Sep 14, 2018

Axios Vitals

By Caitlin Owens
Caitlin Owens

Good morning ... Situational awareness: José Baselga has stepped down as chief medical officer at Memorial Sloan Kettering Cancer Center, on the heels of a ProPublica/New York Times investigation that found he had failed to disclose millions of dollars in payments from industry.

1 big thing: Employers' role in surprise bills

Illustration: Lazaro Gamio/Axios

If there's an end in sight for big, surprising hospital bills, employers likely would need to be part of the solution. But, as Axios' Bob Herman reports this morning, they don't support some prominent proposals to rein in surprise billing.

Where things stand: Analysts at the Brookings Institution have suggested fixes that would force health care providers and the purchasers of care (employers and insurers) to agree on a couple things:

  • Patients should not be on the hook for surprise bills that are tied to emergencies, nor should they have to pay for care they receive at in-network hospitals where a specific doctor, like an anesthesiologist or a surgeon, turns out to be out-of-network.
  • Regulators should cap how much hospitals, doctors and others can charge in certain situations, and legislation should force fair arbitration when providers and insurers/employers can't agree.

Yes, but: Providers loathe the idea of having their payments regulated, and employers aren't keen about being forced into a dispute resolution process.

The bottom line: Provider regulation — like outlawing balance billing for emergency care or requiring all doctors at in-network facilities to accept in-network rates — is probably the most direct way to solve this issue.

  • One compromise that could neuter surprise billing by reining in providers is all-payer rate setting, but corporate America isn't championing it.
2. ACA lawsuit gets a countersuit

Blue states are already defending the Affordable Care Act in court against red states’ latest legal challenge. Now Maryland has taken it a step further, filing what amounts to a competing lawsuit.

The details: Texas, the leader of the red states’ lawsuit, says the ACA’s individual mandate has become unconstitutional, and that the whole law should fall as a result. It has asked a federal court to issue an injunction that would prevent the entire law from being enforced as a result.

  • Maryland filed its own lawsuit yesterday seeking an injunction that would require the Trump administration to enforce the ACA.

What to watch: "Depending on how quickly the Maryland case moves, it’s possible we could see dueling injunctions — one ordering the Trump administration to stop enforcing the law, the other ordering it to keep enforcing," ACA legal expert Nick Bagley writes.

3. Senate drops drug price disclosures

Congress is making unusually easy progress on an HHS spending bill, but one controversial provision has officially gotten the ax: an amendment to facilitate regulations requiring drug companies to disclose their prices in their direct-to-consumer advertising, like they do with side effects.

The intrigue: "Current and former congressional aides following the negotiations pointed fingers at House Republicans, as did [Sen. Dick] Durbin and several other lawmakers," STAT News reports.

  • A similar, if not identical, proposal was part of President Trump's blueprint to lower prescription drug prices, and the FDA is working to implement that policy now. So Congress' intervention may not have been necessary.
  • The overall policy also faces big questions. Because so few patients pay the sticker price for a drug, and because each patient's price will be different, how do you disclose a price that will be relevant and useful for everyone who sees it?
  • Still, it's noteworthy to see congressional Republicans, already facing an onslaught of health care-related attacks ahead of the midterm elections, step in to help sideline a proposal the drug industry doesn't like.
4. FDA to outline antibiotic strategy

FDA Commissioner Scott Gottlieb will announce the agency's new approach to antimicrobial resistance today, including ideas for encouraging drugmakers to come up with new antibiotics. Via my colleague Caitlin Owens, the plan also includes:

  • Steps to promote careful antibiotic stewardship in human and animal medicine.
  • New tools to better collect data on antimicrobial use and when pathogens become resistant.

1 big problem: The current system doesn't give pharma companies an incentive to make new antibiotics. The point is to use them sparingly enough that pathogens don't become resistant, but a drug companies’ profits depend on heavier use.

  • Gottlieb is expected to discuss the need for new payment models that better promote the development of new antibiotics. These models might pay more for drug upfront, but result in savings to the system down the road.
  • For example, hospitals could pay a subscription fee for access to doses of new antibiotics, which would have to be high enough to make drug companies' investment worthwhile.
Caitlin Owens

Have a great weekend. See you back here on Monday. Let me know what you're watching next week: