Chart of the Week
Congress
MCIT. CMS’s decision to revoke the Medicare Coverage for Innovative Technology (MCIT) has met with some resistance. Brett Guthrie (R-KY) and Anna Eschoo (D-CA) sent a letter to CMS expressing disappointment with CMS’s decision to repeal the rule. Sen. Amy Klobuchar has expressed similar sentiments.
CMS’ decision to repeal the rule after implementation – something the agency does not normally make a practice – was based on concerns about patient harms. As Guthrie and Eschoo point out, patient harm may be occurring because of the rule’s repeal.
Codification of the rule is included in the Cures 2.0 legislation but that is not likely to make it to law before 2022. In the meantime, Congress is applying pressure to reverse or amend the repeal.
Nurse Staffing. Senators Mark Kelly (D-AZ) and Bill Cassidy (R-LA) wrote their own letter to Jeffrey Zients, the White House COVID-19 Response Team Coordinator earlier in the month. Like you, they are getting reports that nurse staffing agencies are commanding huge rates often on the order of 9k/week or more.
The Senators are asking about anti-competitive practices and federal financial support have played a role in the rate hikes. The California Hospital Association sent a letter suggesting the same dynamics and asked the state Attorney General to consider looking into the matter.
Letter writing is not legislating, and it is not investigating. Be aware there may be a few negative headlines if the issue gets legs.
Continuing Resolution. As the government was scheduled to close shop Dec. 3rd when the current Continuing Resolution expires, Congress huddled and approved a new CR that extend the current appropriations until Feb. 18, 2022.
While the new CR relieves us of budget drama during the holiday season, it means that the 2% Medicare sequester will be re-imposed on Jan. 1, 2022. The good news is that most providers indicated that they are counting on a return of the sequester in their guidance.
The bad news is that in the big-ticket American Rescue Plan – which did not get a PayGo waiver – is still on the budgetary scorecard (wonky stuff, call me if you need a better explanation). If PayGo does not get waived additional cuts – not contemplated in guidance at most companies -could be imposed in January. These could be across the board cuts or, if Congress gets involved, more targeted.
Hearings Next Week.
House Committee on Energy and Commerce, Subcommittee on Health The Future of Biomedicine: Translating Biomedical Research into Personalized Healthcare Wednesday, December 8th, 2021 at 10:30 AM
The White House
New COVID Response Plan. The White house traded the COVID-as-a-wedge issue for a kinder gentler effort to cajole and encourage vaccines, booster, testing and therapeutics this week. After over a year of some of the worst public health messaging in modern history, the Biden administration rolled out a multi-prong plan. Some of the highlights:
- Expanding free home testing by requiring insurance coverage and offering free tests at community centers and health clinics. Insurance coverage will be required under rules to be issued by Jan. 15, 2022. As a reminder at-home tests are generally not reported to health departments and results from rapid tests will not appear in daily case data.
- Encouraging vaccinations and boosters via outreach by the AARP, Medicare and Medicaid.
- Discouraging school closures with test to stay policies.
- Increasing donations of vaccines and supplies to Low Income Countries
- Increased supply of therapeutics.
The policy also “calls on” businesses to require/encourage vaccinations for employees. This approach is much softer than the mandates imposed by rule a few weeks ago and now the subject of litigation. It also happens to represent a more traditional path to compliance which usually includes education, advice and consent.
The new policy also encourages childhood vaccinations. Here the administration will probably have less luck for the time being. The other controversial part of the policy is a testing requirement for non-U.S. citizens entering the country. They will need to produce a negative test dated one day prior to departure.
RFI on Kidney Care. In one of its few areas of agreement with the Trump administration, CMS issued a Request for Information on ways to improve treatment of Chronic Kidney Disease, dialysis treatment and expand access to transplants. The RFI provides valuable information on racial and ethnic disparities in prevention and treatment of CKD and ESRD and asks for suggestions on improvement. $DVA $BAX.
Pending Rules
HHS Notice of Benefit and Payment Parameters for 2023 (CMS-9911)
Most Favored Nation (MFN) Model (CMS-5528)
Other Stuff
Employment. The BLS report was nothing to write home about. Employment barely budged for all of health care and aggregate hours worked actually declined. One of my favorite data points is employment at skilled nursing facilities. After policy makers cheered a reversal in October, the sector continued its path downward in November.
Past Events.
Ready for Prime Time? Venture-funded Unicorns (or maybe just nice ponies) in Post-COVID reality (Originally aired on 12/1)
Upcoming Events
Dec. 15 @ 10 am ET Sequestration, More Sequestration and Medicare's Reimbursement Problems
SPAC and S-1 Corner
Updated SPAC list can be found here.
Hedgeye Health Policy Publication/Event Calendar. Click here for searchable calendar.
Have a great weekend.
Emily Evans
Managing Director – Health Policy
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