This Week in Healthcare Reform: September 18th, 2020

Hospital testing charges prompt questions; surprise medical billing drives up premiums; telehealth continues to reshape care delivery; and, drug and device manufacturers paid hundreds of millions to teaching hospitals.

We encourage you to stay involved as implementation efforts surrounding health care reform progress.  Visit the Health Action Network and be sure to let us know what’s on your mind.

Week in Review

Hospital COVID Charges: The discrepancy in the prices charged by hospitals and labs for coronavirus diagnostic testing continues to make headlines.  Earlier this summer, that wide disparity was widely reported, with some facilities charging as little as $20 for diagnostic testing, while others charged as much as $850.  But, new analysis published in the Journal of General Internal Medicine now points to an even wider gulf, with prices ranging from as little as a penny to a staggering $14,750.  With Congress having mandated how those tests are covered, stakeholders have been urging lawmakers and regulators to map out a more comprehensive testing approach that better articulates their different roles and responsibilities as a part of a larger, holistic public and occupational health strategy.  Given the limited guardrails that legislation has placed around the amount that hospitals and labs are able to charge for COVID-19 testing, with 85 million tests having been administered to date, there’s growing alarm that testing requirements have incentivized these facilities to remain outside of insurers’ networks in order to charge higher prices that those insurers would then be required to pay.

Surprise Billing & Premiums: A new study establishes a direct link between specialty and emergency health services that have been shown to commonly surprise medical bill patients and increased health insurance premiums.  Researchers set out to quantify the proportion of spending by health plans on services associated with surprise billing – provided by radiologists, anesthesiologists, pathologists, and emergency specialists.  Publishing their results in the American Journal of Managed Care, researchers found that more than 10 percent of overall health plan spending is attributable to these ancillary specialty and emergency services that most commonly surprise bill.  They conclude that advancing policies aimed at addressing the issue of surprise medical billing could, in fact, reduce health insurance premiums by as much as 5 percent.

Telehealth: While our health care system has had to adapt in real-time to the coronavirus pandemic, experts have begun to take a look at what some of those adaptations might look like on the other side of the pandemic, such as telehealth.  Across the board, utilization of telehealth services has gone up, with access to virtual care playing a critical role in helping our health care infrastructure balance the needs of patients against the restrictions imposed upon the delivery of that care by COVID.  For instance, the vast majority of specialty providers have seen their telehealth usage increase.  In a recent survey, nearly 80 percent of cardiologists, gastroenterologists, pulmonologists, and respiratory physicians said that their use of virtual care technology had gone up as a result of the coronavirus.  By comparison, fewer than half of that group reported using telehealth prior to the pandemic.  But, as more traditional, in-person services come back online, telehealth usage has dipped, with these visits accounting for just 21 percent of total encounters in July, down from the peak of 69 percent observed in April, forcing many providers to re-recalibrate.

Manufacturer Payments: Teaching hospitals serve an inescapably important function in the training and development of medical professionals.  However, a new analysis published in Health Affairs exposes hundreds of millions of dollars in payments from medical device manufacturers and drugmakers to these institutions, unrelated to research.  Specifically, in 2018, teaching hospitals received $832 million from these industries.  In fact, of the nearly 1,300 institutions looked at, 91 percent brought in payments for royalties, consultations, speaking fees, space rentals, and gifts.  The concern here, as pointed out by the study’s authors, is the potential conflict of interest created by these financial relationships.  This analysis only adds to the growing body of research establishing just how pervasive the financial ties between the medical profession and these industries has become, raising further questions about independence and integrity.


A new report takes a look at the impact that the public option would have on our country’s existing health care infrastructure.  Given the challenging conditions caused by the coronavirus health crisis, researchers determined that the public option would only worsen the stresses on the health care system and could leave many Americans worse off.  Additionally, hospital services would be threatened, as would access to affordable, quality health care in rural and underserved communities.  And, states would experience significant financial consequences resulting in the degradation of their ability to contain future outbreaks.

Stay safe and be well.

You can keep up with the latest by following the Health Action Network on Twitter and by liking us on Facebook.  And, as always, be sure to let us know if there’s something you’d like to see covered in a future newsletter.