Significant Federal Changes to Healthcare Regulation Loom

Significant Federal Changes to Healthcare Regulation Loom

The Biden Administration has been extremely busy this summer, with the development of new initiatives designed to reform the healthcare system in the U.S. The focus has been on so-called “junk fees” hidden in almost every sector of the economy, as well as lowering healthcare costs for Americans. And three recent actions in particular have emphasized just how important this is to the Administration – even in the face of criticism and legal action.

The Federal Trade Commission (FTC) recently withdrew two policy statements that deal with competition in healthcare. They were originally published in 1996 and 2011, but the agency stated that given how much things have changed since then, they are “outdated and no longer reflect market realities.

And while policy statements are non-binding and don’t set any legal requirements, the FTC did state that it believes removing these two statements will significantly help promote fair competition in healthcare. 

But that doesn’t mean that the FTC is exiting stage left from antitrust enforcement. It will just now look at mergers and conduct reviews on a case-by-case basis. 

Not everyone is pleased by this move, however, with the American Hospital Association (AHA) citing their disappointment that the agency withdrew, rather than modernized, the written guidelines – and did not have a conversation with stakeholders in the field about doing so. 

The Consumer Financial Protection Bureau (or CFPB), U.S. Department of Health and Human Services (HHS), and the U.S. Department of the Treasury recently announced a joint request for information (RFI) on medical credit cards and installment loans proposed to patients as a way to cover their medical costs. 

The agencies hope to obtain commentary on how common these medical credit cards and loans are, what the interest and fees are, patient experiences, and whether they felt that the cards and loans were pushed on them – and if providers are in any way incentivized to offer them (and if so, what types of incentives are offered). They are also hoping to gain information on if these types of medical credit cards and loans for patients are actually making existing healthcare billing and collections issues worse. 

The CFPB additionally recently held a hearing on the issue, wherein examples were provided of times in which a consumer felt pressured or uninformed about the patient financing option they selected. The agencies hope that together, they’ll be able to better understand the overall market, as well as how their individual agencies might need to respond through regulation.

The Administration also recently announced new data on how effective the Inflation Reduction Act is expected to be at reducing costs of pharmaceuticals, highlighting an estimated $400 per year savings for Medicare beneficiaries. Just last week, the White House brought in leaders of in retail health to help spread the word about the law and its potential cost savings to the retail chains’ customers: CVS Health, Walgreens, and Walmart stopped by to discuss how to best educate customers about who can benefit and how much, as well as how best to convey that information, whether it be through social media or printing it on customer receipts. 

This meeting was held amid the filing of several lawsuits against the Administration on this initiative, however. Multiple pharmaceutical companies and groups have sued over the provision of the Act that allows Medicare to negotiate prices for certain drugs, arguing that the measure is unconstitutional. 

It will prove to be a busy next few months for both the Administration and for the industry. But I’ll leave you with these remarks from HHS Secretary Becerra – when asked about some of the challenges the Administration is facing in implementing its initiatives, he stated it “won’t be deterred” and “isn’t letting anything get in our way” when it comes to lowering healthcare costs.

Facebook
Twitter
LinkedIn

Cate Brantley, JD

Cate Brantley is a Senior Government Affairs Liaison for Zelis. She has over 9 years of experience in both the public and private sector. Cate is licensed to practice law in the state of Oklahoma.

Related Stories

Integrating AI in Healthcare

Integrating AI in Healthcare

Artificial Intelligence (AI) is revolutionizing the healthcare industry, bringing significant advancements in clinical applications, patient care, and administrative efficiency. However, while much of the discussion

Read More

Leave a Reply

Please log in to your account to comment on this article.

Featured Webcasts

Heart Failure Coding Essentials: Ensuring Compliance and Optimal Reimbursement

Heart Failure Coding Essentials: Ensuring Compliance and Optimal Reimbursement

Master the complexities of heart failure coding with this expert-led webcast by Emily Montemayor, CCS, CMBCS, COC, CPC, CPMA. Discover strategies to ensure compliance with ICD-10-CM guidelines, documentation integrity, and capture comorbidities like CKD and hypertension. Learn how to resolve coding challenges, improve documentation practices, and submit clean claims to minimize denials and safeguard your organization’s financial health. With practical insights and real-world examples, this session equips you to prevent revenue leakage, enhance compliance, and secure optimal reimbursement—all while supporting better patient outcomes.

February 26, 2025
Decoding 2025 OPPS Charge Capture and Coding Complexities: Strategies for Success

Decoding 2025 OPPS Charge Capture and Coding Complexities: Strategies for Success

Prepare your organization for the 2025 OPPS updates with expert insights from Tiffani Bouchard, CCS, CRCR, a Revenue Integrity Professional with over 30 years of experience. This webcast will address critical challenges in charge capture and coding, providing clarity on APC policies, C-APC packaging, exclusions, and payer-specific requirements. Attendees will learn actionable strategies to ensure compliance, optimize reimbursement, and mitigate risks of claim denials. Gain the knowledge needed to implement updates effectively, educate your team, and maintain seamless revenue cycle operations in the face of evolving OPPS complexities.

January 29, 2025
Enhancing Outcomes with CDI-Coding-Quality Collaboration in Acute Care Hospitals

Enhancing Outcomes with CDI-Coding-Quality Collaboration in Acute Care Hospitals

Join Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P, as she presents effective strategies to strengthen collaboration between CDI, coding, and quality departments in acute care hospitals. Angela will also share guidance on implementing cross-departmental meetings, using shared KPIs, and engaging leadership to foster a culture of collaboration. Attendees will gain actionable tools to optimize documentation accuracy, elevate quality metrics, and drive a unified approach to healthcare goals, ultimately enhancing both patient outcomes and organizational performance.

November 21, 2024

Trending News

Featured Webcasts

Utilization Review Essentials: What Every Professional Needs to Know About Medicare

Utilization Review Essentials: What Every Professional Needs to Know About Medicare

Dr. Ronald Hirsch dives into the basics of Medicare for clinicians to be successful as utilization review professionals. He’ll break down what Medicare does and doesn’t pay for, what services it provides and how hospitals get paid for providing those services – including both inpatient and outpatient. Learn how claims are prepared and how much patients must pay for their care. By attending our webcast, you will gain a new understanding of these issues and be better equipped to talk to patients, to their medical staff, and to their administrative team.

March 20, 2025

Rethinking Observation Metrics: Standardizing Data for Better Outcomes

Hospitals face growing challenges in measuring observation metrics due to inconsistencies in classification, payer policies, and benchmarking practices. Join Tiffany Ferguson, LMSW, CMAC, ACM, and Anuja Mohla, DO, FACP, MBA, ACPA-C, CHCQM-PHYADV as they provide critical insights into refining observation metrics. This webcast will address key issues affecting observation data integrity and offer strategies for improving consistency in reporting. You will learn how to define meaningful metrics, clarify commonly misinterpreted terms, and apply best practices for benchmarking, and gain actionable strategies to enhance observation data reliability, mitigate financial risk, and drive better decision-making.

February 25, 2025
Navigating the 2025 Medicare Physician Fee Schedule: Key Changes and Strategies for Success

Navigating the 2025 Medicare Physician Fee Schedule: Key Changes and Strategies for Success

The 2025 Medicare Physician Fee Schedule brings significant changes to payment rates, coverage, and coding for physician services, impacting practices nationwide. Join Stanley Nachimson, MS., as he provides a comprehensive guide to understanding these updates, offering actionable insights on new Medicare-covered services, revised coding rules, and payment policies effective January 1. Learn how to adapt your practices to maintain compliance, maximize reimbursement, and plan for revenue in 2025. Whether you’re a physician, coder, or financial staff member, this session equips you with the tools to navigate Medicare’s evolving requirements confidently and efficiently.

January 21, 2025
Patient Notifications and Rights: What You Need to Know

Patient Notifications and Rights: What You Need to Know

Dr. Ronald Hirsch provides critical details on the new Medicare Appeal Process for Status Changes for patients whose status changes during their hospital stay. He also delves into other scenarios of hospital patients receiving custodial care or medically unnecessary services where patient notifications may be needed along with the processes necessary to ensure compliance with state and federal guidance.

December 5, 2024

Trending News

Prepare for the 2025 CMS IPPS Final Rule with ICD10monitor’s IPPSPalooza! Click HERE to learn more

Get 15% OFF on all educational webcasts at ICD10monitor with code JULYFOURTH24 until July 4, 2024—start learning today!

CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24