Becker's ASC Review

51 HEALTHCARE NEWS Hospitals lose appeal, must disclose inurer rates By Morgan Haefner A n appeals court rejected hospitals' challenge of a rule that requires hospitals to disclose the rates they negotiate with insurers beginning in 2021. On Dec. 29, the U.S. Court of Appeals for the District of Columbia Circuit affirmed the district court's grant of summary judgment to HHS. Under the final rule issued in November 2019, hospitals are required to disclose the standard charges, including payer-specific negotiated rates, for 300 services begin- ning Jan. 1. Seventy of the services are stipulated in the final rule. Hospitals can choose the other 230 services they post online. Hospitals that fail to publish the negotiated rates online could be fined up to $300 per day. e American Hospital Association, As- sociation of American Medical Colleges, Children's Hospital Association and the Federation of American Hospitals sued HHS in December 2019, arguing the department lacks statutory authority to require public disclosure of individually negotiated rates between commercial insurers and hospitals. HHS argued its definition of standard charg- es is permissible under a 2010 law enacted to lower the cost of healthcare coverage. Both sides filed motions for summary judg- ment, and Judge Carl Nichols with the U.S. District Court for the District of Columbia granted HHS' motion and denied the hospi- tal groups' motion on June 23. e AHA announced June 27 that it was appealing the decision. On appeal, the trade groups argued that CMS unlawfully expand- ed the definition of "standard charges" that hospitals must disclose under a provision in the ACA to include negotiated rates. In response to the appeals court's Dec. 29 decision, the American Hospital Associa- tion said it continues to "believe that the disclosure of privately negotiated rates does nothing to help patients understand what they will actually pay for treatment and will create widespread confusion for them." e AHA said it has urged the incoming Biden administration to review the rule. e as- sociation added that it is reviewing the appeals court's decision to determine next steps. n Ayla Ellison and Alia Paavola contributed to this article. FDA issues new guidelines for opioid prescribing By Maia Anderson The FDA has issued new rules related to the prescribing of opioid painkillers. The rules apply to transmucosal immediate-release fentanyl, or TIRF, drugs. The drugs contain fentanyl, a powerful opioid, and are used to manage breakthrough pain in adults with cancer. To be prescribed a TIRF drug, patients have to be opioid tolerant. The agency updated rules for TIRF drugs' risk evaluation and mitigation strategies, including: Requiring prescribers to document patients' opioid tolerance with each TIRF prescription Requiring outpatient pharmacies that dispense TIRF drugs to document and verify patients' opioid tolerance before dispensing Requiring inpatient pharmacies to develop policies and procedures to verify opioid tolerance in patients who are prescribed TIRF drugs Requiring a new patient registry to monitor for accidental exposure, misuse, abuse and overdose The FDA said the new rules, announced Dec. 23, are designed to address the persistence of concerning prescribing practices and to improve its ability to monitor for adverse events. "We remain committed to using all facets of our regulatory authority to lessen the impact of opioid addiction, misuse, and abuse while also striking a careful balance between patient access and safety to ensure that patients suffering from significant pain have access to appropriate medication," the agency said. n Is Walmart Health the future of US healthcare? By Katie Adams W almart Health opened 15 clinics last year and plans to add seven more by the end of 2021, accord- ing to a Jan. 4 CNBC report. The health clinics, located in Georgia, Illinois and Arkansas, offer primary care ser- vices, X-rays, dental exams, hearing services and mental health counseling. Walmart Health also established 600 COVID-19 test- ing sites last year and began administering COVID-19 vaccines to healthcare workers in New Mexico in December, CNBC reported. Some experts regard the retail giant as a formidable disruptor of the healthcare industry, attracting customers with its trademark low prices. Affordability is a top concern for the country's low-income and uninsured patients. Data from the Kaiser Family Foundation shows that 28.9 million people were uninsured in the U.S. in 2019. Accessibility also attracts customers to Walmart Health services, as 90 percent of Americans live within 10 miles of a Walmart store, according to CNBC.n

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