With Josh Sisco

Driving the Day

WILL STATES PAY UP? States could be in a bind over the Biden administration’s controversial mandate requiring a minimum number of nursing home staff, POLITICO’s Robert King reports.

The rule, released last month, is estimated to cost nursing homes $43 billion over the next decade, according to CMS. States could be forced to raise their Medicaid rates or risk having the homes close when the rule takes effect in three years.

“The concern about funding is not a misplaced concern,” Sen. Bob Casey (D-Pa.) said. “I have been promoting not just a minimum staffing rule but coupling that with funding to make sure these facilities have the resources they need.”

Only 1 in 5 nursing homes currently meet the staffing mandate, according to an April 22 estimate from the think tank KFF. But homes in certain states such as Louisiana and Oklahoma could be hit especially hard by the need to hire more nurses.

CMS has said the rule is vital to improve nursing home quality, especially after the Covid-19 pandemic. The agency included exemptions for homes that can’t find sufficient staff and is investing $75 million to bolster nurse education.

Nursing homes not happy: The nursing home industry said the cost of compliance will be too great. An analysis from the American Health Care Association and the National Center for Assisted Living, an industry group, released an estimate Thursday that homes would need to hire an extra 102,000 nurses and nursing aides to comply.

“Chronic underfunding and soaring inflation means many facilities are operating on the brink," Clif Porter, senior vice president of government relations for the AHCA/NCAL, said in a statement. “This unfunded mandate could push them over the edge.”

But opponents of the rule said that wouldn’t be enough and that states would have to shoulder the cost.

“You cannot expect salaries to increase when … Medicaid’s reimbursement isn’t increasing,” said Rep. Larry Bucshon (R-Ind.) during a House Energy and Commerce subcommittee hearing last week. “It just doesn’t work.”

Supporters say states have the means to help.

“Texas has plenty of resources,” said Rep. Lloyd Doggett (D-Texas). “Whether they use it to see disadvantaged seniors are safe is far from certain.”

WELCOME TO FRIDAY PULSE. A CDC report details how three patients contracted a drug-resistant pulmonary bacterial infection in 2022 after receiving embryonic stem cell treatments at Mexican health clinics. The agency calls it a warning against medical tourism. Send your tips, scoops and feedback to [email protected] and [email protected] and follow along @ChelseaCirruzzo and @_BenLeonard_.

Telehealth

REMOTE-MONITORING PAY ON HOLD — A key industry panel has tabled consideration of changes that would make it easier for doctors to be paid for remotely monitoring patients’ vital signs, Ben reports.

Why it matters: CMS often follows recommendations from the American Medical Association-blessed panel, which is reviewing potential changes to CPT codes, which are key for billing across the health care sector. The soonest that CMS could adopt changes would be 2026. Digital health circles closely watch the panel.

The details: The CPT Editorial Panel reviewed an application for changes Thursday and discussed several proposed modifications, according to a source familiar with the meeting. The applicants are addressing feedback from the panel and the discussion may be revisited in September, the source said, though the change in timing won’t impact when potential changes could go into effect.

The proposed changes include allowing doctors to bill for remote monitoring if they review at least two days of data from patients through monitoring devices, as opposed to 16 under current requirements.

The bigger picture: During the Covid-19 public health emergency, the federal government eased rules on remote patient monitoring, helping usage soar. But with the emergency’s end, CMS said remote monitoring would no longer be covered for new patients, which has limited access.

AROUND THE AGENCIES

ANTITRUST TASK FORCE — The Justice Department is expanding its focus on competition in the health care sector, forming a task force at the antitrust division to root out monopolistic and collusive conduct across the industry, Josh reports.

The new group will draw from staff across the antitrust division, including not just civil and criminal prosecutors but also data scientists, industry experts and economists, the DOJ said in a statement. The effort will be led by Katrina Rouse, a longtime DOJ prosecutor who also serves as an adviser on health care issues to DOJ antitrust chief Jonathan Kanter.

Kanter said at an event Thursday that health care “is among our highest priorities,” and the consolidation of multiple lines of business under a single roof warrants heightened scrutiny.

“The platformization of health care has resulted in multisided giant, intermediaries that have a coordinated stack of businesses that flow together,” Kanter said. That includes insurers, doctors, pharmacy benefit managers, claims processing and banks, he said.

The announcement follows an interagency effort launched in March among the Justice Department, Federal Trade Commission and Department of Health and Human Services to scrutinize the role of private equity firms in the health care system.

Cybersecurity

HHS LOOKING INTO ASCENSION ATTACK — A cybersecurity attack hit one of the nation’s largest private health care systems Thursday, prompting federal officials to offer assistance to the network.

Catholic nonprofit Ascension said Thursday that the attack impacted their electronic health records system, phone systems and ability to order certain tests and procedures. Some elective procedures have been canceled, and emergency care is being diverted away from some hospitals, Ascension said.

There is no timeline for when systems will be restored.

It comes on the heels of another major health care cyberattack that prompted congressional inquiry.

In a statement to Pulse, an HHS spokesperson said the department “is in communication with Ascension Leadership to understand and assess their efforts to minimize any disruptions to patient care.”

Ascension, which operates more than 140 hospitals, said it’s working with Mandiant, a third-party cybersecurity firm, to investigate the attack.

“Should we determine that any sensitive information was affected, we will notify and support those individuals in accordance with all relevant regulatory and legal guidelines,” the organization said.

A cyberattack at the major medical bill clearinghouse Change Healthcare, owned by UnitedHealth Group, earlier this year also scrambled the health care industry, causing disruptions to provider payments. UnitedHealth CEO Andrew Witty came to Congress last week to field questions about the attack.

WEIGHT-LOSS DRUGS

INCREASING NUMBER OF GLP-1 USERS — One in 8 adults say they have taken a GLP-1 drug, the popular class of drugs used for weight loss and to treat diabetes and heart disease, but more than half struggle with the cost, according to a KFF poll.

The poll, published today, highlights the increasing popularity of the drugs, which are often advertised with catchy jingles on television and have garnered congressional support to remove Medicare coverage restrictions. A third of adults polled say they’ve heard “a lot” about the drugs in the past year — up from 19 percent in July 2023.

According to the poll, half of those who said they’ve used GLP-1 drugs continue to use them. The survey also found that the share of adults who’ve used them rises to 4 in 10 among adults who’ve been told they have diabetes, a quarter among those told they have heart disease and 1 in 5 among those told they’re overweight or obese.

Just more than half of adults who’ve taken the drugs — 54 percent — say it was hard to afford them, even though most say their insurance covered some of the cost.

Names in the News

The Better Medicare Alliance has hired:

— Don Dempsey as vice president of policy and research. He previously oversaw Marwood Group’s Washington office.

— Jennifer Nord Mallard as vice president of government affairs. She previously was head of governmental affairs at Tempus.

— Susan Reilly as vice president of communication. She previously was director of communications at the Association for Accessible Medicines.

— Jonathan Wolfe as senior director of strategic partnerships, having previously been senior director of communications at the Association of State and Territorial Health Officials.

— Andrew Young as director of grassroots. He previously was senior coordinator at the American Clinical Laboratory Association.

WHAT WE'RE READING

The Washington Post reports on a lawsuit alleging that New York City discriminates against gay couples by denying in vitro fertilization benefits.

Reuters reports that a study of Merck’s endometrial cancer treatment has failed.