RISE summarizes recent regulatory-related headlines and reports.
ProPublica report examines staffing cuts at HHS
A new data analysis by ProPublica uncovers the extent of positions eliminated at federal health agencies since January.
The publication states that to date, more than 20,500 employees or 18 percent of the workforce at the Department of Health and Human Services have lost their jobs as part of an effort to restructure the agency and save taxpayer money. In March, HHS Secretary Robert F. Kennedy Jr. announced the overhaul would involve eliminating the jobs of 10,000 workers and consolidating and creating new divisions.
Although the administration didn’t respond to the publication’s request to find out how many workers had left federal health agencies, the reporting team used a federal employee directory to determine who was hired or appointed .and who left the federal government since January 25 and through August 16. They tracked workers’ email addresses to determine when they first and last appeared. When email addresses disappeared, the reporting team marked them as departures.
The report takes a deep dive into the loss of jobs at individual departments within the government, including the Food and Drug Administration, the Centers for Disease Control and Prevention, and the National Institutes of Health. However, ProPublica believes the number of departures is an undercount because it doesn’t include employees who have received layoff notices but remain on administrative leave. It also does not include the number of people who have left the Indian Health Service due to high turnover as well as departures at the Centers for Medicare & Medicaid Services because that directory has not had regular updates.
Meanwhile, last week CNN reported that at least 600 employees from the Centers for Disease Control and Prevention will soon receive permanent termination notices due to a court decision that had protected some employee layoffs.
When the restructuring plans were announced, Kennedy said the eliminations and centralizing of agencies will make HHS more responsive and efficient, while ensuring that essential health services remain intact. “We aren't just reducing bureaucratic sprawl. We are realigning the organization with its core mission and our new priorities in reversing the chronic disease epidemic. This department will do more–a lot more–at a lower cost to the taxpayer,” he said.
More carriers announce exits from ACA, MA marketplaces
In the wake of other departures from the Affordable Care Act (ACA) marketplace and Medicare Advantage, other insurers have announced plans to exit the markets.
UnitedHealth Group and Elevance Health Inc. plan to leave some individual health plans in the Colorada ACA marketplace, Modern Healthcare reported. Their departures will mean 96,000 Coloradans will need to find new coverage next year.
In Georgia, Sonder Health Plans will be liquidated on Oct. 1 causing the termination of its Medicare Advantage chronic special needs and dual eligible special needs plans, according to Insurance Business. Georgia and the Centers for Medicare & Medicaid Services have scheduled a special enrollment period through October 31 for policyholders.
Health care groups urge CMS to create better access to breakthrough medical technology
Sixty-seven health care groups, including patient advocacy groups, have asked the Centers for Medicare & Medicaid Services (CMS) to establish a timely, streamlined pathway for Medicare patients to access Food and Drug Administration (FDA)-authorized breakthrough medical technology.
AdvaMed, the Medtech Association, is among the organizations pressing CMS to move more quickly. In a letter to CMS Administrator Dr. Mehmet Oz, the groups said medtech enables remarkable patient outcomes, yet FDA-designated, authorized breakthrough medtech faces years of delays in Medicare coverage.
“Despite this remarkable impact and the continuous pace of innovation, Medicare patients face a significant and unacceptable barrier to accessing innovative medical technology,” the letter said. “A recent study alarmingly revealed that for technologies requiring a new reimbursement pathway, nearly six years passed between FDA market authorization and Medicare coverage. Patients should not be forced to wait the better part of a decade for access to safe and effective medical technology that holds the potential to meaningfully improve their health and life.”
UnitedHealth creates new public responsibility committee
In a securities filing last week, UnitedHealth Group said it will form a new public responsibility committee. The group will monitor and oversee financial, regulatory, and reputational risks that may affect the company's operations and mission. Core oversight responsibilities include underwriting and forecasting, regulatory relationships, reputational matters, and mergers and acquisitions.
The company said the new committee is part of its continuing commitment to a mission-driven culture of responsibility, integrity, and performance. Officials said it will provide an additional layer of governance, including enhanced oversight of pricing, operational, regulatory, and reputational risks. The committee will coordinate with other board committees in monitoring key risks and intersecting areas of oversight. The formation of the committee comes in the wake of a company announcement that it is cooperating with the Department of Justice investigation into its Medicare billing practices,
OIG report: Medicare enrollees left acute care hospitals against medical advice at increasing rates
A new Office of Inspector General (OIG) report found that the rates at which Medicare enrollees leave acute-care hospitals against medical advice have steadily increased since 2006 across most demographics and spiked during the COVID-19 public health emergency. According to the report, those who left the hospital against medical advice are more likely to have poor health outcomes than enrollees discharged to their homes. The watchdog also found that rates correlate to the quality ratings of the associated hospitals: The lower the rating, the higher the rates.
OIG also found that dual enrollees who are eligible for both Medicare and Medicaid and enrollees with a mental health diagnosis were more likely to leave a hospital against medical advance than Medicare-only enrollees and enrollees without a mental health diagnosis, respectively.
OIG analysts said the briefing may be useful in developing future guidance to address the increasing number of enrollees leaving against medical advice and help improve enrollee health outcomes and save taxpayer dollars.