Axios Vitals

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February 16, 2018

Good morning … Vitals is off Monday for the President’s Day holiday, so try to hold yourself together in its absence, and we’ll see you back here on Tuesday.

Congress doesn’t know what to do about opioids

Police arrest a woman outside a suspected drug house. Photo: Scott Olson/Getty Images

Almost everyone seems to agree that Washington needs to do something to help get the opioid epidemic under control. But there’s no real consensus about what that something should be.

What’s next: The Energy and Commerce Committee is going to begin a legislative push later this month, and the Senate health committee is aiming to mark up a bill in late March. Congress also provided $6 billion in opioid funding as part of its big budget deal last week.

Yes, but: My colleague Caitlin Owens asked around about what Congress will try to do. It hasn’t decided yet.

  • “I think it’s a rapidly growing problem ... We know some things to do, but we don’t know that everything we’re trying is going to work,” Sen. Chuck Grassley tells Caitlin.
  • Sen. Roy Blunt says the Appropriations health care subcommittee does not yet know what it wants to do with the $6 billion from the budget agreement.

Key quote: Some lawmakers say they’re making progress, albeit slowly. But the death rate from drug overdoses continues to climb.

  • "I’ve had more deaths every year, so how can you be on track? And how can you be winning when you're losing more people?” Sen. Joe Manchin says.

Go deeper: Read Caitlin’s story about Congress’ next steps.

Anthem backs off controversial ER rules

Health insurer Anthem is making some changes to the way it pays for emergency room trips, following criticism of a pilot project that essentially forced patients to correctly diagnose themselves in the middle of an emergency.

Refresher: In an effort to cut down on ER spending, Anthem had decided it would not cover patients for “inappropriate” ER visits. But it defined appropriateness based on the ultimate diagnosis, not on the patient’s symptoms when they first entered the ER.

  • So it was effectively the patients’ responsibility to know what kind of treatment they needed, and if they got it wrong, they were on the hook for their entire bill. (Vox wrote the definitive piece on how this worked.)

What’s new: Anthem now allows new exceptions to its policy.

  • Per Modern Healthcare: “[T]hose exceptions include when a patient is directed by a healthcare provider to go to the ER; the patient is under 15 years old; the patient is traveling out of state; or the patient received any kind of surgery, IV fluids or IV medications, or an MRI or CT scan.”

Quick take: Anthem’s policy was clearly unsustainable — and a nightmare for its customers — but its frustration with high ER bills is widely shared. And some experts and cost hawks were already concerned about hospitals’ financial incentives to perform a lot of MRIs and other imaging tests, even if patients didn’t need them.

Get a flu shot already

Woman getting flu shot

Woman getting this year's flu shot at Walgreens. Photo: Justin Sullivan/Getty Images

It’s true that this year’s flu vaccine isn’t quite as helpful as it could have been — it’s about 36% effective overall, according to new estimates by the Centers for Disease Control and Prevention. But it’s as high as 59% effective for children younger than 9, health officials said yesterday.

Why it matters: This is an especially deadly flu season, and it’s not over.

  • The flu has killed at least 63 kids in the U.S. since the start of this flu season, and this number is expected to rise. About three-quarters of those kids weren’t vaccinated, the CDC says.
  • "Getting the flu shot is the same kind of sensible protection as buckling up your seat belt,” HHS secretary Alex Azar said at a briefing yesterday.

Go deeper: Why this flu season is so bad.

Air ambulance lobby stumps for pay hikes

Companies that operate medical helicopters are again pushing federal lawmakers for hefty raises in their Medicare payments, arguing that Medicare only covers 60% of their costs, my colleague Bob Herman reports.

Here’s the latest:

  • Identical bills in the House and Senate would boost Medicare rates for air ambulance services by 12% in 2018 and 20% in both 2019 and 2020.
  • Air Methods, a large medical helicopter company that was taken private last year in a $2.5 billion deal, just hired a lobbying firm specifically to push for those two bills.
  • Companies that make medical helicopters, like Textron, also are putting lobbying dollars behind the proposals.
  • Similar legislation has not gone anywhere over the past three years, so there’s no guarantee things will change this time around.

The impact: Many patients who have had to use medical helicopters have been stunned by the high bills and aggressive collection tactics, according to the New York Times and several local reports.

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