This Week in Healthcare Reform: June 4th, 2021

Lawmakers propose bills to ease telehealth access; COVID-related price-gouging still an issue; fewer independent physicians remain as hospitals gobble up private practices; and, stakeholders make price transparency tools increasingly available to consumers.

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Week in Review

The Value of Medicaid: As highlighted above, stakeholders from across the healthcare spectrum have come together to highlight the impact that the Medicaid program is having on a growing number of American lives.  Currently, over two-thirds of Medicaid enrollees receive coverage through Medicaid managed care programs, a public-private partnership that plays an increasingly essential role in implementing strategies to improve quality of – and, access to – care.  In addition to connecting some of the most vulnerable populations to the vital healthcare services they need, Medicaid managed care plans have been integral in expanding the reach of telehealth, addressing social determinants of health, and delivering enhanced consumer tools aimed at improving the patient experience.

Audio-Only Telehealth: Even before COVID forced a radical rethink of how and where and when we interacted with our healthcare system, seniors had shown an increasing level of comfort in utilizing technology to access care.  That familiarity served them well in the immediate wake of the coronavirus pandemic as telehealth became a vital lifeline, connecting people to the healthcare they needed even as the public health crisis kept all of us socially-distanced.  To facilitate its utilization, lawmakers eased restrictions governing its use, allowing both providers and payers the regulatory flexibility they needed to ensure that patients were able to seek out and receive the care they needed.  As a result, more than a quarter of Medicare beneficiaries used telehealth between the summer and fall of last year.  More tellingly, however, is that, of those seniors, more than half used only a telephone for that telehealth visit.  With that in mind, lawmakers have now advanced bills that would seek to make permanent the regulatory changes regarding telehealth’s utilization that had been enacted during the pandemic.  Those flexibilities are currently only meant to last through the extent of the public health emergency, meaning, they’ll expire once the pandemic has come under sufficient enough control to allow that declaration to expire.  Among those changes, House lawmakers have proposed legislation that would remove geographic and originating site restrictions that would allow Medicare beneficiaries to continue to access audio-only telehealth services.  The bipartisan bill would establish coverage for providers connecting via phone-only or non-video telehealth platforms to patients without access to video-supported services.

COVID Price-Gouging: Unfortunately, while the expansion of telehealth showed what’s possible when stakeholders work together to better address patient access, the pandemic also created the conditions that allowed bad actors to take advantage of the system for their own exploitative benefit.  Almost immediately, egregious examples surfaced of unscrupulous hospitals charging exorbitant amounts for testing and treatment as the coronavirus upended our daily lives.  By the fall of last year, data pointed to out-of-network tests for COVID continuing to rise, far exceeding in-network costs and threatening affordability for everyone.  In fact, price-gouging had become so prevalent that, by then, as much as 16 percent of out-of-network test claims were more than 3 times the average cost.  As we continue into our second year under the pandemic, no procedure has been more frequent than tests for coronavirus.  With that in mind, there’s a growing sense of alarm as these tests continue to generate higher and higher charges from hospitals and clinics.

Independent Physicians: With large and wealthy hospital systems continuing to gobble up smaller, independent physician offices, last year marked an historic shift in our country, as fewer than half of all doctors in the U.S. now work in private practices.  Against that backdrop, there’s increased concern over how the makeup of our healthcare delivery system is impacting patient quality, access, and affordability.  In April, House lawmakers held a hearing investigating anticompetitive conduct in healthcare markets.  That was followed late last month by a separate Senate hearing focused specifically on hospital consolidation.  The timing couldn’t be more appropriate, as recent reporting suggests that, buoyed by federal COVID aid, wealthy hospital systems – some of whom are managing to emerge from the pandemic even richer, thanks to federal bailouts – have been using these funds to buy up competitors.

Price Transparency Tools: A lot of policy and regulatory attention has been paid to the role that transparency can play in helping to address rising healthcare costs, the idea being that by shining the light on these prices, consumers can make better choices.  However, as a growing body of research has established, transparency, at least when it comes to healthcare prices, isn’t exactly straightforward, with wide variation between what’s being charged occurring, both, between and within geographies.  Complicating matters further, efforts employed by hospital and provider systems to obscure pricing data.  For their part, payers have already worked to bring innovative price transparency tools to consumers, which they’re also working to better operationalize.  While encouraging, despite the prevalence of these tools, initial data shows consumers picking the same providers regardless of this pricing information.
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