News Briefs: Supreme Court ruling allows the COVID-19 vaccine mandate for healthcare workers to proceed

The federal COVID-19 vaccine mandate is set to be enforced across the country after the Supreme Court on Jan. 13 lifted injunctions that had blocked the mandate in 24 states.

Siding with the Biden administration in a 5-4 ruling, the court said the mandate “falls within the authorities that Congress has conferred upon” the secretary of the U.S. Department of Health and Human Services (HHS).

The court’s decision did not apply to Texas, which was granted an injunction in a separate case. But on Jan. 19, a federal court dismissed the Texas lawsuit at the request of the state.

The Supreme Court reimposed injunctions on a vaccine-or-test mandate that had been implemented for large businesses. The Occupational Safety and Health Administration likely does not have authority to issue such a directive, the court said.

Both decisions pertain only to injunctions, meaning the cases can continue to work their way through the federal court system. But the opinions suggest the fate of each set of regulations should the cases reach the Supreme Court.

Covered providers in the 25 states where the healthcare mandate wasn’t blocked had until Jan. 27 to comply with the first phase of requirements, specifically to ensure staff receive the first dose of a two-dose vaccination series or complete a single-dose series. Full vaccination is due by Feb. 28.

In the states in which injunctions were issued and then lifted, the first deadline is Feb. 14. Staff then must be fully vaccinated by March 15.

Update: After hfm went to press, CMS announced that the deadlines for Texas are Feb. 21 and March 22.

CMS proposes to restrict Medicare coverage of a high-profile new Alzheimer’s drug

Medicare plans to pay for use of a new drug to treat Alzheimer’s disease only in limited scenarios, CMS announced Jan. 11 in a highly anticipated preliminary coverage determination.

Biogen’s drug Aduhelm would be covered only for patients enrolled in approved clinical trials that are conducted in hospital outpatient settings. Coverage also would encompass related services such as PET scans.

Aduhelm, a monoclonal antibody treatment, gained attention in 2021 for both its price and the seemingly fast-tracked nature of its approval by the FDA. An outside advisory panel had not recommended approval, saying the drug’s clinical benefits were unproven. The approval process is under investigation by Congress and the HHS Office of Inspector General.

The $56,000 initial price tag affected Medicare premiums, which rose by $22 for 2022. CMS said about half the increase was tied to the prospective cost of covering Aduhelm. In response to Biogen’s decision in December to cut the price, HHS Secretary Xavier Becerra said the premium increase would be reassessed.

Stakeholders can provide feedback on the proposed coverage policy during a 90-day comment period.

Hospitals, physicians file lawsuit over the arbitration process in new surprise billing regulations

In December, leading hospital and physician associations went to court to try to stop an aspect of the surprise billing regulations that appears to favor insurers over providers.

The American Hospital Association and American Medical Association were among the parties that filed a lawsuit in Washington, D.C., federal court regarding the forthcoming independent dispute resolution (IDR) process.

The suit contends that the criteria to be considered in the IDR process do not match statutory intent. The plaintiffs hope the court will issue an injunction to stop that specific component of the regulations, which began in January.

For providers, the primary concern with the IDR process is that it places too much emphasis on the qualifying payment amount (QPA) as the benchmark for determining out-of-network payments. The QPA generally is defined as the insurer’s median contracted rate for a given service in a given market.

The plaintiffs in the lawsuit wrote that Congress “did not simply select the QPA as the appropriate ‘out-of-network’ rate to be paid by insurers.” Rather, they asserted, Congress intended for arbitrators to give equal weight to several other factors.

Study finds glaring issue with federal price transparency requirements

The federal price transparency regulations that took effect in 2021 aren’t necessarily conducive to providing actionable information for consumers, according to a study published Dec. 13 in JAMA Network Open.

The issue is that healthcare entities aside from hospitals may contribute substantially to the cost of care episodes, the researchers posited.

Examining more than 4.5 million commercial claims for 70 hospital-based shoppable services in 2018, the researchers reported: “When entities that billed for care independently from the hospital were involved in care delivery, their aggregate reimbursement both in dollars and as a percentage of the hospital portion of costs was often nontrivial.”

New surprise billing regulations may mitigate the issue by ensuring that patients don’t face out-of-network cost sharing for services received at in-network facilities. But that protection won’t help them know the full cost of those services upfront.

Attaining such a level of transparency likely requires the involvement of health plans, the researchers wrote.

New data quantify the COVID-19 pandemic’s impact on the nurse workforce

A study that examined nurse employment between February 2020 and June 2021 found a 2.2% decrease in hospital nursing jobs.

The reduction was 0.7% in physician offices, while nurse employment at outpatient centers increased by 2.6%, researchers reported in the January issue of Health Affairs.

After increasing by close to 25% between 2011 and 2020, employment of registered nurses across healthcare decreased by 1% during a five-quarter period ending in June 2021.

Even as demand for healthcare services rose and wages increased over the course of the pandemic, employment levels of nurses remained lower than usual.

“This suggests a tightening labor market in which employers could not hire as many nurses as they wanted,” the researchers wrote.