| | | | |  | | By Chelsea Cirruzzo and Ben Leonard | | | | | | | 
HHS wants to penalize health care providers that engage in information blocking. | AP Photo | INFO-BLOCKING PENALTIES DROP — HHS is proposing to broaden its efforts to push health care providers to share patient information, which could lead to some providers paying millions in penalties if they don’t comply, Ben reports. The agency’s proposed rule, released Monday, calls for new enforcement measures for those that violate so-called information-blocking rules, which prevent the thwarting of patient data flow. The agency threatened hospitals with penalties that could run into the millions of dollars, and physician groups more than $160,000 per violation, at the extremes, by preventing them from getting incentive payments for adopting electronic health records systems. It estimated typical penalties for hospitals would run $394,000 and $686 for individual clinicians. ACOs also impacted: Doctors who participate in performance-based Medicare payment systems known as accountable care organizations, which allow them to share the money they save the government, could be suspended from that sharing for at least a year. The backstory: Congress ordered HHS to bar health care organizations from hoarding patient data in a 2016 law, the 21st Century Cures Act. Lawmakers had expressed concern that EHR system vendors and providers made it harder to let information flow to prevent competition, and the law aimed to facilitate data-sharing and patient access. Congress set penalties of as much as $1 million for certified health IT developers and health information exchanges and networks engaging in information blocking. But HHS hadn’t proposed penalties for providers until now. Looking ahead: The Office of the National Coordinator for Health IT wrote in a blog post that the agency is taking comments from Nov. 1 until Jan. 2. The agency is asking for public comment on whether it should apply penalties to providers that aren’t eligible for the accountable care organizations or the electronic health records incentive program. Still, the rule would apply to a range of providers, including hospitals, pharmacies and nursing facilities. Initial reaction: Andrew Tomlinson, director of regulatory affairs at the American Health Information Management Association, said the group was “pleased” to see HHS release additional details. “We look forward to … seeing how it can provide better predictability and certainty,” Tomlinson told Pulse. WELCOME TO TUESDAY PULSE. Happy Halloween! If you put your pet in costume, please send us a photo. Cloud was a (reluctant) fish taco. Send your tips, scoops and feedback to ccirruzzo@politico.com and bleonard@politico.com and follow along @ChelseaCirruzzo and @_BenLeonard_. TODAY ON OUR PULSE CHECK PODCAST, your host Chelsea talks with Ben, who breaks down President Joe Biden's executive order directing HHS to develop guidelines and oversight for the use of AI in health care and explains the order's potential impact.
| | | | GO INSIDE THE MILKEN INSTITUTE FUTURE OF HEALTH SUMMIT: POLITICO is proud to partner with the Milken Institute to feature a special edition of our Future Pulse newsletter at the 2023 Milken Institute Future of Health Summit from November 6-8. The newsletter takes readers inside one of the most influential gatherings of global health industry leaders and innovators solving the biggest public health issues to ensure a healthier, more resilient future for all. SUBSCRIBE TODAY TO RECEIVE EXCLUSIVE COVERAGE. | | | | | | | | | | A message from Optum Rx: 46 million Americans live in rural areas, and community and independent pharmacies play a vital role in their health care. That’s why Optum Rx is proud to partner with more than 26,000 community and independent pharmacies to deliver care, improve the pharmacy experience and help make prescription drugs more affordable. That’s pharmacy care “Optumized.” Learn more. | | | | | | | 
People who used telehealth for mental health care seemed to have fared just as well as those who visited their doctors in person. | Tim Boyle/Getty Images | SIMILAR OUTCOMES — Telehealth has played an outsized role in mental health care since the pandemic began, and a new study suggests that the outcomes are similar for virtual care versus in-person care, Ben reports. The study of more than 120,000 Medicare beneficiaries with serious mental illness, published in JAMA Health Forum, examined practices using telehealth at different frequencies. It found that patients using telehealth for nearly all visits had similar quality measures to those using virtual care at lower rates. A group of leading telemedicine researchers found that the groups using telehealth as a higher share of visits had more overall mental health visits than those with a lower share of virtual visits. Hospitalizations and medication adherence remained level between the groups with high levels of telehealth versus those with lower usage. Dr. Ateev Mehrotra, a study author and professor of health care policy and medicine at Harvard Medical School, said the study backs lawmakers’ and agencies’ decisions to expand telemedicine access. “That expansion of telemedicine does not appear to be at all harming patients. If anything, people are getting a little more contact,” Mehrotra told Pulse. “On the spending side, just don’t expect this … to suddenly save a ton of money.”
| | HOSPITALS BRACE FOR RSV — Children’s hospitals said supply shortages of a new monoclonal antibody shot to protect babies against respiratory syncytial virus means the preventative measure won’t have a meaningful impact on this year’s respiratory season and are preparing for a surge of hospitalizations, Chelsea reports. Background: The CDC has urged doctors to ration the limited number of RSV shots amid supply shortages and a seasonal uptick in cases. Manufacturer Sanofi, which had underestimated demand, paused orders for the 100 milligram dose earlier this month. The dose was approved this summer for children up to 8 months who weigh more than 11 pounds. Babies who weigh less than 11 pounds receive a 50 milligram dose. Meanwhile, the CDC is allowing only limited orders of the doses through the Vaccines for Children program, which helps cover the cost of shots for low-income, uninsured and underinsured children. Both CDC and Sanofi told Pulse they didn’t have updates on the supply shortage. The Children’s Hospital Association said in a statement Monday that “widespread access [to the drug] will take time across many sectors of the pediatric population.” “We’re expecting another surge in RSV cases, which could lead to a strain on our nation’s network of children’s hospitals and health systems as they near bed capacity,” Matt Cook, CEO of the Children’s Hospital Association, said in a statement. As of Oct. 21, the CDC has reported more than 2,600 RSV cases as case rates tick upward. According to the agency’s forecast of the respiratory illness season, overall respiratory virus activity is low, and RSV is in line with normal seasonal patterns from before the pandemic.
| | | | A message from Optum Rx:   | | | | | STENTS ARE COSTLY, OVERUSED: STUDY — One in 5 coronary stents placed in Medicare patients from 2019 to 2021 aren't needed and cost the program roughly $2.44 billion, a new study says. The new study by the think tank Lown Institute looked at stent procedures at 1,733 hospitals and said more than 229,000 were considered unnecessary. The group said the stents can be lifesaving for patients having heart attacks but provide no benefit over medication therapy for patients with stable heart disease. Why it matters: The researchers said the unnecessary procedures aren’t only costly for Medicare but can also run a patient around $1,600, with Medicare paying the remaining roughly $9,000. Stent procedures also run the risk of tears in the artery, blood clots and kidney damage, according to the report.
| | BIDEN WANTS NALOXONE IN SCHOOLS — The Biden administration is urging all schools to have naloxone, or Narcan, on hand to combat youth opioid overdoses, POLITICO’s Mackenzie Wilkes reports. “In the midst of this fentanyl overdose epidemic, it is important to focus on measures to prevent youth drug use and ensure that every school has naloxone and has prepared its students and faculty to use it,” Education Secretary Miguel Cardona and Rahul Gupta, director of the White House Office of National Drug Control Policy, wrote in a letter sent to school leaders today. Why it matters: Between July 2019 and December 2021, the number of monthly overdose deaths increased by 65 percent among adolescents and teens ages 10 to 19, according to data from the CDC. Naloxone was administered in roughly 30 percent of those instances. Key context: Lawmakers on Capitol Hill also want to see naloxone in schools. Last month, Rep. Suzanne Bonamici (D-Ore.) and Kevin Kiley (R-Calif.) introduced legislation that would allow school-based health centers to use federal funding to purchase naloxone.
| | The Washington Post reports on an FDA recall of eye drops because of a potential infection that could lead to blindness. The New York Times reports on the confusing, chaotic over-the-counter market for hearing aids. CBS News reports that heat-related cardiovascular deaths, mostly among older and Black adults, are projected to increase.
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That’s pharmacy care “Optumized.” Learn more. | | | | | | | Follow us on Twitter | | | | Follow us | | | | |
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