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Surprise Billing Ban: Now the Hard Part Begins

Congress’s passage of a ban on surprise medical bills came after years of debate on the issue and was still somewhat of a surprise.

But in hindsight, passing the ban may end up being the easy part.

Now, federal officials need to develop regulations that will flesh out the ban, define terms, establish new processes, and more, and every indication is that this will be no less difficult than developing and passing legislation.

According to Politico, lobbying on future regulations has already begun, with providers, consumer advocates, insurers, and even private equity interests vying to ensure that their needs are reflected in the final guidelines, the first of which are due by July.

Learn more about the unfinished work associated with the surprise billing ban and what to expect in the coming months in the Politico article “Biden faces health industry fight over new ‘surprise’ billing ban.”…

Health Care Reportedly Out of Biden American Families Plan

President Biden’s soon-to-be-introduced “American Families Plan” proposal apparently will not include a major health care component.

The New York Times reports that

The plan will not include an up to $700 billion effort to expand health coverage or reduce government spending on prescription drugs. Officials have decided to instead pursue health care as a separate initiative…

Learn more about what is expected from the American Families Plan – and what is not expected – in the New York Times article “Biden Will Seek Tax Increase on Rich to Fund Child Care and Education.”

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Earmarks Expected to Return

After a ten-year absence, congressional earmarks appear to be on their way back.

Earmarks – special budget items chosen by members of Congress specifically for their districts – were banned in 2011 but now, members of the House have voted to revive them, citing the oft-used rationale that members of Congress are more qualified to choose projects for their districts than federal bureaucrats.  In addition, it is widely thought that earmarks can help build bipartisan support for challenging legislation.

Amid concern about the possibility of increasing federal spending at a time of rising deficits, the Senate still has not agreed to revive earmarks.

In anticipation of their return, the House Appropriations Committee will start accepting earmark requests later this month.

DeBrunner & Associates has extensive experience successfully helping health care providers secure congressional earmarks for programs and capital projects.

Learn more about the return of congressional earmarks, what it means, and how it might work in the Washington Post article “Congress revives earmarks in hopes of bipartisan deals on infrastructure, budgets.”…

Bundled Payments Produce Savings Among Privately Insured

Bundled payments for a limited number of surgical procedures produced a savings of 10.7 percent among privately insured patients according to a study by the RAND Corporation.

For the study, participants working for self-insured employers who received three types of surgery – total knee and hip replacement, spinal fusion, and bariatric weight-loss procedures – were offered the opportunity to have those procedures without cost-sharing in exchange for undergoing surgery by specific providers that agreed to accept a bundled payment for the procedure and 30 days of post-surgical care.  The result was a savings of 10.7 percent in costs, 85 percent of which was retained by the employer, while patients saved an average of nearly $500.

Learn more about the study from this RAND Corporation news release and the study itself, “An Employer-Provider Direct Payment Program Is Associated With Lower Episode Costs,” published in the journal Health Affairs.…

The New Administration’s Health Care Team

Becker’s Hospital Review has published a list of 35 officials who are currently part of the Biden administration’s health care team.

Some are staff, some are appointments awaiting Senate confirmation, and some are serving on an interim basis until permanent replacements can be chosen and/or confirmed.

The list includes links to information about each individual.

See the list here.…