Top of the Funnel: Macro
JOLTS. Job Openings in Health Care and Social Assistance jumped from 1.722M to 1.907M sequentially in April or 10.7%. Notwithstanding that robust result, openings are down 6.2% YoY.
The number of Job Openings signals the continued returned to full strength of the sector, although we should probably keep an eye out for revisions. We continue to hear that contracts terms are improving for providers. We also keep hearing that the trajectories for for-profit and not-for-profit hospitals have been different. We may continue to see a less than smooth improvement depending on tax status, geographic locations and payer mix, among other things.
CONGRESS.
The debt ceiling debate occupied most of Congress’ time this week and ended with the Speaker successfully negotiating an agreement with the White House to suspend the debt ceiling requirement until 2025, limit spending growth and impose certain requirement on poverty programs. Like all compromises, some people are really mad.
Notwithstanding that, the agreement represents an inflection of sorts. Unlike 2010 and 2017, Republicans did not make health care programs the focus of the fiscal restraint. A requirement to impose work requirements on Medicaid beneficiaries was dropped as part of the compromise.
A portion of unspent/unobligated COVID monies will be rescinded. The agreement left in place money for next generation COVID vaccines and a few other items. Full list here.
The bill would also apply a “pay-go” restriction on administrative rulemaking. If the White House proposes a rule that would impose more than $1B in costs over the course of the 10-year budget window, it would have to propose certain offsets. This provision does not apply to rules required by law such as the Medicare payment updates.
Additionally, the discretionary spending cap for non-defense items of $704B would mean flat funding for domestic programs including the FDA and the ACA exchange plan subsidies.
However, with this debate mostly behind Congress, there are few other opportunities or vehicles to alter the spending trajectory of health care until 2025.
THE WHITE HOUSE.
Mandatory Staffing for SNFs. The long-awaited proposed rule on mandatory staffing levels for nursing facilities arrived at the Office of Management and Budget this past week.
Whatever is proposed, expect it to be hotly contested. On the one hand, organized labor will be pushing hard for maximum and staffing ratios. On the other hand, the industry will be pressing their concerns about access.
In many ways the issue could be one of irreconcilable differences which would land a proposed rule in the purgatory of “under consideration.” It will be a very difficult baby to split.
In the good labor news department, CMS has officially moved toward encouraging vaccines through quality scores instead of mandates. This approach allows for more flexibility as low vaccination rates can be overcome.
Alzheimer’s Drug Coverage. CMS plans to cover all Food and Drug Administration approved drugs for the treatment of Alzheimer’s. However, it requires the use of registries so clinical data can be easily aggregated and analyzed.
Some researchers believe this requirement may limit access to treatment.
Other Stuff.
No one Saluted. $UNH ran up the flagpole a medical policy requiring prior authorization for diagnostic colonoscopies and other scoping services and no one saluted. Under pressure from gastroenterologists, $UNH backed away from the plan and suggested they would only require prior notification.
$UNH’s approach to the GIs follows their March announcement they would be rolling out a “gold card” program for eligible providers. Gold Card holders would only be required to submit an advanced notice of a procedure instead of going through the entire prior authorization process.
The GIs are not on board, at least not yet, proving just how difficult it is to limit the use of health care services. (Hint: probably time to work on price.)
Cost Plus. Mark Cuban’s DTC generic drug company announced it would be manufacturing and distributing the biosimilar version of Humira. Additionally Cuban announced his company would be seeking FDA approval for the manufacture of certain chemotherapy drugs in shortage.
The Cost Plus Humira biosimilar will cost about $995/package or about $500 per dose.
Have a great weekend.
Emily Evans
Managing Director – Health Policy
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