyterian Hospital and UC San Diego Health have notified HHS and the public that they previously used such web trackers.   LISTEN TO POLITICO'S ENERGY PODCAST: Check out our daily five-minute brief on the latest energy and environmental politics and policy news. Don't miss out on the must-know stories, candid insights, and analysis from POLITICO's energy team. Listen today.     INFLUENCERS Advocates for medical mushrooms have a new lobbyist. | AP The Psychedelic Medicine Coalition has hired its first lobbyist to promote federal investment in research on psychedelic substances like ketamine, psilocybin and MDMA. The lobbyist: The Conafay Group’s Darin Gardner — a one-time chief of staff to House Appropriations Chair Kay Granger (R-Texas). The job: The coalition hopes to carve out funding for psychedelics research in the VA budget, given the substances’ potential utility in treating post-traumatic stress disorder. The Advanced Research Projects Agency for Health is another prospect, given its mission to back research too risky for the private sector. The coalition is focusing on building a support base for the medicinal use of psychedelic drugs before it pushes for decriminalization, in the hopes of sidestepping political land mines, the group’s CEO, Melissa Lavasani, told POLITICO’s Influence newsletter. Lavasani helped spearhead a successful ballot initiative in Washington in 2020 to deprioritize the policing of mushrooms.   Follow us on Twitter Ben Leonard @_BenLeonard_ Ruth Reader @RuthReader Carmen Paun @carmenpaun Erin Schumaker @erinlschumaker   Follow us

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