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  • Writer's pictureJulie Barnes

October 8, 2021

Maverick's Update

Only What Matters In Health Information Policy

There are good surprises and bad surprises. A good surprise was learning that 95-year-old Tony Bennett and his younger counterpart Lady Gaga released a new album called Love For Sale, which followed a couple of sold-out concerts at Radio City Music Hall over the summer. A bad surprise was learning that Tony Bennett, a singularly talented musician that appealed to multiple generations of fans with good, old-fashioned crooning, has Alzheimer’s disease. The 60 Minutes episode, the NPR story, and the USA Today article do a fine job explaining how these surprises are both breathtakingly sad and an opportunity to celebrate a life that is still being well-lived. Another story about surprises, but for the healthcare industry, in the One Thoughtful Paragraph below.

For now, these news items may surprise you:

  • FTC Chair Lina Khan made a statement to Congress on privacy and security, highlighting that protecting data privacy and security is now a mainstay of the FTC’s work. Other statements from FTC Commissioners are available here, here, and here.

  • A new Premier report shows that hospitals spent $24 billion more on clinical labor per year than they did prior to the pandemic, mostly due to higher labor expenses from staff turnover and overtime hours.

  • Rock Health report showed that digital health funding reached $21.3 billion so far this year, a number that breaks 2020’s full-year record of $14.6 billion.

One Thoughtful Paragraph

Medical services are for sale, but the payment isn’t love -- the federal government just made it official. The No Surprises Act, passed by Congress in 2020, now has three regulations and one FAQ guidance to make sure patients aren’t surprised by big bills and to explain how to decide what providers should be paid (read more here, here). The latest rule released last week clarified that, if health plans and providers can’t agree on a reimbursement amount for a service, then the providers will be paid the median rate normally paid by health plans for that service in that same geographic area. To be clear, this is what the first regulation released in July said too -- but this last regulation said that even an independent arbitrator must choose a reimbursement amount that is closest to the plan’s normal payment rate. No more going to court and hashing it out for a year or two -- unless something really out of the ordinary is going on, providers are going to have to live with what health plans normally pay. And that IS a surprise -- because it makes arguing about a payment rate not worth the effort. So if this rule sticks -- and it can only be unstuck if HHS suddenly changes its mind before the effective date on January 1, 2022, or an Act of Congress changes things, or a successful lawsuit happens down the road -- then providers will only get to charge more for a medical service if patients agree to be charged more. And if patients agree to be charged more, that would be surprising. Why wouldn’t they just use the money saved to buy the latest Tony Bennett album?

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