We have come to our final day our 12 Days of Christmas Posts this year. It is always good to reflect back and look to the future. And it’s always amazing how fast the year gets away from you. We are still debating and in disagreement over the ACA. We are still struggling to come together on securely exchanging health information records and doing interoperability right. We are still spending more on healthcare with US health expenditure as percent of GDP at 17.8%. We are still a nation divided on Medicare for All or what that even means. Personal healthcare deductibles continue to rise with not end in site. Surprise billing was top of the list of “patient stories” this year. The hype of big tech in healthcare dominating the news in 2018 has not shown any healthcare benefits for anyone. There will be no “Drum Roll Please” in looking back on 2019. But headline there were.
January – Federal shutdown dominates the headlines. From December 22, 2018, until January 25, 2019 it was our longest government shutdown in history, and the second involving furloughs during Trump’ presidency. Optum tries to sue to block a former executive from working at the Amazon/Berkshire Hathaway/JPMorgan Chase’s health care venture headed by Atul Gawande. Surprise billing gets attention from the administration, the senate, and a coalition of health insurance, business, and consumer protection organizations. A Kaiser Family Foundation poll finds that one in 10 insured adults had received a surprise medical bill from an out-of-network provider in the past year.
February – CMS completes large-scale effort to provide new Medicare cards without Social Security numbers to people with Medicare. Announcing at the HIMSS Conference, ONC and CMS release long awaited proposed rules to support seamless and secure access, exchange, and use of electronic health information. Kaiser Permanente health system waives tuition for every student in its first five medical school graduating classes. Accenture’s 2019 Digital Health Consumer Survey said Millennials and Gen Z—are much more likely to say they’re dissatisfied or very dissatisfied with the effectiveness of treatment, convenience and transparency of care than patients in the Baby Boomer generation. Measles outbreaks brings anti vaccinating issues to national public health discussion and state emergencies. Chief executive officers from seven prescription drug companies testified before the Senate Finance Committee on drug pricing practices. Members asked the executives how their companies set prices, determine rebates, and why prices for patients vary from country to country. EHR vendor Athenahealth goes private under new ownership.
March – Hospital Acquired Conditions (HAC) Reduction Program, created by the Affordable Care Act cited 800 hospital with penalties for patient safety. 110 hospitals for the 5th year when program started. Food and Drug Administration Commissioner Scott Gottlieb resigns. HealthEdge Voice of the Market survey shows while CMS has embraced value-based reimbursement, private payers have been moving slowly. Women vets triple since wars in Iraq and Afghanistan forcing spotlight on health services. VA women’s health officials testify at House Appropriations Committee hearing stating they are working to improve women’s health services, including mental health treatment associated with military sexual trauma. Most popular mobile health apps are exposed for sharing your data. Legislators still debating solutions on surprise billing.
April – ONC and CMS extend comment period for proposed rules aimed at promoting the interoperability of health information technology (health IT) and enabling patients to electronically access their health information. GAO finds $23B in improper Medicare payments. Federal judge strikes down a Trump administration rule that allows small businesses to band together and set up health insurance plans that work around requirements of the Affordable Care Act. Lyft IOP filing states they more than 60 health care transportation brokers and plans to expand. Alexa gets HIPAA compliant. Walgreens to launch in store Primary Care to compete with CVS Health. Amazon began marketing PillPack’s at-home prescription drug delivery to American consumers. Microsoft announces their HeathVault is sunsetting.
May – HHS Finalizes rule requiring manufacturers disclose drug prices in TV ads to increase drug pricing transparency, to go into effect July 9. Attorney generals in 44 states sue some of the largest generic drug manufacturers, alleging they conspired to artificially inflate and manipulate prices for more than 100 different generic drugs, including treatments for diabetes, cancer, arthritis and other medical conditions. Aetna rolls out app for the Apple watch. COO Jack Stoddard leaves Amazon, Berkshire Hathaway and JP Morgan health venture Haven. Kaiser Family Foundation poll reveals three-quarters of the public want the federal government to protect patients from being stuck with surprise medical invoices after they are unwittingly treated by doctors or medical facilities that are out of their insurance network. Legislators still debating solutions. HELP Committee releases details of a plan they hope will help bring down health costs and eliminate surprise medical bills for patients.
June – Trump signs executive order on price transparency in health care that aims to lower rising health care costs by showing prices to patients. CMS seeks public input on Patients over Paperwork Initiative. Democrats first national primary debates, healthcare takes center stage. Maine legalizes medically assisted suicide. FDA issues warning to vaping companies. AMA adopt AI policies and recommendations at annual meeting. House passes $99.4B HHS appropriation bill that includes provision to lift the decades-long ban on developing a national patient identifier (NPI). Debate over congressional proposals to ban surprise medical bills continues. The House and Senate both have draft proposals to cap out-of-network charges at the regional insurers’ in-network rate.
July – CMS releases 2020 Proposed Rule for the Quality Payment Program. Frances S. Collins, director of the NIH, will no longer speak at conferences that don’t include women presenters. CMS reports 98% of clinicians receive bonuses in MIPS program. House votes to abolish Cadillac tax, the vote was 419-6. CVS Health announces plans to start a clinical trial of its new home dialysis system putting them in direct competition with Fresenius and DaVita. CMS delays updating controversial hospital star ratings pending a review from expert panel. CMS proposes to cover Acupuncture for chronic lower back pain.
August – Cherokee Indian Hospital’s integrated care model—designed by Alaska Natives provides care tailored to the tribe thanks to casino revenues. JAMA and CDC research reveals as income inequality worsens, so does health equity. CVS Health and the Aetna Foundation imitative to expand its work on the social determinants of health through its new “Destination: Health” platform. Medicare could save $57 million annually by delivering free meals to seniors after hospitalization, according to a BPC report. Anthem is rolls out a new smartphone app to schedule and pay for medical visits, learn about potential diagnoses and text with doctors. JAMA reports surprise billing is on the rise among patients with private insurance. Urban Institute reports after several years of declines, the uninsured rate went up in 2017–from 10.0% in 2016 to 10.2% in 2017. CDC investigates a cluster of lung illnesses that may be linked to e-cigarette use.
September – American Well’s Telehealth Index: 2019 Consumer Survey reveals 66% of Americans are willing to use telehealth, and 8% have had a telehealth visit with a doctor. Walmart Health follows CVS and Wallgreens and opens health clinics in Dallas and Georgia. AMA updates CPT code set to include almost 400 changes with include six new e-visit codes and two for reporting self-measured blood pressure monitoring. Aetna and CVS get green light from courts to merge. CMS Administrator Verma calls on hospitals to get on board with transparency and value-based payment policies. HHS awards $9M to develop new models to improve obstetrics care in rural communities. Walgreens announces plans to test on-demand drone delivery service with Wing Aviation. Senate fails to support unique patient identifier and did not include language overturning a ban in its HHS funding bill. Walmart stops selling e-Cigarettes. CMS releases Omnibus Burden Reduction (Conditions of Participation) Final Rule to remove Medicare regulations identified as unnecessary, obsolete, or excessively burdensome on hospitals and other healthcare providers to reduce inefficiencies and moves the nation closer to a healthcare system that delivers value, high quality care and better outcomes for patients at the lowest possible cost.
October – Kaiser Family Foundation reports premiums and deductibles are making employer-based coverage too pricey. Despite employers paying a significant portion of those premiums, the employee share of coverage costs has grown faster than wages. JAMA publishes research that roughly a quarter of US health care spending is wasteful. CMS releases data showing it saved $739M in 2018 Medicare ACOs. FDA releases new guidelines on which types of software fall under the agency’s regulatory oversight. HHS releases two proposed changes to two anti-fraud laws. Surprise billing turns into a battle between providers and insurers. Over 100 physician organizations say congress is giving more power to the health insurer with their proposed solutions. Former ONC and HHS administrator, Karen DeSalvo becomes Google’s as its first chief health officer. CMS Primary Care First the new value-based payment model gets delayed until 2021. Flagler Health+ to open telehealth clinics in Publix pharmacies in FL. Amazon acquires Health Navigator in their Amazon Care group for employee benefits in virtual care.
November – CMS issues finalized Policy, Payment, and Quality Provisions changes to the Medicare PFS for CY 2020. CMS selects top 25 participants to advance to Stage 1 of the CMS AI Health Outcomes Challenge. CMS issues first annual update to the Medicaid and CHIP Program Scorecard. CMS issues final rule requiring hospitals to disclose the rates they negotiate with insurers beginning in 2021. Kaiser Permanente Chief Executive Bernard Tyson, 60, dies of heart complications. Gregory Adams, an executive vice president and group president, is named interim CEO and chairman. WSJ breaks story on Google’s Project Nightingale with Ascension health system to collect detailed health information on 50 million American patients sparked a federal inquiry and criticism from patients and lawmakers.
December – Law firm Foley & Lardner report on telemedicine shows 42 states and the District of Columbia have passed laws encouraging health insurance plans to cover telehealth services, but only 16 specifically address reimbursement. Amazon Web Services (AWS) launches Amazon Transcribe Medical, an automated speech recognition service for developers to add medical diction and documentation to their apps. CVS Health launches oncology precision medicine initiative, Transform Oncology Care a first-of-its-kind precision medicine strategy for payors. Amazon teams up with pharma giant Novartis AG to make the manufacturing and delivery of new medicines more efficient. Hospital group sues HHS to block price transparency rule. Senate confirms cancer specialist and hospital exec Dr. Stephen Hahn as FDA commissioner. House passes legislation to allow the federal government to negotiate prices with pharmaceutical companies. It does not look like the Senate will follow suit. While states take up the surprise billing cause the feds fall short on resolving anything. The long awaited ONC and CMS rules on interoperability and information blocking have yet to be released.
Happy New Year.