|THIS WEEK IN HEALTHCARE
What happened in healthcare this week—and what we think about it.
Hospital groups file suit to block new transparency rule
As expected, industry lobbying groups filed a lawsuit this week to halt the Trump administration’s attempt to force hospitals to reveal the rates they negotiate with insurance companies for services. The suit, brought by groups including the American Hospital Association, the Federation of American Hospitals, the National Association of Children’s Hospitals, and the Association of American Medical Colleges, asserts that the new regulations represent significant overreach of legal authority by the government, as well as a violation of hospitals’ First Amendment rights to keep their negotiations with insurance companies private. Meanwhile, insurance industry groups wrote to the administration this week seeking to extend the comment period for a parallel rule that would require insurers to give patients information about expected out-of-pocket costs in advance of seeking care. Some legal analysts believe the industry lawsuit may prove successful in turning back the transparency regulations, based on other recent court cases in which executive overreach and First Amendment violations have been ruled to invalidate attempts to reform healthcare pricing.
Seeking to push back against industry opposition, Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma wrote an op-ed in Tuesday’s Chicago Tribune, stating that “the decades long norm of price obscurity is just fine for those who get to set the prices with little accountability and reap the profits, but that stale and broken status quo is bleeding patients dry. The price transparency delivered by these rules will put downward pressure on prices and restore patients to their rightful place at the center of American health care.” We’ll soon know whether the courts agree, but meanwhile we’d observe (again) that engaging in a public battle to keep pricing secret from consumers—particularly in this political season—leaves hospitals open to being further demonized as bad actors driving healthcare costs ever higher. Dangerous ground.
Virginia joins backlash against Medicaid work requirements
Newly emboldened by his party winning control of the legislature for the first time in a generation, Virginia Democratic Gov. Ralph Northam’s administration is dropping its federal approval request for Medicaid work requirements. Following years of partisan opposition, Democrats conceded to Medicaid work requirements in mid-2018 as a compromise to gain Republican support for expansion beginning last January. Since then, more than 300,000 Virginians have signed up for coverage—about a 30 percent increase in the state’s total Medicaid population. Northam’s decision comes amidst a flurry of legal challenges and delays to work requirements nationwide. Earlier this year a federal judge blocked such requirements in New Hampshire, Arkansas, and Kentucky—actions which the Trump administration is appealing. Indiana, often seen as “ground zero” for strict Medicaid eligibility rules, announced in late October that it would delay work requirements scheduled to go into effect in January through its “Gateway to Work Program.” Arizona recently announced it would also delay its program until the ongoing court cases are resolved. And just this week Michigan Democratic Gov. Gretchen Whitmer called for a pause on work requirements to avoid coverage losses, although the Republican-led state legislature immediately rebuffed Whitmer’s proposal.
As we’ve written previously, Medicaid work requirements cost states a lot of money to implement, especially in comparison to the size of the population they’re intended to target. Research from the Kaiser Family Foundation estimates only one in five non-working Medicaid enrollees—1.7M nationwide—will fall under work requirements once exemptions are taken into account. Further, the burden of having to report working status will probably be onerous for potential Medicaid enrollees, discouraging them from seeking coverage in the first place. That will likely mean larger numbers of low-income patients with no coverage—a persistent challenge for providers, who will be put in the position of delivering even more uncompensated care.
Amazon launches new medical transcription service
In addition to capturing your personal conversations at home through its ubiquitous Echos, Amazon is now in the business of recording physician-patient conversations. This week the company announced Amazon Transcribe Medical, a machine learning service for quickly creating accurate speech-to-text transcriptions for providers in clinical settings. Cerner, a co-developer, has already signed on as a customer “to develop a digital voice scribe that can ‘listen’ in the background during a patient’s visit”, transcribe the conversation into text, and automatically document the note in its electronic health record (EHR) system. Amazon’s move into this space is a natural extension of both its “Transcribe Service”, which automatically converts speech to text with natural formatting and punctuation, and its “Comprehend Medical” technology, which can read and mine unstructured medical text for specific information. While cloud rivals Microsoft and Google are also making a play for speech-to-text tools that work with EHRs, Amazon is looking to differentiate on the basis of providing highly accurate automatic speech recognition specifically designed to go directly into medical records. The company claims the service can understand the nuances of medical language, including the myriad abbreviations used by clinicians.
Amazon is focusing on an area ripe for improvement in cost, time, and patient experience. At a cost of less than a quarter of a cent per minute (!), Transcribe Medical looks like a very cost competitive alternative to what most providers are paying for medical transcription today—especially those who rely heavily on scribes. It remains to be seen if providers and patients will be comfortable having their often very personal conversations added to Amazon’s cloud, word for word. Providers who adopt this new service should be as transparent as possible with their patients about their partnership with Amazon, as well as how personal data is being stored and used.