Zelis Legislative Weekly Update: Nov. 18 - 22

Table of Contents

1. No Surprises Act (NSA) and Transparency Rules (TinC)
2. DC and Federal Update
3. Cybersecurity, AI and tech
4. The Industry

Highlights

• Hospitals still falling behind transparency requirements;
• More healthcare predictions for Trump’s second term;
• MedPAC expresses concern over MA provider directories; and
• Healthcare keeping pace in AI adoption.

No Surprises Act & TinC

A new report from the federal Office of the Inspector General (OIG) indicates that many hospitals are not publishing their prices in compliance with the price transparency law.

• Over a third of the 100 hospitals reviewed by the OIG did not post machine-readable files (MRFs) correctly, or at all, as required by the 2021 federal law.

DC and Federal Update

Last week, we offered readers a roundup of what various news outlets believe President-elect Trump's re-election to the Oval Office means for healthcare policy. As a follow up:

• Medpage Today reports on several of President Biden's Executive Orders on healthcare that Trump is “likely to undo.” ?
• MedCity reports on what the future of prescription drugs might look like under President-elect Trump, with a focus on research and development, drug pricing, and PBM reform.
• PWC reports on President-elect Trump’s plans to prioritize in the realm of AI and healthcare.
• Finally, how will the second Trump administration impact the Medicare and Medicaid programs? Perspectives here from NPR and here from Bloomberg Law.

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The DOJ filed a lawsuit in Maryland federal court to block UnitedHealth’s acquisition of a large home health company, saying the merger would “forever eliminate…competition”.

• UnitedHealth responded to the suit, stating that the joining of the two companies would be “pro-competitive and further innovation.”

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The Medicare Payment Advisory Commission (MedPAC) is a nonpartisan, independent legislative branch agency of the federal gov’t that provides Congress with analysis/policy advice on the Medicare program. Late last week, MedPAC, commenting on MA network provider directories, noted that their “listing of in-network providers is too narrow, and flaws in rules governing them need to be addressed to prevent situations that are ‘horrible, unfair, and can harm’ beneficiaries.”

• MedPage Today dives deeper into MedPAC’s criticisms and some potential implications.
• MedPAC also recently debated solutions to “lackluster” physician reimbursement.

Cybersecurity, AI, & Tech

A recent study found that a whopping 90% of healthcare executives see a positive ROI by investing in GenAI technology.

• PYMNTS examined key trends in how healthcare is utilizing GenAI and found that the technology is considered “critical” for staying competitive and advancing patient care and administrative efficiency.
• The study also found that the average full-scale adoption timeline is just over 7 years-similar to other industry averages.? This suggests that healthcare is implementing AI at a normal rate.
• For more on AI in healthcare, check out Becker's six “things to know,” including how the industry is only the sixth-largest user of AI currently.
• In addition, Bloomberg argues that AI will transform medicine, but not without giving the AI models more data and the innovators more access.
• Finally, gain some insight into the doctors who are “pioneering” the use of AI to improve patient outcomes. According to this article, they’re already making advances in areas such as diagnostics, targeted treatments, and communications.

The Industry

Healthcare companies are increasingly using electronic payments to pay for supplies and take advantage of time-sensitive opportunities. In a PYMNTS study, experts estimate that healthcare CFO’s across the globe used tools such as virtual credit cards to pay for 30% more of their invoices earlier than the prior year.

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High labor costs continue to plague health systems as the median investment per employed physician providers hits an all-time high at over $300,000.

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Private equity healthcare investment fell again in Q3 but is set for a comeback according to experts.

• High interest rates and labor costs – as well as higher scrutiny from regulators – are reportedly behind a decrease in PE investments.? Q3 saw 37 fewer announced deals than Q2. However, experts believe a “turning point” has been reached.

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·Cigna released a statement denying it is attempting to acquire rival Humana “in light of recent and persistent speculation.”

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Drugmaker Novavax received clearance from the FDA to continue developing a joint C19 & flu vaccine.

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A recent survey found that a mere half of US hospitals have enough IV fluids for more than 2 weeks following supply chain issues after Hurricane Helene.

This update is solely for informational purposes and should not be relied upon as legal advice