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Delivered daily by 10 a.m., Pulse examines the latest news in health care politics and policy. | | | | |  | | By Daniel Payne and Krista Mahr | With help from Megan Wilson PROGRAMMING NOTE: We’ll be off for Thanksgiving this Thursday and Friday but back to our normal schedule on Monday, Nov. 28.
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Doctors and other health care providers seek to prevent Medicare reimbursement cuts from taking effect. | AP Photo | DOCTORS TRY TO THWART CUTS TO MEDICARE — As the countdown to year’s end continues, health care providers are racing to avert a tsunami of potential Medicare reimbursement cuts that kick in unless Congress acts. As lawmakers put together the year-end package, these are the most talked about cuts on Capitol Hill: — Physician Fee Schedule cuts: Doctors face a 4.5 percent across-the-board cut to Medicare reimbursement rates next year. Some specialties are at risk for additional reimbursement cuts as well. — PAYGO-mandated cuts: All providers face a 4 percent reduction in payments if Congress doesn’t waive the cuts triggered by the pay-as-you-go budget control requirements. — Alternative Payment Model bonuses sunset: A 5 percent bonus for providers who participate in so-called Advanced Alternative Payment models, which require doctors to take on some risk related to health outcomes for patients, expires at the end of the year. — Clinical laboratory cuts: Medicare payments for clinical laboratory tests could face a 15 percent cut. Providers have been holding meetings with congressional offices for months to try to avert the future cuts, but that lobbying is now being pushed into overdrive, Megan reports. “The big [cuts] get most of the attention, but when you talk to providers and you say, ‘What’s keeping you up at night?’ it’s those first two that keep them from falling asleep, and then it’s the others that then keep them up all night,” Ilisa Halpern Paul, a senior policy adviser at Venable, a law and lobbying firm, told Megan. “If you’re an integrated health system, this is death by 1,000 cuts.” The American Hospital Association wrote to congressional leadership last week, saying that not waiving PAYGO could cost the industry $10 billion in 2023. The Medical Group Management Association, an industry group, also wrote to lawmakers and said a failure to delay the cuts “will be catastrophic.” More than 500 medical practices across the U.S. reported to the group that the current Medicare reimbursement rates already “did not adequately cover the cost of providing care.” But wait, there’s more: An additional 2 percent budget sequester — which had been waived for most of the pandemic — reducing Medicare reimbursements took effect earlier this year. Policymakers may extend the sequester to offset some costs of the large government spending package. WELCOME TO MONDAY PULSE, where we recently learned NFL games in the 2020–21 season were associated with spikes in Covid-19 cases, according to one study — at least when there were more than 5,000 attendees. Large gatherings causing more cases may be among the least surprising research from the pandemic. But that doesn’t mean we don’t like surprises — send us a tip we aren’t expecting at dpayne@politico.com and kmahr@politico.com. TODAY ON OUR PULSE CHECK PODCAST , Katherine Ellen Foley talks with Krista about why the rise of respiratory syncytial virus in infants 6 months and younger is worse this season compared with previous seasons as the surge in caseloads fill pediatric hospitals. | | | | | | | GO INSIDE THE MILKEN INSTITUTE FUTURE OF HEALTH SUMMIT: POLITICO is featuring a special edition of our “Future Pulse” newsletter at the 2022 Milken Institute Future of Health Summit from Dec. 6 to 8. The newsletter takes readers inside one of the most influential gatherings of health industry leaders and innovators solving the biggest global health issues to ensure a healthier, more resilient future for all. SUBSCRIBE TODAY TO RECEIVE EXCLUSIVE COVERAGE . | | | | | | | | | 
The way the Biden administration plans to enforce the No Surprises Act, aimed at protecting patients from surprise medical bills, has come under some scrutiny. | Chris Hondros/Getty Images | Getty Images | SURPRISE BILLING SHOWDOWN — Leaders of the House Ways and Means Committee sent a letter to the Biden administration Friday asking for a change in how it plans to enforce the No Surprises Act. The administration’s final rules “follows neither the letter nor the intent of the law,” Rep. Richard Neal (D-Mass.) and Kevin Brady (R-Texas) said in the letter, citing concerns about the ways billing disputes are decided. The letter, addressed to the heads of HHS, the Department of Treasury and the Department of Labor, emphasizes issues similar to those raised by health care providers in an ongoing case about the administration’s plans for carrying out the law. The providers in the case, filed by the Texas Medical Association , argued that the final rules unfairly advantaged insurers. Large provider groups agree with Neal and Brady and support the law as passed but not the administration’s interpretation. Insurers have sided with the administration’s approach . The congressional leaders are concerned that the law’s implementation could be delayed, pointing to some regulations based on the law that were months late. It’s not the first time the rules have been challenged in court or by Congress: Richard and Neal note three other letters from members of Congress to the Biden administration with similar concerns. FIVE THINGS A GOP HOUSE MAJORITY MEANS — Now that the House has been called for Republicans, POLITICO’s Alice Miranda Ollstein, Lauren Gardner and Carmen Paun write about some major health care implications. Though the new majority’s agenda is still being formed, five items to watch for in the new Congress include: 1. Commercialized Covid responses 2. An intense focus on Covid oversight 3. Significant scrutiny of pharmacy benefit manufacturers 4. A shift away from infectious diseases in global health 5. New pressures for Dems to perform in the lame-duck session
| | | RSV FUELS DEBATES ABOUT KIDS’ MASKING — A surge of children hospitalized with respiratory syncytial virus has reignited debates about the pandemic’s impact on kids’ health, Krista reports. Central to the debate is the term immunity debt, which describes a potential negative impact of not being exposed to viral and bacterial infections because of measures taken to stop Covid’s spread. Many people may not have been exposed to RSV because of measures like masking and social distancing, according to some doctors and infectious disease experts. “These little children who are being hospitalized are canaries in the coal mine,” said Ruth Karron, a pediatrician, RSV expert and professor at the Johns Hopkins Bloomberg School of Public Health. “They tell us how little immunity there is in the population.” But the theory, not a widely accepted medical concept, has been criticized, with some on the front lines of the crisis saying it encourages dangerous disregard for Covid’s impacts. During a Nov. 4 press briefing , José Romero, director of the CDC’s National Center for Immunization and Respiratory Diseases, discussed the surge, attributing it partly to kids not being infected in recent years. Some front-line health providers called Romero’s explanation irresponsible, saying it could fuel the misconception that exposure to a potentially deadly disease is beneficial for kids. Public health leaders are trying to better understand the causes of the case increase — and how to best discuss its causes — while pediatric groups ask for federal support to handle the outbreak.
| | | LOOKING FOR A DEALMAKER — Lobbyists hope that Sen. Bill Cassidy (R-La.) can work across party lines to get policy passed in the HELP Committee, Megan reports. Working alongside Sen. Bernie Sanders (I-Vt.), who will chair the committee, Cassidy is seen by much of K Street as a leader steeped in health policy — a more productive choice than Sen. Rand Paul (R-Ky.), who could have chosen to lead HELP but opted for the Homeland Security Committee instead. “If he wasn’t a senator, I think he’d want to be a health LA [legislative assistant],” said Chris Gillott, a longtime former Cassidy aide now at lobbying firm Invariant. Though Sanders still hasn’t discussed significant plans for the committee, Cassidy signaled hopes of working with him in the committee and addressing drug pricing, the implementation of surprise billing and dyslexia .
| | | FLORIDA’S BAN ON GENDER-AFFIRMING CARE INSPIRES TEXANS — Less than a month after Florida’s medical board signed off on a ban that prohibits gender-affirming care for minors, a Texas state representative introduced a bill for similar measures in his state. GOP state Rep. Brian Harrison also asked the Texas Medical Board to ban treatments for gender dysphoria in minors — advice that would go against prevailing medical guidance. Medical associations, including the American Academy of Pediatrics and the American Medical Association, support gender-affirming care for adolescents. But medical experts have said gender-affirming care for children rarely, if ever, includes surgery. Instead, doctors are more likely to recommend counseling, social transitioning and hormone replacement therapy. Recently, some doctors and families have raised concerns about the trade-offs being made in one of the therapies — or forgoing it. The action in Texas signals the possibility of more state-level bans on care, following in the footsteps of Florida.
| | | WHAT’S NEXT FOR ANTI-ABORTION ACTIVISTS — After a series of elections affirmed abortion rights in several states, anti-abortion groups are looking to Republicans to more forcefully champion their cause, POLITICO’s Alice Miranda Ollstein and Megan Messerly report . Less than six months ago, anti-abortion activists were celebrating the fall of Roe v. Wade. Now, the groups — and the GOP — disagree about how to move forward, particularly after Roe’s overturning bolstered significant abortion rights support. Some abortion opponents blame Republican Party leadership, saying they didn’t emphasize the issue enough. Others call for an introspective approach to rethink how it messages restrictions, particularly for younger voters.
| | | Amanda Lincoln will be the staff director for Republicans on the Senate HELP Committee in the new Congress.
| | | The Washington Post’s Sabrina Malhi explores the current crisis of RSV, flu and Covid in hospitals — and the possibility of it worsening. Kaiser Health News’ Andy Miller and Sam Whitehead write about the Medicaid work requirement that may be on the way in Georgia. The New York Times’ Natalie Kitroeff writes about the gang warfare getting in the way of a battle against cholera.
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