Modern Healthcare Sept. 24, 2018 | Special Supplement

The 115th Congress on the State of Healthcare is ranked

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18mh0300.pdf RunDate: 0924/18 Full Page Color: 4/C Contents

Page 2 Letter from Editor Aurora Aguilar Senate 3 Sen. Roy Blunt (R-Mo.) Increasing funding to improve behavioral health 4 Sen. Shelley Moore Capito (R-W.Va.) States need to partner with Congress in opioids battle 6 Sen. Bill Cassidy (R-La.) We’re making progress on lowering prices for patients 7 Sen. Heidi Heitkamp (D-N.D.) Addressing challenges facing rural providers, rst responders 8 Sen. Chris Murphy (D-Conn.) ‘Choose Medicare’ should be an option for all Americans 10 Sen. Rand Paul (R-Ky.) Association health plans open new coverage options

House of Representatives 11 Rep. Rosa DeLauro (D-Conn.) One thing President Trump must do to protect coverage 12 Rep. Ben Ray Lujan (D-N.M.) Medicaid buy-in would offer an attractive insurance option 14 Rep. Doris Matsui (D-Calif.) Let’s take additional steps to destigmatize addiction 15 Rep. Scott Peters (D-Calif.) Open, bipartisan process needed to x insurance markets 16 Rep. Tom Reed (R-N.Y.) Lawmakers need to ful ll their role as problem-solvers 18 Rep. Peter Roskam (R-Ill.) It’s time to modernize Stark law to reect changing times 19 Rep. Raul Ruiz (D-Calif.) Outdated infrastructure, policies hindering telehealth 20 Rep. Fred Upton (R-Mich.) Cures Act is delivering on promises to advance research

Thank you to the participating lawmakers for their commentaries on key issues affecting the state of healthcare. The viewpoints expressed by the contributors are published as a public service and do not re ect the opinion of Modern Healthcare. Cover photo: Getty Images

September 24, 2018 | Modern Healthcare Congressional Supplement 1 from the editor Healthcare remains critical issue and Americans demand change

By Aurora Aguilar HIS ISSUE IS INTENTIONALLY TIMED close to the midterm elections this year. In just over a month, voters T will take to the polls to decide whether the Senate and House will remain controlled by Republicans; if the GOP prevails that would likely give new momentum to the campaign to repeal the Affordable Care Act. Yet the number of people who continue to be affected by rising premiums on the marketplace is marginally low. Those who may be affected by Congress eliminating provisions that prevent underwriting based on pre-existing conditions and encouraging people to buy skimpy health plans is greater. Poll after poll has shown that plans to lower drug prices, Medicare and Medicaid funding are top of mind for voters. And while the U.S. adopting a universal health plan might seem unrealistic, look no further than Alexandria Ocasio-Cortez’s primary win in New York to see that her stance on healthcare supported her victory. But let’s face it, Americans are fed up with the cost of healthcare, especially when compared to what we get in return. At $3.4 trillion, healthcare spending is now 18% of the nation’s gross domestic product. Americans are increasingly responsible for a bigger chunk of these costs. Deductibles can soar as high as more than $6,000 for one person to more than $13,000 for a family of four. Meanwhile, the U.S. claims the lowest life expectancy and the highest childhood mortality rate among comparable developed nations. As House Ways and Means Committee Health Subcommittee member Rep. Tom Reed (R-N.Y.) states well in his op-ed (p. 16): “Failure to act is not fair to the people we were all sent to Washington, D.C., to represent. In fact, it is inexcusable. While politicians talk, Americans suffer. This is what is wrong with our politics today.” The lawmakers and healthcare organization leaders who contributed to this special issue know what’s at stake in the midterms and beyond. Our readers, high-level executives at hospitals, healthcare systems, insurance companies and the vendors who serve them, are vigilant and well- prepared for what’s to come. Similarly, our team in D.C.—bureau chief Virgil Dickson covering rules and regulations and reporter Susannah Luthi covering Capitol Hill—is on guard and ready to cover the role of healthcare issues in the elections and its aftermath. We hope to continue to be your independent source to learn how to weather these changes and the responsibilities of each of your sectors and committee appointments. To stay up to date, be sure to bookmark ModernHealthcare.com for the latest industry news, analysis, research and data. And please, feel free to share your feedback on this issue by emailing me at [email protected]. Thank you for your continued readership.

2 Modern Healthcare Congressional Supplement | September 24, 2018 T   C    S  H  Increasing funding to address the ongoing opioids crisis and improve behavioral health

By Sen. Roy Blunt

CROSS THE COUNTRY, OPIOID opioid epidemic, it will also dramatically OVERDOSES AND DEATHS have reduce the amount of money spent treating A surged in recent years. In 2017, opioid other health concerns. overdose deaths hit a record high, taking the Stemming the number of individuals lives of 134 people every day. who become addicted in the rst place is Addressing the opioid epidemic has been a another top priority reected in this bill. top priority for me and my colleagues on the That includes improving surveillance to Appropriations Committee’s Labor, Health gain a better understanding of where the and Human Services, Education, and Related problems are and where they are most Agencies Subcommittee. Since I became severe, and ensuring the public understands chairman of that subcommittee four years the risks of taking opioids. The bill ago, we’ve increased funding to combat the provides $476 million to the Centers for epidemic by $3.5 billion, or nearly 1,300%. Sen. Roy Blunt Disease Control and Prevention for opioid To save lives, we must maintain a (R-Mo.) overdose prevention and surveillance, as federal response that is up to the challenge SERVING SINCE: 2011, now well as a public awareness campaign. we’re facing. The scal 2019 Labor/HHS in his second term The bill also addresses the needs of appropriations bill provides $3.8 billion for infants, children and youth who have been HEALTHCARE-RELATED opioid-related programs. From researching affected by the opioid crisis. It provides COMMITTEES: Senate opioid alternatives and expanding access Appropriations Committee $60 million to help states develop and to treatment and prevention programs, to (chair of the Labor, Health implement plans of safe care for infants providing critical services for children, this and Human Services, exposed to opioids at birth, and includes bill tackles the opioid crisis from every angle. Education and Related $40 million for prevention and treatment The bill includes $1.5 billion for state opioid Agencies Subcommittee and activities for children and families in, or at- response grants, which provide exible funding member of the Agriculture, risk of entering, the foster-care system. for states to implement programs that best t Rural Development, Food Finally, simply reducing opioid their needs. It also includes $130 million in and Drug Administration, prescriptions does not address the core targeted funding for rural areas, which often and Related Agencies problem—effective pain management. If lack the same access to healthcare and support Subcommittee) patients with acute or chronic pain do not services found in urban or suburban areas. have reasonable access to non-addictive Making sure people who are struggling with pain medications or alternative treatments, addiction can access effective treatment—including mental it will be dif cult to solve this crisis. The bill provides health services—is also essential to effectively addressing the $500 million for research related to opioid addiction, opioid epidemic. To that end, the bill includes a $50 million pain management and addiction treatment as well as increase for certi ed community behavioral health clinics. If developing opioid alternatives. people are addressing their behavioral health issues, they are The opioid epidemic has touched people of all ages, feeling better and sleeping better and are more likely to take from every background, in communities across the nation. the medications needed for other conditions. I think we will I’ll continue working with my colleagues to ensure we’re nd that, as a result, expanding access to behavioral health putting the right amount of resources in the right places to won’t just allow us to make more headway in addressing the end this public health crisis.

September 24, 2018 | Modern Healthcare Congressional Supplement 3 T   C    S  H  States battling the opioid epidemic need partnerships with Congress in battle to nd creative solutions

By Sen. Shelley Moore Capito

T’S NO SECRET MY HOME STATE OF programs to battle opioid abuse through federal WEST VIRGINIA has been hit hard by drug programs. That’s a 1,275% increase over I the opioid crisis. In fact, the communities the past four years. in our state are feeling the consequences of the Equally as important, the Appropriations drug epidemic more than almost any other state Committee has dedicated $1.5 billion for in the country. exible state grants, and thanks to language Recent statistics from the Centers for I authored along with Sen. Jeanne Shaheen Disease Control and Prevention conrmed (D-N.H.), 15% of that dedicated funding that once again West Virginia has the highest goes to states with the highest opioid-related rate of death due to drug overdose in the deaths. By targeting resources to where they’re nation. needed most, we can make our efforts to Nationwide, these statistics show there were ght this epidemic more strategic and more more than 72,360 drug overdose deaths in Sen. Shelley Moore effective. 2017, and of those deaths, 49,068 involved Capito In many of the other appropriations bills, opioids. That’s an increase from 2016, driven (R-W.Va.) we have worked to provide funding to address primarily by a continued surge in synthetic SERVING SINCE: 2015, in her different aspects of the epidemic like education opioids, including fentanyl. rst term and job opportunities.

Each day in 2017, 134 Americans died HEALTHCARE-RELATED From healthcare to law enforcement, we are because of this crisis. COMMITTEES: Senate working to tackle the crisis from all angles. The CDC estimates there are 200 drug Appropriations Committee In January, President Donald Trump signed overdose deaths every single day. That’s one (chair of the Homeland the Interdict Act, legislation that will equip U.S. person every eight minutes. Think about that. Security Subcommittee Customs and Border Protection ofcers with Every eight minutes, someone’s neighbor, friend and member of the Labor, scanning devices and other technologies to detect or child dies of a drug overdose. Health and Human synthetic opioids like fentanyl, protecting our These statistics are devastating, but they Services, Education, communities from in uxes of these deadly drugs. don’t dene the West Virginia I know. The and Related Agencies As chair of the Appropriations Committee’s West Virginia I know is ghting back. We are Subcommittee; Military Homeland Security Subcommittee, I will Construction, Veterans combating this epidemic head on through a ensure the funding is there to implement this Affairs, and Related wide range of creative and innovative strategies. Agencies Subcommittee; bill. And the ght is being waged all across and Commerce, Justice, This federal government is playing its part, America. Science, and Related but we all know that it’s local government and That’s because we understand that it is Agencies Subcommittee) community leaders who know what works best going to take a coordinated, all-hands-on-deck, for their cities and towns. community-focused effort to ght this epidemic. Take Wheeling, W.Va., for example. Folks And while our local leaders are at the forefront in Wheeling are working to start a addiction of that ght, Congress is by no means taking a back seat. In treatment center for pregnant women. Meanwhile, a local Washington, D.C., we are doing what we can to support and pharmacy has started a scholarship program for people who strengthen those community-led efforts across the country. have completed recovery programs to help jump-start their As a member of the Senate Appropriations Committee, college education or career training. I’ve worked hard to ensure the scal 2019 Labor, Health and These are the kinds of partnerships and local efforts that, Human Services appropriations bill includes increased funding when combined with federal support, will truly help us to to combat the opioid epidemic that is ravaging my state and so tackle this crisis. many others. We owe it to our families, friends and neighbors to In fact, the current bill provides more than $3.7 billion for continue the ght.

4 Modern Healthcare Congressional Supplement | September 24, 2018 SPONSORED CONTENT

Hospitals have become epicenters of transformation, but their community mission will never change

Innovation has been a popular buzzword in healthcare We know that the age of fee-for-service medicine is for all the time I’ve been in the health policy eld, and gradually, yet undeniably, giving way to value-based care. well before that. But what is meant by the term is Hospitals have become organizations that reward value fundamentally different today than it was decades or, for instead of volume, developing delivery methodologies that matter, even a few years ago. that achieve greater ef ciencies while using evidence- based practices, procedures and technologies to attain Where we have commonly thought of innovation in terms optimal outcomes. of the latest diagnostic scanning technology or a new surgical procedure that reduced recovery times and The need for innovation, though, isn’t limited to the improved outcomes, now it has a much broader, game- system’s shift to a pay-for-value orientation. Hospitals changing meaning. and health systems know that they can’t remain an analog service in a digital environment. Americans The rise of consumerism, the digital economy, precision expect the convenience and exibility that 21st century medicine, predictive analytics, the increased use of telecommunications capabilities make possible. Providers arti cial intelligence, and the acute awareness of have heard the call and are working to meet this demand. healthcare affordability pressures—these are all serving as catalysts for change on a scale that we have not Hospital care is no longer con ned to brick-and-mortar witnessed before. parameters. For example, hospitals have embraced the use of telehealth, strengthening communications While the media focus on large cross-sector acquisitions between providers and patients, and improving the like CVS Health buying Aetna or new players like patient experience. They are offering programs Amazon entering the healthcare arena, the major that monitor and care for patients at home. story is occurring in cities and small towns across And they are investing in technology to the country as the local hospitals and health coordinate care and make access easier systems that have been cornerstones in their for patients. At the same time, we need to communities for decades are now epicenters of prepare our workforce to be more nimble transformational change. and responsive to be successful.

We’re calling this transition “Rede ning This is not to say change isn’t challenging. the H,” referring to the iconic white-on-blue Hospitals, unlike many others, cannot undergo road sign that for decades has said wholesale transformation. They “follow me” to have your medical Rick Pollack will continue to provide the needs met. President and CEO comprehensive healthcare services American Hospital Association that communities require. They will Hospital and health system leaders are continue to perform sophisticated well aware of the challenges before them surgery, diagnostics and therapeutics and are reshaping their operations to that are on the cutting edge of meet patient needs and consumer expectations. science. In fact, the need for those services will continue At the same time, unlike some other players entering the to grow. They will maintain the capability to respond to healthcare “space,” we will not compromise our values or disasters ranging from hurricanes to u outbreaks. And they whittle away at our obligation to care. will continue to care for anyone who walks through their doors 24 hours a day, seven days a week. We are committed to ensuring that vulnerable and marginalized communities have the same access and “Rede ning the H” can bring hospitals even closer to the opportunity as those who are much more privileged. communities and patients we serve. It is our opportunity to provide better care for more people in a way that ensures And we will work with lawmakers and regulators to every hospital can play a leadership role as an anchor or ensure that this transformation occurs in a way that will access point for healthcare in their communities. protect the viability and sustainability of vital community health providers. This Sponsored Section was produced and brought to you by: “Rede ning the H” can bring “ hospitals even closer to the communities and patients To learn more about the American Hospital we serve. ” Association, please visit www.aha.org T   C    S  H  We’re making progress on lowering prices for patients, especially on costly drugs, and we’re just getting started

By Sen. Bill Cassidy

EALTHCARE COSTS ARE TOO good sign for American consumers. HIGH. Families are grappling with The administration has also taken action H double- and triple-digit increases in to stop back-end rebates for drugs, which health insurance premiums and rising out-of- create a perverse incentive for companies to pocket expenses. A growing percentage of our raise drug prices in order to gain formulary nation’s gross domestic product is consumed by access. The CMS requested information from healthcare costs—far more than other developed stakeholders on effectively ending the practice countries. We need solutions. in Part D, and the Of ce of Management To advance the conversation, in May, I and Budget is now reviewing a proposed released a nine-page white paper of ideas to rule concerning the safe harbor for pharmacy make healthcare affordable again. bene t managers, which allows these rebates To get healthcare costs under control, we to occur. must restore market forces and equip patients Sen. Bill Cassidy, M.D. The administration also effectively banned to be involved in their care. That means (R-La.) PBMs from using gag clauses to stop empowering the doctor-patient relationship, SERVING SINCE: 2015, in his pharmacists from telling a patient when paying which bene ts not just the patient’s health, rst term the cash price for a drug could be cheaper but also the patient’s pocketbook. Currently, than using their insurance. I worked with my HEALTHCARE-RELATED practice, laws and regulations work to keep colleagues on the Senate Health, Education, COMMITTEES: Senate the power and money surrounding healthcare Health, Education, Labor Labor and Pensions Committee to pass decisions in the hands of bureaucrats, lawyers and Pensions Committee legislation that would end gag clauses in the and lobbyists. That is wrong. As a doctor, I (Children and Families private market, and I hope to see the legislation know that giving power to patients creates Subcommittee and Primary passed and signed into law this year. a healthcare system that is aligned with Health and Retirement Our committee also tackled so-called patients’ health and nancial interests. Security Subcommittee); “pay-for-delay” deals, where brand-name drug President Donald Trump and HHS Senate Finance Committee companies pay generic-drug makers to stay Secretary Alex Azar understand the incentives (chair of Social Security, out of the market. While manufacturers of in our healthcare system are not aligned Pensions and Family Policy small-molecule brands and generics must report with the interests of patients. That’s why Subcommittee; member these deals to the Federal Trade Commission, of Health Subcommittee); the administration has moved to implement and Senate Veterans’ Affairs currently, biologics and biosimilars—the most policies included in my white paper. Committee expensive drugs on the market—do not. The As I proposed, when a sole-source generic-drug committee passed a bill to x this, which will manufacturer exists, U.S. buyers should be able Cassidy is a save taxpayers roughly $100 million over the gastroenterologist to buy that drug on the international market, as next 10 years and get cheaper biosimilars to long as the supply chain and facility are certi ed patients faster. safe by the U.S. Food and Drug Administration. These are strong steps that will help lower The FDA recently announced it would form a healthcare costs for patients—and we’re just working group to explore this policy, and that’s a getting started.

6 Modern Healthcare Congressional Supplement | September 24, 2018 T  C   S  H Opioid abuse epidemic poses unique challenges for providers, rst responders in rural communities

By Sen. Heidi Heitkamp

PPROXIMATELY 20% OF overdose epidemic on children and families. AMERICANS live in rural areas. In Among them is legislation that would expand A North Dakota, that number is much resources for rst responder training and access higher—around 50%. to the opioid overdose reversal drug naloxone, as Rural communities are the backbone of well as require HHS to issue best practices for my state and have always been economic recovery housing facilities. drivers for important industries like While this legislation is a good step in agriculture. But as someone who represents providing additional resources to rural and a largely rural state in the U.S. Senate, I also tribal communities struggling with this recognize that these areas, across the country, national emergency, Congress must continue face unique healthcare challenges due to to build a united front that expands access their isolated locations. to treatment, family support services, and That’s why I’ve long been working to craft Sen. Heidi Heitkamp evidence-based evaluations of children bipartisan solutions to make healthcare more (D-N.D.) experiencing trauma—which is why it’s so affordable and accessible for rural populations. SERVING SINCE: 2013, in her important that my provisions to tackle the Right now, it’s no secret that the ongoing rst term consequences of childhood trauma were addiction crisis is casting its shadow on small included in this bill. HEALTHCARE-RELATED towns, farms and tribal areas, where prevention COMMITTEES: Senate While we’re addressing the urgent threat and treatment options are historically hard to Agriculture, Nutrition and posed by opioids and methamphetamines, come by. I’ve heard story after story about how Forestry Committee and we can’t let other aspects of rural healthcare North Dakota families and communities are the Senate Indian Affairs deteriorate. As co-chair of the Senate Rural being ripped apart due to drug abuse. And at Committee Health Caucus and as the spouse of a family seven listening sessions across my state over Heitkamp also serves as physician, I know that doctors, nurses and the past two years, I’ve heard from community co-chair of the Senate community providers are key components of leaders, treatment experts, law enforcement Rural Health Caucus delivering high-quality, affordable healthcare of cers and rst responders who are on the front in these small towns and townships. lines of the rural drug abuse crisis and need Back in February, my bipartisan bill to additional help. strengthen rural healthcare delivery systems We simply can’t ignore the trauma young people are passed out of a U.S. Senate committee. Introduced alongside exposed to and the massive burden placed on our rural U.S. Sen. Pat Roberts (R-Kan.)—my co-chair on the Senate healthcare providers. It’s clear that childhood exposure to Rural Health Caucus—our bill would allow state of ces of trauma—such as the opioid abuse by a parent—can often rural health to continue receiving the critical support they lead to severe health and behavioral complications that can need through 2022 to bolster the rural health workforce and detrimentally impact children throughout their lives. We need increase affordability of local clinics and hospitals. It recently a strong plan that gives additional attention to rural and tribal passed the Senate by unanimous consent, and it accompanies communities. Otherwise, we’ll see an entire generation of a recently passed ve-year extension of rural Medicare young people crippled by this crisis. “extenders,” which will continue to strengthen important In April, a U.S. Senate committee passed bipartisan, rural healthcare operations. comprehensive legislation to combat opioid and substance We still have lots of work to do. I’ll keep ghting to abuse. Several items I fought for were included in the bill, improve and expand healthcare services in North Dakota and including six provisions to address the ripple effects of the across the country—regardless of ZIP code.

September 24, 2018 | Modern Healthcare Congressional Supplement 7 T   C    S  H  ‘Choose Medicare’ should be an option for all Americans, to ensure coverage and boost competition

By Sen. Chris Murphy

HEN PEOPLE ACROSS THE exchanges, and people could use their existing COUNTRY go to cast their ACA subsidies to help pay for it. Employers W ballots this November, they’re could also choose to select this Medicare plan going to be voting on healthcare. Poll after poll instead of private insurance to cover their shows that healthcare is the No. 1 issue on the employees. Choose Medicare builds on the minds of voters this fall. existing network and low administrative costs For the past two years, much of the action of the program, and it would help save even around healthcare in Washington, D.C., has more money by allowing Medicare to negotiate been focused on saving the Affordable Care drug prices. Act and its many protections, especially for Having Medicare as an option will force people with pre-existing conditions. And while private insurance companies to be more Republicans may have failed in their attempts competitive, bringing down costs for everyone. to repeal the law outright, they continue to Sen. Chris Murphy It also tests the idea that Medicare is the right do damage to the healthcare system through (D-Conn.) bene t for everyone by allowing consumers and deliberate sabotage, driving up costs and SERVING SINCE: 2013, in his businesses to choose for themselves. putting the coverage gains and guaranteed rst term I believe that, given the choice between protections of the ACA in jeopardy. a private insurance plan and Medicare, the HEALTHCARE-RELATED Democrats have rightly focused most of our COMMITTEES: Senate majority of people will choose Medicare. A attention on ghting off these attacks. But as Health, Education, Labor recent Kaiser Health Tracking Poll con rms our party seeks to win over voters this fall, and Pensions Committee it: three-quarters of Americans supported we’ve also laid out a variety of forward-looking (Primary Health and a Medicare buy-in, including 6 out of 10 health policy proposals, so that we have a menu Retirement Security Republicans. of options to debate when we’re back in charge. Subcommittee and Candidates running in 2018 are embracing “Medicare for all” may command much Employment and Workplace Medicare buy-in plans as an on-ramp to of the attention (and the breathless pearl- Safety Subcommittee) and universal coverage—and not just in safe blue clutching from the right), but Democratic Senate Appropriations states or districts. Candidates promoting ideas range from full single-payer systems to Committee (Labor, Health Medicare buy-in plans can be found in and Human Services, broad expansions of Medicaid, and plans to let Education, and Related Massachusetts and California, but also in Medicare negotiate drug costs. Agencies Subcommittee) swing districts in places like Texas and South My contribution to the discussion is the Carolina. Choose Medicare Act, a bill I introduced with There’s no denying that if I were designing Sen. Jeff Merkley (D-Ore.), that will let people a healthcare system from scratch, I’d build a of all ages buy a Medicare health plan if they “Medicare for all” type of system. But opening want to, and let any business buy in to Medicare up Medicare to anyone who wants to buy in for its employees. to it will help us build on the system we have The Choose Medicare Act would offer a and brings us one huge step closer to affordable new Medicare plan on all state and federal coverage for everyone.

8 Modern Healthcare Congressional Supplement | September 24, 2018 SPONSORED CONTENT

PAs Can Help Drive Healthcare Forward, But Outdated Laws Are Holding Them Back

In discussions about healthcare, there are two ubiquitous the top of their education and experience, and dif cult for subjects: cost and access. Everyone from patients to hospitals, health systems and physicians to fully deploy providers to legislators are driven by the fact that healthcare these critical team members. should be accessible and affordable for all. These issues are exacerbated by the growing physician shortage—which data PAs, physicians, and other members of healthcare teams from the Association of American Medical Colleges shows should be empowered to make decisions at the practice could be up to 120,000 physicians by 2030. It is no wonder level, where the skills and experience of every team member that hospitals and other healthcare organizations have are well understood. The reality is, every medical setting may embraced PAs (physician assistants) on their healthcare experience unique challenges—one may treat more patients teams for over fty years. affected by a chronic condition, such as diabetes, whereas another practice may treat a larger proportion of elderly PAs are medical professionals who diagnose illness, develop patients with a higher prevalence of co-morbidities. In any and manage evidence-based treatment plans, prescribe case, enabling this type of decision making at the practice medications, and often serve as a patient’s principal level allows healthcare teams to better harness the time and healthcare provider. With thousands of hours of medical talents of each clinician—ultimately increasing their ability to training, PAs practice in every state and in every setting and meet patients’ needs in a cost-effective manner. specialty—and they’re enhancing access to affordable care. Experts are coming to the same conclusion. A June 2018 Hospitals and health systems that employ PAs already know study conducted by the Hamilton Project, an economic their immense value. PAs provide high-quality, inexpensive, research group and think tank within the Brookings patient-centered care with excellent outcomes. Research Institution, concludes that removing barriers to published in the Journal of Clinical Outcomes PA care would alleviate healthcare shortages Management compared different staf ng models at and improve ef ciency and productivity in community hospitals: one with a provider group of the delivery of healthcare—without adverse three physicians and three PAs; the second with effects on patient outcomes. nine physicians and two PAs. The data showed that the quality indicators were equal between the Practices and health systems need the ability two groups, but the cost of care was far less in the to build a care team that meets the needs of provider group with more PAs—illustrating two key their patients. And the many restrictive laws bene ts of hiring PAs. and regulations currently in place simply don’t allow for that. Plus, patients love their PAs. A Harris Jonathan E. Sobel , DMSc, MBA, Poll found that 93 percent regard PAs as PA-C, DFAAPA, FAPACVS The American Academy of PAs is trusted healthcare providers, 92 percent President and Board Chair, committed to modernizing laws and regulations affecting PAs, and putting said that having a PA makes it easier to get American academy of PAs a medical appointment, and 91 percent decisions about practice where they believe that PAs improve the quality of belong—at the practice level. It’s healthcare. time to put patients rst by allowing healthcare teams to determine how Over the past few decades, the PA they can best care for their patients. profession has grown exponentially, with more than 123,000 PAs currently practicing in the United States. In fact, the Healthcare in the United States is constantly evolving as profession is expected to grow signi cantly faster than we adapt to advancements in technology, changing patient average for all occupations—37 percent by 2026, according needs, and emerging health threats. PAs have the versatile to the Bureau of Labor Statistics. And as we inch closer to skill set and the rigorous education needed to help move 2030 and the physician shortage worsens, the growing PA healthcare forward and ensure access to affordable, high- workforce is well-positioned to increase access to care— quality care for all. Let’s make the most of America’s PAs. especially in rural or underserved areas.

But right now, the healthcare industry can’t make the most This Sponsored Section was of what this expanding segment of healthcare providers has to offer. produced and brought to you by:

To the detriment of patients, other providers and health systems, PAs practice under some of the most restrictive state practice laws and regulations. The most stiing requirements dictate how PAs and their collaborating physicians work together, including where and how often a physician must consult with each PA, and with how many To learn more about AAPA, please visit PAs a physician can collaborate. Over time, these outdated www.aapa.org requirements have made it dif cult for PAs to practice at T   C    S  H  Association health plans open new coverage options, but Congress needs to take steps to level the playing eld

By Sen. Rand Paul

OOKING TO “BIG GOVERNMENT” insured plan. FOR ANSWERS to skyrocketing Prior to the Labor Department issuing L healthcare costs may be some politicians’ its nal AHP rule this past June, outdated solution, but that only results in giving the administrative guidelines forced small American people more frustration and fewer businesses and the self-employed to remain options—along with still-expensive healthcare. in the high-cost small group and individual Throughout 2017, I worked directly markets—yet another government barrier to with President Donald Trump and his businesses growing and hiring more workers. administration on a pro-patient, pro-family, and Unfortunately, the new rule maintains pro-worker reform proposal that ips the status state regulation, and AHPs are additionally quo script and returns power to the American Sen. Rand Paul, M.D. subject to federal laws such as the Employee people to nd the healthcare coverage that best (R-Ky.) Retirement Income Security Act, HIPAA and meets their needs at a price they can afford. parts of the ACA, which means AHPs will Known as association health plans, or SERVING SINCE: 2011, now in still not achieve the cost savings that multistate his second term AHPs, this alternative allows small businesses large corporate plans do. and self-employed individuals to join together HEALTHCARE-RELATED While the Labor Department did a great to be considered as a large group for the COMMITTEES: Senate job putting forward this rule, more needs to purpose of offering health insurance as an Health, Education, Labor be done so these plans can more easily operate and Pensions Committee employee bene t, similar to a single large nationwide and achieve the size and scale (chair of the Children and employer plan. AHPs allow thousands or even Families Subcommittee and necessary to be a viable option for as many millions of Americans to join together to member of the Employment businesses as possible. achieve better negotiating power with large and Workplace Safety In particular, Congress will need to change insurance companies, decrease administrative Subcommittee) the law to allow legitimate associations that costs, and get more comprehensive bene ts. Paul is an ophthalmologist have health plans to operate across state lines, Last October, President Trump of cially ensuring AHPs have the same exemptions paved the way to allow more people to join from state regulations large corporations AHPs through an executive order entitled already get—to help groups such as National “Promoting Healthcare Choice and Competition Federation of Independent Business and the Across the United States.” Chamber of Commerce—reach the necessary That’s exactly what this effort is all about: economies of scale. providing more choices in a way that is allowed I also believe Americans should be able under current law but has for decades gone to access AHP coverage through individual underutilized due to government barriers created membership in a broad array of organizations through a closed process. like the National Rie Association, Costco or Our reform expanded the types of groups even eBay. that can band together to form AHPs, and it Such freedom has the potential to be empowered self-employed Americans who have transformative, and I will continue ghting to help no other employees to nd family coverage more Americans gain access to affordable group through a large-group AHP, including a self- coverage.

10 Modern Healthcare Congressional Supplement | September 24, 2018 T  C   S  H The one thing President Trump must do to protect 130 million Americans from losing their health coverage

By Rep. Rosa DeLauro

URING THE INITIAL FIGHT children born with life-threatening conditions FOR THE AFFORDABLE CARE and individuals living with chronic diseases. D ACT, I met Melissa Marottolli. Only Women were denied coverage because they 28 years old at the time, she told me her story had a C-section, or were a survivor of domestic of dealing with Stage 4 lung cancer and how abuse. People like Melissa were afraid to follow having a pre-existing condition was “killing” their dreams, lest their new insurer deny them her. She feared losing her job or changing coverage. careers, because that would result in her being In many ways, junk plans represent the denied medical coverage. failed healthcare system that the president As an ovarian cancer survivor myself, her is trying to take us back to. Junk plans are story still inspires me. No one should be not bound by the ACA’s medical-loss ratio, punished for bad luck. And there are 130 allowing insurers to raise their pro ts and million Americans with pre-existing conditions Rep. Rosa DeLauro commissions. They can use loopholes and ne who would struggle to get quality, affordable (D-Conn.) print to avoid covering illnesses. For example, health insurance, if not for the protections in SERVING SINCE: 1991, now some junk plans cover emergency room visits, the ACA. in her 14th term except on weekends. It is imperative for President Donald Trump Nor is the president’s sabotage making HEALTHCARE-RELATED to protect those millions of Americans. And he COMMITTEES: House healthcare cheaper. By expanding junk can. He only needs to stop sabotaging the ACA. Appropriations Committee plans and repealing the individual mandate, Since taking of ce, President Trump has (ranking member of the premiums could increase 18% in nearly every advanced a number of policies to undermine Labor, Health and Human state’s ACA exchange, according to the Urban the ACA: curtailing outreach, repealing the Services, Education, Institute, while costing the federal government individual mandate and stopping cost-sharing and Related Agencies $28 billion over the next decade, according to payments that lower insurance costs for lower- Subcommittee and member the Trump administration. income Americans. He and congressional of the Agriculture, Rural Clearly, we cannot afford to be going Republicans also repeatedly attempted to repeal Development, Food and backward, something with which the American it outright. Drug Administration, people agree. According to the Kaiser Family and Related Agencies Then in July, the president signed an Foundation, 64% do not want to see protections Subcommittee) executive order expanding the availability for pre-existing conditions overturned. of junk plans—short-term health insurance DeLauro is chair of the Neither did the president, based on what he plans that among other things circumvent the Congressional Food Safety promised voters. During the 2016 campaign, he ACA’s protections for pre-existing conditions. It Caucus and co-chair of said with regards to these protections, “I want the Congressional Ovarian followed his June endorsement of a lawsuit by Cancer Caucus and the to keep pre-existing conditions. I think we need 22 states to overturn the protections in court. Congressional Baby Caucus it.” Now the president can and must protect The sabotage is wrongheaded. Before the 130 million Americans like Melissa with the ACA, insurance companies could deny a pre-existing condition. All he needs to do is coverage or gouge people. We are talking about stop the sabotage.

September 24, 2018 | Modern Healthcare Congressional Supplement 11 T   C    S  H  ‘Healthcare is a right, plain and simple.’ Medicaid buy-in would offer an attractive option to guarantee coverage

By Rep. Ben Ray Lujan

HILE CONGRESSIONAL New Mexico to talk with community leaders, REPUBLICANS have spent the labor and business communities, health W the 115th Congress repeatedly advocates, healthcare providers and insurers attacking a law that protects tens of millions about Medicaid buy-in. Tough questions were of Americans, the New Mexico state put on the table and not everything had an Legislature took a bipartisan step forward by immediate answer. approving a measure to study how a Medicaid With the acknowledgment that “healthcare buy-in program could strengthen healthcare in is complicated” con rming what I know as a the state. member of the House Energy and Commerce The concept is simple: allow states to Committee’s Health Subcommittee, there are open their Medicaid programs to anyone, tough questions we need to work through. regardless of income. People who chose to Should reimbursement rates go up? Sure. buy in to the Medicaid program would have Rep. Ben Ray Lujan Should the cost of prescription drugs go down? access to Medicaid’s bene t package and (D-N.M.) You bet. Do we need to think about network provider network. SERVING SINCE: 2009, now adequacy and federal waivers and a whole lot Though the Affordable Care Act and in his fth term more? Yes. But what’s not complicated is that Medicaid expansion cut New Mexico’s too many sick people are unable to afford a HEALTHCARE-RELATED uninsured rate by half, as many as 1 in 10 COMMITTEES: House Energy trip to the doctor. That’s why smart people are New Mexicans still remain uninsured. Over and Commerce Committee invested in making this happen. 12,000 more are enrolled in high-deductible (Health Subcommittee) New Mexico is rich in history and culture, health plans, which encourage people to forgo but as a rural state with its fair share of health Lujan is also chair of the needed care. Democratic Congressional challenges, it often needs to think outside the I believe that Medicaid buy-in could provide Campaign Committee box to help families. This Medicaid buy-in a more affordable coverage option for those effort is the result of some of the smartest struggling to pay premiums and deductibles health policy minds in the country and a erce right now and in my state help the more than grassroots engagement to protect Medicaid 180,000 uninsured get coverage. It could also help insulate expansion—stories were sent to my of ce from New Mexicans New Mexicans from the Republican-caused turmoil at the who make just too much money to qualify for Medicaid federal level. This could be replicated across the country. coverage yet not enough to piece together real insurance options New Mexico families already bene t from and know on the exchanges. Medicaid. The program serves as the foundation of the state’s This bottom-up approach to solving policy problems healthcare system and provides comprehensive coverage to motivated the State Public Option Act, a bill I introduced over a third of the state’s residents. Introducing an option for with my colleague Sen. Brian Schatz of Hawaii and legislators individuals and families to purchase Medicaid would increase who encompass the full spectrum of the Democratic Party. competition and give consumers more choices. In addition, From Sen. Bernie Sanders of Vermont and Elizabeth Warren people in the individual insurance market can experience of Massachusetts, to Reps. Beto O’Rourke of Texas and Andre “churn” as their income changes and they move between Carson of Indiana, this concept is gaining traction with Medicaid and the private insurance market. The opportunity Democrats who, one day, hope to offer universal health coverage to purchase Medicaid could help minimize the disruption to all Americans. that consumers currently face when their circumstances Currently, 14 states across the country are considering change. a Medicaid buy-in option. Healthcare is a right, plain Recently, former CMS acting Director Andy Slavitt visited and simple.

12 Modern Healthcare Congressional Supplement | September 24, 2018 SPONSORED CONTENT

Improving Outcome Measurement in Behavioral Healthcare

There is general consensus that meaningful healthcare system by all stakeholders. Reasonable challenges are driven reform requires a focus on increasing value for patients, by what to measure and how. These are fair concerns as typically de ned as health outcomes achieved per dollar clinical outcome measures have potential consequences spent. While the transition from a fee-for-service to a value- rooted in extending or declining ongoing care, readmissions, based model has been underway for many years, effective reimbursement, accreditation, or federal regulation. implementation in the behavioral health discipline has proven Beginning the journey to be slow or non-existent. Fortunately, there are some Rather than mandate a single set of measures for all notable exceptions of providers utilizing clinical outcome providers, we must provide incentives for patients, assessments and comprehensive patient satisfaction data to providers, and payers to work together to identify desirable improve care and demonstrate clinical value. clinical outcomes. We must provide a marketplace full of Earlier this year, The Joint Commission provided a strong clinically relevant measures and allow a publicly driven rating and promising model toward increasing value for patients, system to develop, while providers and researchers work to requiring residential and outpatient psychiatric care improve the means and methods of measurement. Providers providers to implement standardized outcomes assessments must take the lead in conscientiously assessing patients, of their choosing and to speci cally utilize the results in the evaluating care, and transparently reporting the results. provision of care. Payers are likewise increasingly expecting Demonstrating clinical outcomes, satisfaction, and behavioral health providers to demonstrate evidence-based publicly reported measures value and prioritizing providers who do. However, concerns Universal Health Services, the largest provider of over potential disruptions of patient care and clinical freestanding behavioral health hospitals in the U.S., progress due to an externally mandated, “one size ts all” treating approximately 500,000 patients annually, has in approach from uncoordinated payers and regulators strongly recent years dramatically increased its investment suggests that providers are those best positioned to in and utilization of a wide variety of respected re-shape and spearhead improved public quality assessment tools across its network of over reporting with patient-reported outcomes. 200 facilities. Doing so has greatly enhanced Inadequate Reporting its ability to capture, benchmark, and utilize Regulatory agency interests in population health currently clinical outcomes and patient satisfaction drive publicly reported measures of quality. However, data to improve clinical care. In 2017, UHS these measures are often inadequate or inapplicable to measured outcomes across 571 distinct behavioral health settings, as they neither address the treatment programs, with results revealing immediate interests of patients nor reect the true clinical that approximately 75% of patients reported purpose of behavioral health treatment. statistically meaningful improvement While suicide is a leading cause of death in Johan Smith from admission to discharge and over the U.S, it is not represented in any publicly Vice President, Health Informatics 85% at 45-day post-discharge. reported outcome measures. Nevertheless, Mental Health Outcomes, LLC. even a basic measure of suicide rates within inpatient programs, despite low frequency, would align more You can manage only what you measure closely than currently used and largely inapplicable measures Valuing this data-driven approach, we encourage further such as inuenza vaccine rates or tobacco cessation. collaboration and engagement from all stakeholders to promote “Practice-Based Evidence” vs. “Evidence-Based Practices” increased use of behavioral health outcomes to improve Practice-based evidence is gleaned from real-world clinical treatment. We must start somewhere. Patients deserve it. practice and observation – assessed and measured at the treatment facility level, allowing patients, providers, and Johan Smith heads Mental Health Outcomes, a payers to identify best treatment practices. Doing so avoids leading consultancy specializing in the design and the pitfalls of highly controlled, evidence-based trials, delity implementation of custom outcomes measurement for concerns relative to such programs, and provider or payer behavioral health programs. biases when interpreting treatment results, while honoring the philosophy of data-driven, patient-centric care. “Did the patient get better?” How we pay for healthcare, risk-adjust patient mix, and provide care are all critical components of the healthcare This Sponsored Section was discussion. In the raucous conversation, the simple produced and brought to you by: parameter, “Did the patient get better?” seems to have been lost. For the patient and the community that supports them, getting better is all that matters. Capturing patient-reported outcomes is a reasonable solution that combines the transparent reporting of practice- based evidence with the patient’s perspective on symptoms, To learn more about Mental Health Outcomes, severity, functioning, or quality of life. To be sure, this LLC., please visit www.mho-inc.net “simple” concept has a complexity not yet fully explored T   C    S  H  Addiction is a medical condition, not a moral weakness. We need to take additional steps to reinforce this fact

By Rep. Doris Matsui

DDICTION IS A MEDICAL of physical, mental and substance abuse CONDITION. This is a fact, yet treatment, and expanded support for families A despite our efforts to bring mental of people living with mental health issues. illness out of the shadows, the misconception Eight states now have such clinics; because of that a substance use disorder is a reection of a the original Excellence Act that I co-authored, character aw remains. they’ve been able to hire more addiction Recently, the Harvard T.H. Chan School of specialty staff and successfully expand recovery Public Health and Politico released a poll showing services to more patients. that 37% of respondents believed that opioid Without this sustained investment, the care addiction is a sign that someone has a personal for people with a mental illness in our country weakness. This poll reiterates the ndings of a is more likely to remain an exhausting and 2014 study from the Johns Hopkins Bloomberg frustrating process of isolated, cyclical visits to School of Public Health led by Dr. Colleen Barry, Rep. Doris Matsui emergency departments. When this happens, chair of the health policy and management (D-Calif.) we are reminded that mental illness affects department and co-director of the Center for SERVING SINCE: 2013, now families and communities—the parents, siblings, Mental Health and Addiction Policy Research. in her third term grandparents, children and friends of patients are As Barry stated, “The American public is more all integral to supporting their treatment, care HEALTHCARE-RELATED likely to think of addiction as a moral failing than COMMITTEES: House Energy and recovery. And when a patient is hospitalized, a medical condition.” and Commerce Committee there inevitably follows a sequence of events that Congress has the ability—and the (Health Subcommittee, results in confusion for providers, families and responsibility—to play a larger role in Environment Subcommittee patients about what information can be shared destigmatizing all addictions, including opioid and Communications and under the federal HIPAA privacy law. use disorders, as part of our work to improve Technology Subcommittee) If we want to support the recovery of the behavioral healthcare system. Matsui is also co-chair of patients, providers need the best tools to engage While the House-passed opioids package, the Congressional Caucus with a patients’ family and communities of HR 6, took steps to expand treatment for to Cure Blood Cancers and support. That is why I included a provision in individuals with a substance use disorder, it did Other Blood Disorders as the 21st Century Cures Act requiring HHS’ so with a unilateral focus on opioid use disorder. well as the Congressional Of ce for Civil Rights to conduct education and If we are truly going to address the root causes High Tech Caucus awareness efforts on patient and family rights of the opioid epidemic, we need to look at the under HIPAA. A year later, this has resulted entire spectrum of care. That means updating in the education of over 3,000 health policy our systems to integrate behavioral and physical healthcare lawyers, a strategy to conduct outreach to healthcare providers, while funding services for patients who need crisis care as well and a funding opportunity to establish a Center of Excellence as prevention and early intervention services. for Protected Health Information Related to Mental and Substance use disorder is not limited to opioids, and Substance Use Disorders. addiction can co-occur with other mental health conditions What people still don’t realize is that HIPAA does actually like depression, eating disorders and schizophrenia. Therefore, allow for information sharing when it is in the patient’s best changes need to be made across the system. If not, we are only interest. We need to make sure that clinicians know that they legislating from crisis to crisis. can and should work a patient’s loved ones into their care and The Excellence in Mental Health and Addiction Treatment recovery, just as we would if the patient had a disease like cancer. Expansion Act, HR 3931, takes a more holistic approach by These legislative actions are only part of the larger solution. expanding funding for certi ed community behavioral health Expanding treatment will be most effective when a patient clinics. These clinics cover a broad range of mental health suffering from a mental health disorder can ask for and receive services, including 24-hour crisis care, increased integration assistance from supportive communities without stigma.

14 Modern Healthcare Congressional Supplement | September 24, 2018 T   C    S  H  Bipartisanship is key to insurance market stabilization and lasting healthcare reform

By Rep. Scott Peters

EPEAL AND REPLACE” was government and higher out-of-pocket costs President Donald Trump’s main for everyone. Congress should reauthorize and “R policy objective for nearly a make permanent federal reinsurance programs year, yet he had no better plan for what an to protect insurers against the costliest medical alternative healthcare initiative would claims. look like. Insurers currently don’t know what will Americans were outraged, and made their happen with cost-sharing reduction payments outrage known. As a result, the Republican from month to month, and that leads to higher replacement bills—and later, the repeal-only premiums. President Trump ended cost- bills—failed to pass Congress. sharing reduction payments and as a result, Many months later, the healthcare market premiums across the country have spiked. is still not stable. While my Democratic Congress should end the uncertainty and work colleagues and I are thankful the previous Rep. Scott Peters together to ensure consistent funding for the measures failed, that doesn’t mean we should (D-Calif.) payments over time. do nothing. SERVING SINCE: 2013, now To keep insurance available and premiums The Affordable Care Act was not perfect— in his third term down (and reduce risk in markets), we need nor was it intended to be that way. Full repeal to encourage young, healthy people to buy HEALTHCARE-RELATED or failure of the current system would take COMMITTEES: House insurance. Congress could authorize an us back to a time when an unexpected illness Energy and Commerce automatic enrollment system that would would bankrupt a family and emergency rooms Committee (Environment provide basic primary-care, catastrophic illness were full of parents seeking basic care for their Subcommittee) and or injury coverage for young individuals who do children. Instead, everyone should welcome the the House Veterans’ not purchase insurance. opportunity to make necessary adjustments to Affairs Committee There can—and should—be conversations the framework of our current system. When we (Technology Modernization about what the future of healthcare looks do, the xes must be bipartisan. Subcommittee and the like. There will continue to be real differences I strongly believe that with certain reforms Oversight and Investigations on policy and ideology, but Congress should and a recommitment to policies that work, we Subcommittee) seek common ground and xes that are not can improve the individual market and make purely partisan. Long-term stabilization healthcare more affordable. These include that’s necessary to drive down costs requires a making federal reinsurance programs permanent, providing concerted effort from both parties. long-term funding for cost-sharing reduction payments, and These are solutions that members of both parties can nding ways to boost the participation of young, healthy support, and they should be the starting point for a enrollees in the marketplace. bipartisan, open process to protect what is working in our Without federal reinsurance programs, insurers with healthcare system and x what isn’t. Maybe then, instead sicker enrollees would have to charge higher premiums of playing games with people’s healthcare, Congress could to all their customers to stem their nancial losses. stop trying to revive partisan bills, and instead build on our That means larger subsidies being paid by the federal healthcare system.

September 24, 2018 | Modern Healthcare Congressional Supplement 15 T   C    S  H  Lawmakers need to ful ll their role as problem-solvers to address the soaring cost of healthcare and health insurance

By Rep. Tom Reed

EPUBLICAN LAWMAKERS DO coverage and create more options NOT WANT TO remind people for consumers. R about two things: rising healthcare While no one in the caucus got everything costs and the failure to repeal the Affordable they wanted, we recognized the importance Care Act—which has essentially led to the of working together to reduce the suffering collapse of the insurance market. On the other of our fellow Americans caught in this side of the aisle, Democrats are content with healthcare debacle. doing nothing and blaming Republicans for the We also believe that this proposal should dismal state of healthcare today. be paid for and stand ready to work to nd Failure to act is not fair to the people we were agreeable offsets within federal healthcare all sent to Washington, D.C., to represent. In spending. Potential offsets could include: fact, it is inexcusable. While politicians talk, Recapture premium tax credit overpayments; Americans suffer. This is what is wrong with Rep. Tom Reed encourage use of generic drugs in Medicare our politics today. (R-N.Y.) Part D; speed up brand-name drug discounts While this news is unfortunate, it is not SERVING SINCE: 2011, now in in Medicare Part D as seniors approach surprising given the strong convictions held on his fourth term the coverage gap, or “donut hole”; create a both sides and what shows up as deep divisions bundled-payment system for post-acute care HEATHCARE-RELATED in our political discourse. My colleagues in the in Medicare; reduce Medicare payment for COMMITTEES: House Ways Problem Solvers Caucus, a group of Republican and Means Committee bad debt; and accelerate competitive bidding and Democrat House lawmakers, which I lead (Health Subcommittee) in Medicare Advantage. on the Republican side, foresaw the looming He is also co-chair of the In response to our plan, Larry Levitt, a double-digit insurance premium hikes more bipartisan congressional health policy expert at the Kaiser Family than a year ago. Problem Solvers Caucus, Foundation, said: “Overall, I think it would So, the Problem Solvers Caucus decided to a group of 24 House keep insurers in the individual markets and sit down, listen and learn from their colleagues Republicans and 24 House reduce premiums. And I think it would on the other side. What came out of this was Democrats who meet weekly avoid the potential of coverage losses, while the very rst and only bipartisan plan to x to discuss some of the most also risking a modest loss in coverage from skyrocketing health insurance premiums. contentious issues facing repealing the employer mandate.” the country Some key ideas that resulted from our work: We realize how many Americans desperately Bring cost-sharing reduction payments under Reed is co-chair of the need and deserve a solution to their rising the congressional oversight and appropriations Congressional Diabetes premiums. We are fully committed to continue process, but ensure they have mandatory Caucus working toward a bipartisan solution and urge funding; create a dedicated stability fund that President Donald Trump and our colleagues in states can use to reduce premiums and limit the House and Senate to come together to break losses for providing coverage—especially for those with the gridlock in Washington on healthcare policy and help the pre-existing conditions; repeal the 2.3% medical-device tax, people they represent. since the costs of the tax are passed on to consumers, again Now more than ever, we as a nation need to move past petty contributing to higher healthcare costs; provide technical political games. We are better than this. The American people changes and clear guidelines for states that want to innovate deserve the solutions and leadership the Problem Solvers on the exchange or enter into regional compacts to improve Caucus is providing.

16 Modern Healthcare Congressional Supplement | September 24, 2018 SPONSORED CONTENT

How to Improve America’s Behavioral Healthcare System Repeal Medicaid’s IMD Exclusion and Open Access to Treatment

In September we observe both National Recovery Month and grant programs. NABH is one of many stakeholder groups National Suicide Prevention Awareness Month to educate that support repealing the IMD exclusion, including the Americans that effective behavioral healthcare treatment can President’s Commission on Combating Drug Addiction help those struggling with mental health and substance use and the Opioid Crisis, governors, state Medicaid directors, disorders live healthy, satisfying lives. law enforcement of cials and of cers, mental health and substance use treatment advocates, and healthcare providers There has never been a better time for these annual reminders and professionals. than now. As I write this op-ed, the Senate is preparing to vote on its In 2016, more than 20 million people in the United States had opioid legislation package, which could include a measure that a substance use disorder (SUD), and 89 percent of individuals addresses the IMD exclusion. The House has already done who needed treatment did not receive it. Meanwhile, the so, when it partially repealed the IMD exclusion for SUD in the Centers for Disease Control and Prevention reported this past SUPPORT for Patients and Communities Act (H.R. 6) that the June that suicide is a leading cause of death in the United House passed in June. States and that nearly 45,000 died by suicide in 2016. We applaud Congress for taking steps in the right direction. Millions of Americans are suffering and have lost their way. Still, we will continue to advocate for policymakers to repeal Often when we learn someone has died by suicide or from the IMD exclusion entirely. Only when Congress removes substance misuse, we wish we could do something—and then access barriers to behavioral healthcare treatment will we we move on. have true parity with medical-surgical care, which the Paul Wellstone and Pete Domenici Mental Health Parity We can no longer take this approach. and Addiction Equity Act promised to every Facing these alarming statistics, we need to do all American a decade ago. we can to help our families, friends, neighbors, and As Congress considers ways to address our fellow citizens nd their own road to recovery. nation’s deadly opioid crisis and high suicide The good news is we live in a country with rst-rate rate, we recommend that policymakers and behavioral healthcare providers, health systems, their staff read Pathways to Care: Treating and treatment programs to offer that help. Now we Opioid and Substance Use Disorders, a new need to do more to expand access to those white paper from NABH Director of Quality clinicians and services. and Addiction Services Sarah A. Mark Covall Wattenberg. Pathways identi es the The most effective way to improve access President and CEO, major challenges facing the addiction to behavioral healthcare treatment is for National Association for treatment system today and maps Congress to repeal the outdated and Behavioral Healthcare (NABH) out how we can make the most of the burdensome Institutions for Mental Diseases quality clinicians, health systems, and (IMD) exclusion in Medicaid. Since 1965, Medicaid’s IMD treatment programs we have to help exclusion has prevented bene ciaries between the ages of those who need services desperately. Please visit www.nabh. 21-64 — the same age group affected most severely by our org/pathways to learn more. nation’s current opioid and suicide crises — from accessing short-term, acute care in psychiatric hospitals or SUD We remain hopeful that the United States has the behavioral treatment facilities. healthcare providers and resources to end the opioid crisis and help lower the rate of suicide. In urging Congress to repeal For millions of Americans living with suicidal thoughts and Medicaid’s IMD exclusion and applying the lessons from SUD, including alcohol use disorder, recovery often Pathways, there are actions we can take today to make a real starts with a short stay in an inpatient facility, where difference for those struggling with mental health and SUD. behavioral healthcare providers can help move patients through the behavioral healthcare continuum. Unfortunately, Lives depend on it. the IMD exclusion limits access to this life-saving rst step. This Sponsored Section was The federal government has chosen to address our country’s produced and brought to you by: need for mental health and SUD services primarily through grant funding for years. To be sure, those federal dollars have provided help to those who need it. Today, though, we National Association see federal grants for mental health and SUD services as a for Behavioral Healthcare temporary solution to a permanent problem. Simply put: this Access. Care. Recovery. method is not working.

Repealing the IMD exclusion would expand access To learn more about NABH, please visit immediately by leveraging existing payment mechanisms www.nabh.org and avoiding the long delays associated with time-limited T  C   S  H It’s time to modernize the Stark law as new payment models, technologies require regulatory exibility

By Rep. Peter Roskam

HE HOUSE WAYS AND MEANS In an era when we are now pushing our COMMITTEE’S HEALTH providers to work closely together to bring T SUBCOMMITTEE recently held down costs, and in many cases share in the a hearing titled “Modernizing Stark Law savings they create, we need to update the to Ensure the Successful Transition from laws to ease the burden on providers and give Volume to Value in the Medicare Program.” the CMS more exibility to approve waivers Its purpose was to evaluate the Stark law to providers who enter into these high-value within the context of our modern-day, arrangements. technological advancements and learn from Through bipartisan support, the Health healthcare professionals what steps need to Subcommittee is speaking with healthcare be taken to sustain a more advanced system professionals across the country to identify of healthcare that will provide higher-quality unnecessary regulations that must be care at lower costs. Rep. Peter Roskam met at the cost of patient care. Working The Stark law is a 1980s-era policy (R-Ill.) together, we can nd a balance to maintain originally intended to protect Medicare SERVING SINCE: 2007, now a system of accountability for providers that beneciaries from excessive costs and other in his sixth term makes sense while protecting patients and potential harms that could result from providing quality care at a reasonable cost. HEALTHCARE-RELATED physician referrals of patients to other providers COMMITTEES: House Ways The goal of the subcommittee in evaluating with whom they have nancial ties. However, and Means Committee the Stark law is simple: better care for we’ve seen this law driving up costs and (chair of the Health Medicare patients. creating additional, unnecessary regulatory Subcommittee) Our nation—in fact, our world—has seen burdens for healthcare providers. Roskam also serves on signicant technological advancements over the Named after former Democratic Rep. Pete several healthcare-related past 40 years; it’s now time for our laws to catch Stark of California, who sponsored the initial caucuses, including the up to the modern-day tools at our disposal in bill, the Stark law was, and in many ways still Congressional Primary Care order to ensure we use these tools responsibly is, necessary to ensure patient safety and act as a Caucus and the Bipartisan without hindering progress. safeguard against wasting taxpayer dollars. The Congressional Task Force Regulations are often well-intended, law essentially prevents physicians from making on Alzheimer’s Disease and there is value to smart regulation referrals to entities that provide certain services for patient and provider protection. if they have a nancial stake in that entity, thus However, new regulations year after year eliminating unnecessary services that could have a compounding effect. Healthcare is raise healthcare costs. constantly changing, and we need to review these rules as Over time, however, we’ve seen the web of regulations born technologies and care delivery models change. out of the law become nearly impossible to navigate without Hearings we’ve held on Stark law modernization and legal assistance. The Stark law has become so complex and achievements through the Medicare Red Tape Relief Program burdensome that healthcare providers, legislators and even the offer members of the Ways and Means Health Subcommittee bill’s original sponsor have called for repealing the law in its the opportunity to work together to nd solutions that current form, which has veered from the original intent. improve healthcare quality and safety.

18 Modern Healthcare Congressional Supplement | September 24, 2018 T  C   S  H Outdated infrastructure, federal policy holding back the power of telehealth to improve access to care

By Rep. Raul Ruiz

OU’RE BUTTERING YOUR provider, who tells Tony he needs to see a TOAST when your vision starts dermatologist. Right now, Tony would have Y to blur. You shake it off and think to nd a dermatologist—who could be hours nothing of it, but ve minutes later when you away—and take an entire day to get the care he reach for your keys, you struggle to lift your needs. right arm. That’s when you realize you could be Telehealth, on the other hand, could connect having a stroke, and immediately call 911. Tony with a dermatologist via videoconference Every minute counts in this scenario and in that same exam room, who could then work can be the difference between a full recovery with Tony’s doctor to help screen for cancer and and permanent loss of function or death. In the manage treatment. future, if you have an elevated risk of a stroke That’s the ideal scenario—but there are many or heart attack, you could have access to a obstacles that get in the way. First, Tony’s clinic mobile app paired with a wearable sensor that Rep. Raul Ruiz, M.D. may not have adequate broadband internet. can detect a stroke or heart attack and activate (D-Calif.) Second, Medicare does not cover remote patient emergency medical services immediately—all SERVING SINCE: 2013, now monitoring or “store and forward,” which are before you even notice any symptoms. That’s in his third term necessary for transmitting personal health the power of telehealth. data. Third, community health workers are HEALTHCARE-RELATED Unfortunately, outdated policy and a lack of not an approved telehealth “practitioner” under COMMITTEES: House Energy political will is holding back the widespread and Commerce Committee Medicare. And fourth, Medicare typically does deployment of telehealth. Barriers include (Communications and not allow providers to bill for multiple visits by insuf cient federal funding for telehealth Technology Subcommittee a patient in one day. infrastructure, inconsistent licensing and Environment Bottom line, outdated policies and requirements, lack of broadband internet in Subcommittee) insuf cient infrastructure mean individuals like rural communities and needless bureaucracy. Ruiz is chair of the Tony are going without the care they need. There is no silver bullet to solve these Congressional Hispanic To overcome these barriers, we need a robust, challenges, but the potential for telehealth to Caucus healthcare task coordinated plan that facilitates the expansion improve the lives of individuals in rural and force and a member of the of telehealth services. Medicare should underserved areas necessitates that we try. Congressional Telehealth reward—not punish—telehealth’s ef ciency I represent California’s 36th Congressional Caucus and affordability. Regulations should help District, which is one of the most economically Ruiz is an emergency doctors access their patient’s medical records. and geographically diverse in the country. medicine physician And public investment should enable hospitals Before I was elected, I worked as an emergency to purchase technology that saves money for medicine physician, and I saw how physician patients and providers. shortages, lack of health literacy and proximity to a Telehealth is the future of medicine. It is an hospital determined a patient’s access to healthcare. opportunity to expand healthcare access to improve Telehealth can bridge those gaps. patient outcomes, and the government must be an Take one example: Tony, a retired farmer who is on active partner to pave the way for this transformation. Medicare, has a new and suspicious lesion on his face. A Telehealth has spread its wings; intelligent policy and community health worker refers him to a primary-care smart investment will help it soar.

September 24, 2018 | Modern Healthcare Congressional Supplement 19 T   C    S  H  Delivering on promises of the 21st Century Cures Act to advance medical research and improve the nation’s health

By Rep. Fred Upton

HE 21ST CENTURY CURES Advancing Innovative Neurotechnologies INITIATIVE began with the spark of Initiative, which supports a more dynamic T an idea: What could we in Congress understanding of brain functions; and the do to ensure that life-saving drugs and devices Regenerative Medicine Innovation Project, move to market in the fastest and safest which aims to accelerate the eld of stem cell way possible? That spark was the start of a science. multiyear journey that took us from Michigan Cures provided the FDA with new to Colorado, the halls of Congress to the Oval authorities and also established an FDA Of ce. Innovation Account so of cials can concentrate And after listening, gathering stakeholder on a broad range of goals including patient- feedback and drafting and re-drafting focused drug development to incorporate the legislation, the nal product was what some patients’ perspective, advancing new therapies called the most meaningful legislation we Rep. Fred Upton to transform the way drugs are developed, passed in the 114th Congress. While it was (R-Mich.) modernizing drug-testing trial design, and enacted into law in late 2016, we’ve only SERVING SINCE: 1987, now in development of methodology to use real-world begun to see what it can do to advance his 16th term evidence in the process, and more. cutting-edge healthcare and promote the Cures also focuses on reforming our nation’s HEALTHCARE-RELATED nation’s overall health. mental health system, which is why we worked COMMITTEES: House Energy When a bipartisan group of lawmakers and Commerce Committee so hard to include the Helping Families in including myself and my partner in this effort, (Subcommittee on Health) Mental Health Crisis Reform Act in the bill. U.S. Rep. Diana DeGette (D-Colo.), gathered And, amid our country’s opioid crisis, Cures Upton also serves on in the White House to sign the 21st Century several healthcare-related provides $1 billion for states to ght the Cures Act—also referred to as Cures—into caucuses: the Bipartisan epidemic at the local level through the end of law, it marked a momentous occasion. We not Disability Caucus, 2018. We’re now focused on ensuring that this only had made needed reforms to the Food and Bipartisan Problem Solvers funding continues, and more. Drug Administration and National Institutes of Caucus and Congressional Currently, we are looking at how the Cures Health in order to encourage more ef cient and Addiction, Treatment and implementation is progressing. We’re curious to safer approvals, we also had boosted research at Recovery Caucus nd out how, exactly, it is changing the medical the NIH, funded new mental-health programs, innovation ecosystem and what tweaks can be and appropriated money to states to ght the made to ensure we’re always putting patients ongoing opioid epidemic. rst. When FDA Commissioner Dr. Scott More speci cally, Cures is boosting four major Gottlieb and NIH Director Dr. Francis Collins testi ed in late innovative initiatives at the NIH: the Beau Biden July before the Energy and Commerce Committee’s Health Cancer Moonshot, which works to accelerate progress in Subcommittee on the continuing rollout of this law, they cancer prevention and screening; the Precision Medicine reminded us just how Cures is already having a monumental Initiative, which is a long-term research endeavor aimed impact on health and healthcare delivery. at understanding how a person’s genetics, environment More than a year after it was signed into law, Cures is and lifestyle can help determine the best approach to proving its worth. We look forward to continued engagement prevent or treat disease; the Brain Research through with patients, stakeholders and other lawmakers.

20 Modern Healthcare Congressional Supplement | September 24, 2018 SPONSORED CONTENT

Patients First Policy solutions that address misaligned incentives in supply chain and lower costs for patients

A troubling but familiar scene is playing out in pharmacies We need policies that turn our system on its head and ensure across the country. A patient walks in to pick up a patients share more of the discounts our member companies prescription, but walks out empty-handed. offer - whether it’s from rebates or commercial plans, Part D, 340B, Medicaid, and the list goes on. It simply costs too much. Third, our members are already entering into new payment Today, scientists and researchers are advancing a new arrangements with insurers to be paid based on how well a era of medicine with the promise of new cures and better medicine works for patients. In exchange for taking that risk, treatments. But those medical breakthroughs are only truly companies may negotiate preferred formulary placement meaningful if they reach patients and help them get healthier. for those medicines, which come with lower copays and coinsurance. This would help us move to a system that America’s biopharmaceutical companies are proposing fresh measures what matters most to patients, like how quickly policy solutions that would shake up the status quo, address they can get back on their feet after an illness. misaligned incentives across the supply chain and solve for what patients are most concerned about: rising out-of-pocket Fourth, we need to ensure that 340B – a program designed costs for their medicines. to help vulnerable or uninsured patients access prescription medicines at safety-net facilities– works as it’s supposed Last year, spending on medicines grew 0.6 percent, and net to. Even though hospitals are getting huge discounts on prices grew just 1.9 percent. That’s because our industry medications, according to GAO data, fewer than half of gives steep discounts off of a medicine’s list price to entities hospitals surveyed provide those discounts to low-income, in the supply chain, like insurers and pharmacy bene t uninsured patients when they ll prescriptions at managers (PBMs). These rebates and discounts added pharmacies. Of those that do, some said they still up to $150 billion last year, and that total has been charge patients more than the hospitals paid for growing every year. But all too often those savings that same medicine. We must x this program, are not being applied to help lower patients’ and we’re encouraged that the Administration out-of-pocket costs for their medicines. Instead, is considering more improvements. insurers, PBMs and others use those funds to pad bottom lines, lower premiums or ll other holes in Some look at the challenges in our health their budgets. And because those funds are based care system and assume we have to choose on a percentage of a medicine’s list price, the entire between innovation and affordability. That’s a supply chain has incentives to want higher false choice. We can choose to put list prices. Stephen J. Ubl patients over politics. President and CEO Our system needs to solve for these Pharmaceutical Research and Lawmakers can pursue new policy misaligned incentives that hurt patients. ideas that are as innovative as the That is why we are proposing policies that Manufacturers of America (PhRMA) cures and treatments our scientists would prohibit PBMs and others along the and researchers are developing supply chain from having their compensation calculated as every day. And we can have a future where patients never a percent of the list price of a medicine. Instead, they should have to walk out of a pharmacy empty-handed. America’s be paid a fee based on the value of their services. This would biopharmaceutical companies are ready to make that a reality. require signi cant change for our members. But it is worth it to make sure patients get access to the medicines they need Stephen J. Ubl is president and chief executive of cer at a cost they can afford. of the Pharmaceutical Research and Manufacturers of America (PhRMA), which represents America’s leading Second, patients should have access to negotiated savings biopharmaceutical research companies. that PBMs and insurers receive. Recently, UnitedHealth and Aetna announced they will start sharing some of the rebates they negotiate. This is a step in the right direction. And, we know it works. For example, a recent analysis found that sharing a portion of negotiated rebates with seniors suffering from diabetes could reduce total health care spending by $20 This Sponsored Section was billion over the next decade. produced and brought to you by:

And pharmacists should have the tools available to help patients save money. We need to put an end to gag clauses that prevent pharmacists from telling patients it could be cheaper to buy a medicine out-of-pocket than through insurance. Some states have taken action to prohibit these gag clauses, but more work needs to be done. To learn more about PhRMA, please visit www.phrma.org Turn complexity into clarity.

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