Ways and Means hearings

With help from Arthur Allen (@arthurallen202)

WAYS AND MEANS HEARINGS: On Capitol Hill, a pair of hearings held Tuesday by the House Ways and Means Committee delved into some important health IT topics:

— Data analytics urged to improve: In the first hearing, on Medicare fraud, witnesses told the Oversight subcommittee that CMS needs to do better on anti-fraud data analytics. The government has long been committed to transitioning from a traditional model of fraud prevention, where Medicare pays providers and tries to catch fraudulent or improper payments later. It’s been derided as “pay-and-chase.”

The newer idea is to stop those payments from ever occurring, in much the same way a credit card company will intercept payments to random fraudsters half the world away from you. CMS made one move towards that model with its “Fraud Prevention System,” an arsenal of computer models rooting out fraud which began in 2011.

By the agency’s calculations, it’s done well, saving $6.30 for every dollar spent in fiscal year 2016, a CMS witness at the hearing said. And an OIG witness says that fraudulent payments have decreased, with estimates falling from 11 percent in 2016 to 9.5 percent in 2017.

But witnesses from OIG and the Government Accountability Office say CMS could go farther. An OIG official said that the CMS lacks the ability to attribute savings to specific Fraud Prevention System models. (The anti-fraud data analytics each have slightly different strategies, so it might be useful to figure out which models perform best.)

Meanwhile, and more broadly, the GAO witness said the agency’s overall fraud strategy could use tweaking. For example, while the agency has been active in assessing the fraud potential of specific programs, like home health, it hasn’t examined Medicare as a whole, the witness argued.

— Stark law reform?: Meanwhile, the Health subcommittee held a hearing on Stark Law reform. Enacted in 1989, Stark and its sibling anti-kickback laws are intended to prevent conflicts-of-interest from unduly influencing doctors’ decisions. Over the years, the laws have become devilishly complex, with tons of exceptions and safe harbors intended to separate some good collaborations from bad conflicts-of-interest.

One of those exceptions is an important milestone in the history of health IT: the EHR exception, which allowed hospitals to subsidize the cost of an electronic health record system for an independent practice. But some practices and vendors believe this has become a way to lock providers into referring patients into the home hospital system – if both you and the hospital have the same EHR, the theory goes, then it’ll be easier for you to refer and transfer your patient’s records to the hospital. We wrote about this conflict back in the summer of 2015, for those who’d like more background.

But many people are arguing the laws need modernizing to fit with the new era of value-based pay and accountable care organizations. Those voices were mostly heard on the committee, ranging from HHS deputy secretary Eric Hargan to hospital executives like AdvocateAuroraHealth’s Michael Lappin.

Lappin, in particular, emphasized potential health IT implications for any changes to the law. For example, he advocated for a data analytics subsidization safe harbor — much like that original EHR subsidization.

(Cybersecurity subsidization has also been pushed by other industry groups.) He also said compliance with Stark led to complications with a partnership with a local accelerator. Indeed, compliance is so complicated, he said, the system needs to hire consultants costing in excess of $20,000 to deal with a single physician agreement.

“Because Aurora enters into thousands of contracts with physicians each year, this cost can become astronomical,” he said, in his prepared testimony. (We can recommend our colleague Joanne Kenen’s recent article on health care consultants if you’d like to learn more about their wonderful world.)

Further reading can also be found at The Hill, where former HHS secretaries Tommy Thompson and Kathleen Sebelius penned an op-ed.

eHealth tweets of the day:Sarah Karlin-Smith @SarahKarlin

“Fun moderating with a food reporter @ceboudreau at @POLITICOLive #PROSummit because I get to learn things about the new world of cell-cultured food and dairy labeling.

@SGottliebFDA quote of the day:
‘Almonds don’t lactate’”

Genevieve Morris @HITpolicywonk

“Sarcastic theme song of the week: Carly Rae Jepsen, ‘Call me maybe.’

But really, please don’t call me, especially if you’re just looking for some taxpayer dollars.”

WEDNESDAY: Your correspondent’s friends react with horror to his apartment’s lack of air conditioning. But fans are great! Discuss your plans to switch to fans at [email protected]. Talk about fans socially at @arthurallen202, @dariustahir, @ravindranize, @POLITICOPro, @Morning_eHealth.

JUST RELEASED: View the latest POLITICO/AARP poll to better understand Arizona voters over 50, a voting bloc poised to shape the midterm election outcome. Get up to speed on priority issues for Hispanic voters age 50+, who will help determine whether Arizona turns blue or stays red.

What role will Hispanic voters over 50 play in Arizona this Fall? Read POLITICO Magazine’s new series “The Deciders” which focuses on this powerful voting bloc that could be the determining factor in turning Arizona blue.

CYBER ATTACKS ONSLAUGHT CONTINUES: Only (only!) 5 million patient records were compromised by cybersecurity breaches in 2017—compared to over 100 million in 2015--but the number of health care breaches increased 10 percent over the previous year, Symantec Corporation’s Axel Wirth told a House Homeland Security Committee briefing Tuesday.

Wirth, Symantec’s “distinguished solutions architect,” indicated that larger health care companies are getting better at protecting patient data, but overall the number of successful hacks keeps rising, he said. Wirth also reported a 600 percent increase in attacks on Internet of Things devices and increasing pressure on mobile devices and Apple products, although Microsoft Windows is still the biggest target. Some things in health care never seem to change, though: “Spending as a percentage of health care budgets hasn’t budged in the last few years,” Wirth said. The health care industry spends below 6 percent of its budget on security, compared to 10 percent in finance, he said.

DISTRACTED?: A study of Los Angeles high school kids found that use of digital media may lead to the development attention-deficit/hyperactivity disorder (ADHD) symptoms in adolescence. The study by Adam Leventhal and colleagues at the University of Southern California looked at 2,587 students without symptoms of ADHD at study entry who were surveyed five times from September 2014 to December 2016. Those who used multiple forms of digital media were more likely to develop ADHD over the period. But the authors cautioned that a reverse causation was possible — ADHD leading to more digital media-seeking behavior— and undetected baseline ADHD couldn’t be ruled out in the study subjects.

SENATE PASSES ELECTRONIC VIST VERIFICATION DELAY BILL: Late Tuesday night, the Senate passed HR6042, a bill that delays reductions in federal assistance for Medicaid services that don’t use electronic visit verification, which tracks when, whether and where services were received. The House previously passed the bill, by voice vote, in June.

COMMENTS: Not everyone is totally positive on FDA’s pre-certification program proposal. The Clinical Decision Support Coalition — run by Bradley Merrill Thompson — has submitted a fairly harsh comment, arguing that FDA has not filled in some of the regulatory details behind its proposal to upend software regulation by moving more scrutiny to software firms, not the products they develop. While the proposal has generally elicited praise from software companies and others in industry, there have been persistent questions about how it would work in practice.

The Coalition’s questions are part of this genre, asking how registration, listing, and adverse event reporting would work in the new system; or, for that matter, drug-software combinations.

FDA has generally been receptive to outside comments, emphasizing that the proposal is intended to be iteratively developed over time, so we’ll see how the program evolves.

NET NEUTRALITY UPDATE: Rep. Mike Coffman is the first Republican to support a Democratic gambit to repeal the FCC’s net neutrality rollback through the Congressional Review Act, our Tech colleague John Hendel reports.

Net neutrality has been a thorny subject for health care technology. On one hand, advocates believe that treating all internet traffic similarly will empower startups and other smaller players in the internet ecosystem. (The alternative is internet service providers promoting some services above others, which advocates believe would favor established content providers over the long run.) But, argue critics of net neutrality, health-related data should be prioritized, simply because it’s often quite important.

WHAT WE’RE CLICKING ON:

—A British Medical Journal opinion article wonders if the NHS’s adoption of health tech is too hasty.

—Health insurers are getting their hands on a lot of data, a collaboration between ProPublica and NPR explores.

—The CDC’s director, Robert Redfield, reveals that fentanyl almost killed his son.