Two hospitals are being fined for disobeying price transparency rules

Placeholder while article actions load

Hey good morning. It’s Thursday! Which means tomorrow’s Friday. More fast facts coming to you in today’s edition.

Below: The Biden administration is releasing its plan to vaccinate the youngest children as soon as the week of June 20. Democrats are urging the Biden administration to take action against states that exclude Planned Parenthood and other providers from their Medicaid programs. But first … 

Hospitals have largely flouted price transparency rules – and now two are being dinged for it

The Biden administration issued the first warning shot to hospitals failing to post their prices online. 

For the first time, the federal government has slapped two hospitals with fines for flouting federal price transparency rules that took effect January 2021. The fees to two Georgia hospitals — both within the same system — total nearly $1.1 million. 

The move is part of a sweeping push to force the health industry to open up its books and empower patients to shop around. But the rules haven’t borne out as originally intended. 

The overwhelming majority of hospitals aren’t complying with the Trump-era requirement to display their prices. Even when facilities oblige, there isn’t a standard way of reporting the information, making it difficult for patients to actually compare various prices. 

  • “I think the rule is well intentioned, but I think getting to true transparency is really hard,” said Niall Brennan, the chief analytics and privacy officer at Clarify Health. “My general feeling is that the impact of the hospital price transparency [regulations] are and will continue to be limited.”

The quick backstory: In 2019, the Trump administration finalized a proposal fiercely opposed by the hospital industry.

  • It mandated hospitals disclose five types of charges in an accessible file, including the secret rates they negotiate with insurers.
  • It also required they display standard charge information for 300 services that can be scheduled in advance — such as joint replacements and physical therapy — in a consumer-friendly way.
  • Starting this year, the Centers for Medicare and Medicaid Services upped the ante. The agency increased the maximum annual penalty for larger facilities from $109,500 to over $2 million per hospital.

This week, CMS dinged hospitals for the first time. But before issuing the fines, the agency wrote warning notices to both hospitals and requested a corrective action plan. But neither Northside Hospital Atlanta nor Northside Hospital Cherokee provided a plan, and both are still noncompliant with the rules, according to a CMS spokesperson. 

The agency sent letters, dated Tuesday, to both hospitals detailing the alleged violations and the fines. (Hospital officials didn’t respond to a request for comment as of publication time.) Here’s what CMS wrote in letters quietly posted online Wednesday: 

Many hospitals aren’t adequately complying with the rules, recent reports have shown.

Out of more than 5,200 hospitals, just about 6 percent had both an accessible file and a shoppable display that adhered to the regulations. That’s according to a research piece published Tuesday in JAMA, which analyzed compliance six to nine months after the rules went into effect. 

Other reports found a similar pattern. In February, a report by patient advocates determined that a total of 14 percent of the 1,000 hospitals the group reviewed were in line with the requirements.

As for CMS … the agency has sent 352 warning notices to hospitals. It then issued requests for corrective action plans to 157 hospitals that didn’t make changes. And 171 hospitals have since come into compliance.

The American Hospital Association had originally attempted to stave off the requirements. The trade group sued, arguing that forcing the disclosure of rates is anticompetitive and won’t actually help patients make more informed decisions. But a federal appeals court let the rules go into effect.

Since then, CMS has worked with AHA members on corrective actions since the initial warnings, and the process has been “very collaborative,” per the association.

Lawmakers push CMS to enforce Medicaid ‘free choice of provider’ provision

Two powerful committee chairmen are urging CMS to take action against states that exclude Planned Parenthood and other family planning providers from their Medicaid programs.

Key context: Medicaid serves as the country’s primary payer of family planning services. For decades, the program has guaranteed beneficiaries the right to obtain care from any qualified provider, which Congress codified in response to state efforts to restrict where enrollees could receive care. 

Senate Finance Committee Chair Ron Wyden (D-Ore.) and House Energy and Commerce Committee Chair Frank Pallone Jr., (D-N.J.) argued that any exclusion creates barriers to care and will have a disproportionate impact on marginalized communities.

In a letter to CMS Administrator Chiquita Brooks-LaSure, the lawmakers requested a briefing from the agency by June 24 detailing steps the agency will take to enforce the federal requirements. 

Out today: The Biden administration’s plan to vaccinate the youngest children

The White House is releasing its plan to vaccinate toddler and babies as early as the week of June 20.

Next week, federal health regulators will consider whether to greenlight the shots after numerous setbacks in the quest to deliver a shot to the only population without one. In its operational plan, the administration says vaccines will be available at places like pediatricians and other doctors’ offices, community health centers, rural health clinics, children’s hospitals and other community-based organizations. 

Roughly 10 million doses will be available initially after authorization and millions more will become available in the coming weeks. Federal officials are also working with national organizations to launch a public education campaign to help educate parents about the shot.

White House shifts pandemic money to vaccines, cutting other programs

The Biden administration is shifting dwindling federal coronavirus funds away from public health programs to secure another round of vaccines and treatments as Congress remains at odds over whether to spend more to battle the pandemic, The Post’s Tony Romm reports. 

What you need to know: The U.S. government will redirect about $5 billion in existing funds to purchase any updated vaccines if they become available.  It also intends to repurpose another $5 billion in previously authorized aid to secure access to therapeutics, like the pill Paxlovid. 

  • Without the change, White House officials said they fear the country wouldn’t be able to secure additional vaccines or treatments in the event of a possible fall or winter surge, given high global demand.
  • Even so, the Biden administration’s emergency measures may not be enough to secure next-generation vaccines for every American should they hit the market.

The shift isn’t without consequences. The cuts will affect programs designed to help make tests available and produce them domestically, as well as initiatives to stockpile protective equipment and ventilators. The cuts at the Department of Health and Human Services may also impact planned research on vaccines and treatments.

Megan Ranney, emergency physician: 

ICYMI: Moderna to seek FDA authorization of omicron-specific shot

The company will seek authorization for an updated coronavirus vaccine designed to protect against omicron subvariants that the company described as its “lead candidate” for a fall booster, our colleagues Yasmeen Abutaleb and Andrew Jeong report. 

Preliminary data released by the company showed its targeted shot produced 1.75 times as many neutralizing antibodies against the version of omicron that spread over the winter, known as BA.1, compared with its existing vaccine. It remains unclear how effective the shot will be against the latest versions of the omicron variant circulating throughout the United States.

Dems push Biden to use executive powers to expand abortion access

A group of Democratic senators led by Sens. Elizabeth Warren (Mass.) and Patty Murray (Wash.) is urging President Biden to take executive action to protect abortion rights ahead of a Supreme Court decision that is expected to weaken or overturn Roe v. Wade

What they’re asking: The senators want the White House to immediately issue an executive order instructing the leaders of each federal agency submit their plans to protect abortion rights within 30 days. 

The lawmakers also requested the administration instruct federal agencies to increase the accessibility of medication abortion, support women seeking the procedure over state lines, expand access to the procedure using federal property, especially in states that have moved to restrict it, and more. 

Sen. Tammy Baldwin (D-Wis.):

Armed man arrested near Justice Kavanaugh’s home

An armed man was detained yesterday morning near Brett M. Kavanaugh’s Maryland home after officials said he made threats against the Supreme Court justice and called authorities, The Post reports. 

Following his arrest, the man, identified as Nicholas John Roske, told police he was “upset” by the leaked draft of a Supreme Court opinion that would overturn the constitutional right to abortion, as well as the recent school shooting in Uvalde, Tex. 

According to the affidavit, Roske allegedly planned to kill Kavanaugh and then himself thinking it would give his life purpose, according to an affidavit. He is being charged with the attempted murder of a Supreme Court justice.

The prospect of overturning Roe v. Wade has amplified tensions at the court, which is expected to release a final decision this month or early July. Security measures have been ramped up around the court, its justices and some of their homes as a result.

  • On Tuesday, the Department of Homeland Security warned of potential violence in the coming months because of “several high-profile events,” including the upcoming ruling.

Julio Rosas,

  • In Wisconsin: Gov. Tony Evers (D) will call the state legislature into a special session later this month to repeal the state’s more than 170-year-old criminal abortion ban, The Post’s Eugene Scott reports.
  • House lawmakers yesterday overwhelmingly passed legislation to reauthorize the Food and Drug Administration’s user free programs for prescription drugs and medical devices.
  • Abbott and the FDA were alerted to a host of problems at the company’s infant formula plant in Sturgis, Mich., in February 2021, much earlier than was publicly known, the Wall Street Journal reports.

Covid shots for young kids are almost available. (Lena H. Sun and Laurie McGinley l The Washington Post)

How much medicine does the U.S. actually have to fight monkeypox? (Rachel Cohrs l Stat)

A Vanishing Word in Abortion Debate: ‘Women’ (Michael Powell l The New York Times)

Thanks for reading! See y’all tomorrow.

You may also like