Daily on Healthcare: Another piece of ‘Trumpcare’ rolled out

By | October 9, 2019

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ANOTHER PIECE OF ‘TRUMPCARE’ IS OUT: The Trump administration has proposed relaxing 30-year-old rules that prevent self-referrals and kickbacks in medicine, saying they get in the way of different parts of the healthcare system working together.

The proposal, which President Trump is expected to talk about in speech in Minnesota Wednesday, will apply to the Physician Self-Referral Law and the Anti-Kickback Law, which exist to protect patients so doctors don’t order unnecessary, costly tests or procedures just to benefit financially. Despite the protections, healthcare industries have been pushing for changes, saying the rules had become overly burdensome and expensive, and prevented them from setting up arrangements that would help patients get access to the care they need more easily and at a lower price.

The move is part of a broader effort by the Trump administration to cut red tape through the federal government and to outline Trump’s healthcare priorities ahead of the 2020 election.

How the restrictions work now: Under the self-referral law, doctors aren’t allowed to refer Medicare and Medicaid patients for services from entities from which they could benefit from financially, such as labs or hospitals. The law is commonly known as the “Stark Law,” for its author, former Democratic Sen. Pete Stark of California. The anti-kickback law makes it illegal for healthcare providers to accept bribes in return for getting business from Medicare and Medicaid.

Why the change? When the anti-kickback and self-referral rules were initially created, the healthcare system operated differently than the direction health officials are trying to push it in now. Historically, doctors and hospitals were paid for the specific procedure or service they provided. But increasingly, insurers and the government are pushing for healthcare providers to show that their care made patients better and improved their quality of life, which requires them to better coordinate with the different caretakers involved and to focus on ideas that would reduce hospital readmissions and make it easier for patients to get what they need. It also in a lot of cases means rewards doctors who reach their goals.

While the current regulations have dozens of exemptions to allow for some collaboration, healthcare providers say they are ambiguous and complex, requiring them to pay expensive fees to attorneys to make sure they aren’t running afoul. If they are, intentionally or not, they’ll face fines and will be banned from seeing patients on Medicare or Medicaid.

What the changes would look like: An example permitted under the proposal would allow a hospital to give patients with diabetes the technology they would need to monitor their condition at the time they are discharged from the hospital. This kind of arrangement would mean patients wouldn’t have to take a separate trip elsewhere to get the devices.

The changes would also allow a local hospital to donate cybersecurity software to doctors that refer patients to them, given that both providers work together and want to keep patient information private and safe.

Good morning and welcome to the Washington Examiner’s Daily on Healthcare! This newsletter is written by senior healthcare reporter Kimberly Leonard (@LeonardKL) and healthcare reporter Cassidy Morrison (@CassMorrison94). You can reach us with tips, calendar items, or suggestions at dailyonhealthcare@washingtonexaminer.com. If someone forwarded you this email and you’d like to receive it regularly, you can subscribe here.

COLORADO UNVEILS ‘PUBLIC OPTION’: State officials have released a draft of the plan, which offers lower premiums, between 9% and 18%, by paying hospitals less for care. The plans, which would launch in 2022, aren’t a typical public option, which is run by the government, but are instead more strictly regulated private plans. The idea is similar to what Washington state will launch in 2021. Colorado officials have until Nov. 15 to finalize the idea but there’s no guarantee it’ll be implemented.

SANDERS SAYS HE WAS ‘DUMB’ FOR NOT ACTING ON SYMPTOMS BEFORE HIS HEART ATTACK: On his way to a visit with a cardiologist, Bernie Sanders told reporters Tuesday that he regrets not listening to his body, which had been exhibiting symptoms before having a heart attack last week. “I must confess that I was dumb,” said Sanders, 78. He cited the many rallies he puts on each week, sometimes several in one day, and traveling constantly on the presidential campaign trail as causes for his unusual fatigue that probably contributed to the heart attack. When Sanders tweeted that he was resting from the cardiac event over the weekend, he was greeted with an outpouring of support online, with sentiments like “I’m so glad you are okay, Bernie. Please take care of yourself. We’ve got this in the meantime,” and, “This has only made me more determined! Millions of Americans wouldn’t have been able to get the care you did, so we fight for them.”

MEANWHILE, TRAGEDY STRIKES FAMILY — SANDERS’ DAUGHTER IN LAW DIES JUST DAYS AFTER HER CANCER DIAGNOSIS: Sanders’ daughter-in-law, Dr. Rainè Riggs, died Saturday after undergoing several medical tests last week finding she had neuroendocrine cancer. Riggs was 46. In addition to her husband Levi Sanders, Riggs left three children, Sunnee, Ryleigh, and Grayson. Riggs was an accomplished psychologist in Vermont, working primarily with seniors.

WARREN DEFENDS CLAIM SHE WAS FIRED BECAUSE SHE WAS ‘VISIBLY PREGNANT’: Senator Elizabeth Warren on Tuesday defended her claim that she had been fired from her first teaching job because she was “visibly pregnant” before the school year ended: “When I was 22 and finishing my first year of teaching, I had an experience millions of women will recognize… the principal told me the job I’d already been promised for the next year would go to someone else.”

Skepticism of her story rose this week because the Washington Free Beacon unearthed Warren’s records from working for the New Jersey public school in 1971, finding that the board wanted her to stay on for a second year but she resigned of her own volition. Warren said in a 2007 interview that she chose to leave the job, but has since changed her tune, repeating the discrimination claim in several stump speeches.

CDC RECOMMENDS PREGNANT WOMEN GET VACCINATED, BUT MILLIONS DON’T: Pregnant women are encouraged to receive both influenza and whooping cough vaccines by their third trimester, but only about 50% of pregnant women get at least one and only 35% get both. Officials at the Centers for Disease Control and Prevention told reporters Tuesday that both vaccines are perfectly safe and effective for them and their babies. The vaccine antibodies travel to the fetus when the mother gets immunized, so when babies are born and too young for vaccinations, they are protected from influenza and whooping cough. CDC deputy principal director Dr. Anne Schuchat said she understood why mothers would be hesitant to get vaccinated for fear of possibly hurting their babies. But, Schuchat said, both the flu and whooping cough can be fatal: “We are stressing the importance of two safe and effective vaccines for pregnant women and the risks to both women and their babies when these vaccines are not given during pregnancy.”

STDs HIT 28-YEAR HIGHS: From 2017 to 2018, the number of syphilis and gonorrhea cases increased by 14% and 5% respectively to the highest count since 1991. Chlamydia cases increased 3% to 1.7 million cases — the highest the CDC has ever reported. The CDC said drug use, poverty, and lack of funding for STD prevention education programs helped drive up the number of cases. While Health and Human Services is developing a Sexually Transmitted Infections Federal Action Plan, the CDC is also calling on “all types of stakeholders,” including physicians, to step up to detect STIs early and help prevent them from spreading. State and local governments have been asking for help to combat the rise in STD cases.

The Rundown

Los Angeles Times Los Angeles could ban all e-cigarettes and vaping devices

PBS News Hour Is a vaping-linked lung illness a public health crisis? That depends on who you ask

Modern Healthcare Michigan wants to save $ 40 million by cutting PBMs out of Medicaid

Boston Globe Virtual ‘scribes’ help doctors focus on patients, not note-taking

Kaiser Health News They enrolled in medical school to practice rural medicine. What happened?

The Wall Street Journal J&J hit with $ 8 billion jury award over antipsychotic drug



Congress in recess.

Noon. 1789 Massachusetts Avenue NW. American Enterprise Institute event on “Who benefits? The winners and losers of Medicare for All, Obamacare, and other health care proposals.” Details.

THURSDAY | Oct. 10

9 a.m. W Hotel. 515 15th St. NW. Health Affairs event on “Violence and Health.” Details.

9:30 a.m. National Press Club. 529 14th St. NW. Event on “Healthcare for Illegal Immigrants: What Would It Cost?” Details.

Noon. 214 Massachusetts Avenue NE. Heritage Foundation event on “Bioethics: What It Is and Why It Matters.” Details.

FRIDAY | Oct. 11

9:30 a.m. U.S. Court of Appeals for the District of Columbia will hear Stewart v. Azar and Gresham v. Azar, cases challenging work requirements in Kentucky and Arkansas.

Noon. Dirksen G-50. National Institute for Health Care Management Foundation briefing on “How to Build Healthier Communities: From the Opioid Crisis to Social Determinants.” Details.

TUESDAY | Oct. 15

Medicare open enrollment.

8 p.m. Westerville, Ohio. Democratic debate on CNN.