‘No way to run a health care system’

Aug 09, 2024

Driving the day

Dr. Vibin Roy types notes on his keyboard.

CMS doesn’t have the authority to extend telehealth rules without Congress, and has proposed to let them sunset at the end of 2024. | LM Otero/AP

COST OF DELAYS — Congress is widely expected to extend rules expanding telehealth access for Medicare patients that expire at year's end, likely after the election. That timeline will have consequences.

Tens of millions of beneficiaries have used telehealth since pandemic-era rules to help avert the spread of Covid were enacted in 2020, and Congress has backed continuing the popular provisions. The Centers for Medicare and Medicaid Services doesn’t have the authority to extend the rules without Congress, and has proposed to let them sunset at the end of 2024.

The House Ways and Means Committee advanced a two-year extension of the rules earlier this year, and the House Energy and Commerce Committee has advanced its own two-year extension out of its health subcommittee. A standalone measure extending telehealth rules would pass both chambers of Congress overwhelmingly, but the issue is likely to be addressed in an end-of-year package. Lawmakers are also expected to need offsets to pay for the extension.

The delay and resulting uncertainty has forced providers to craft contingency plans.

“This is no way to run a health care system,” said Kyle Zebley, vice president of public policy at the American Telemedicine Association. “It's being disruptive now but it's going to be tremendously disruptive if we allow this to lapse.”

Anxiety building: The unpredictability is causing anxiety for providers, who have heavily invested in telehealth infrastructure.

“It keeps us up at night knowing that there isn't a permanent solution,” said Dr. Dave Newman, chief medical officer of virtual care at South Dakota-headquartered Sanford Health.

If close to the end of the year comes and Congress hasn't acted, Sanford would need to have "large-scale communications" to patients and providers and find "creative ways" to get patients care, he said. “We'd find a way to serve our patients, but it would be quite the hassle.”

Dr. Raj Patel, vice president of digital patient experience at Mass General Brigham, said that if Congress waits too long to extend telehealth access that would lead to disruptions that would impact access and bottom lines.

Brett Meeks, executive director of the Health Innovation Alliance, said that if Congress waits until late in the year, CMS may have to use an interim final rule without public comment to allow for a telehealth extension. CMS told Pulse it will use “every tool at our disposal” to promote access to technology like telehealth.

“We're going to try to assume that Congress will do what they say they're planning to do," said Helen Hughes, medical director of the telemedicine office at Johns Hopkins Medicine. “But [also have] all of our frontline teams ready to do a potential unwinding of care.”

WELCOME TO FRIDAY PULSE. Are there any other consequences to Congress’ delays on telehealth or other issues? Let us know. Reach us and send us your tips, news and scoops at bleonard@politico.com or ccirruzzo@politico.com. Follow along @_BenLeonard_ and @ChelseaCirruzzo.

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HEALTH INSURANCE

DENIALS, DENIALS — Care denials by Medicare Advantage are on the rise, according to a new KFF analysis of federal data.

The share of overall claims fully or partially denied via prior authorization rose to 7.4 percent in 2022 after being between 5.6 percent and 5.8 percent in each of the three previous years.

A chart showing that Medicare Advantage prior authorization denial rates are on the rise.

Less than 10 percent of denied claims were appealed in 2022, according to KFF, down slightly from the previous two years. More than 4 in 5 of the denials were overturned between 2019 and 2022.

The bigger picture: The data comes as lawmakers increasingly scrutinize Medicare Advantage insurers for claim denials, including for those involving artificial intelligence. More than half of Medicare beneficiaries are now enrolled in the private alternative.

Chris Bond, a spokesperson for insurer lobby AHIP, said that prior authorization is a "vital process to ensure patients receive safe, evidence-based care, and to reduce low-value and inappropriate services so that coverage is as affordable as possible."

Abortion

TELEHEALTH ABORTIONS SURGE — The share of abortions via telehealth has quadrupled since the Supreme Court’s Dobbs decision that returned abortion rights to the states, according to new data from the Society of Family Planning, which supports abortion rights.

As of the first quarter of 2024, 20 percent of abortions were via telehealth, up from 5 percent in the second quarter of 2022, just before the court's decision. The group said the number of telehealth abortions increased for virtual-only as well as brick-and-mortar providers. The data doesn't include "self-managed" abortions — ones coming outside the formal health care system.

The growth in virtual abortions appears to be fueled by abortions in states with shield laws that protect providers who offer abortions in states with restrictions on the procedure, suggesting the laws are helping people circumvent state restrictions.

Also: Overall abortions were higher in 2024 than in 2023 or 2022 despite a slew of states enacting restrictions on the procedure.

AROUND THE AGENCIES

HHS ADDING TECH REQUIREMENTS — HHS is proposing to add standards to its contracts for health information technology.

In a proposed rule released Thursday, HHS said that health IT procured by or for HHS, or procured through contracts with providers and insurers that involve implementing or upgrading health IT, must meet certain standards related to data exchange. The agency said that doing so offers clear guidelines for health tech and can reduce burden for developers, while making it easier to share data across systems.

The agency is taking comments from the public for 60 days after the proposal is published in the Federal Register.

The reaction: Health IT advocacy group the Health Innovation Alliance hammered the proposal, saying “everyone should be concerned.”

“Historically, the government does not do technology well, yet we’re seeing government reach far and wide to control and dictate technology used in health care,” the group said in a statement.

DEVICE MAKERS TO CMS: DO MORE — CMS’ new rules offering broader coverage from some medical devices is drawing lackluster reviews from the medical device industry.

The details: The Biden administration in 2021 overturned a policy, enacted during President Donald Trump’s administration, that allowed four years of Medicare coverage to FDA-approved breakthrough devices, saying it went too far. On Wednesday, CMS finalized a proposal narrower than the Trump proposal allowing devices to be covered on a transitional basis that are relevant to the Medicare population.

The agency said it expects to accept up to five candidates a year for Transitional Coverage for Emerging Technologies.

The reaction: Scott Whitaker, CEO of trade group AdvaMed, said in a statement the move is a "step toward a stronger, more robust policy" but isn't sufficient.

“The limited number of devices CMS can handle demonstrates clearly to Congress the need for greater resources at CMS,” said Whitaker, who called for lawmakers to pass bipartisan legislation mandating Medicare cover FDA-approved breakthrough devices for four years.

Mark Leahey, CEO of the Medical Device Manufacturers Association, also backed the bill and said the trade group is “disappointed” by the move. Leahey said that limiting coverage to five candidates a year won’t “meaningfully improve access or address disincentives to medical innovation.”

HALTING CAT RESEARCH — Medical testing on cats has come to an end at the Department of Veterans Affairs, an agency spokesperson confirmed to Pulse.

According to web archives, the agency as recently as April had planned research involving prosthetics on felines.

“VA has conducted research using sensitive species when absolutely necessary to care for those who have served in our military,” agency spokesperson Terrence Hayes said. “Under Secretary [Denis] McDonough, this practice has begun to come to an end.”

The move comes after Congress in a spending bill this year barred VA animal testing within two years, with some exceptions. Hayes said the VA is “fully complying.” The agency has approved research involving canines and non-human primates.

Congress’ decision came after pressure from groups like the White Coat Waste Project, a watchdog group that opposes federally funded animal experiments.

Names in the News

Kirk Nahra, partner at WilmerHale and co-chair of its cybersecurity and privacy practice, has been appointed to the American Bar Association's cybersecurity legal task force.

Carolyn M. Hutter has been named director of the NIH's Office of Strategic Coordination. She's currently the director of the division of genome sciences at the National Human Genome Research Institute.

Chris Wittwer is joining ADVI Health as chief financial officer. He was previously CFO at The Purple Guys.

Tanya Bailey is joining the National Pharmaceutical Council's executive team as chief of staff. She was previously head of membership and meetings at NPC.

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WHAT WE'RE READING

Reuters reports on how an obscure HHS subagency "became a shield for polluters."

Bloomberg reports on the "weight loss drug capital" of the U.S.: Bowling Green, Kentucky.

The New York Times reports on how Baltimore isn't divulging its plans to address overdoses, which are far higher than any other major U.S. city.

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