| | | | |  | | By Ben Leonard and Chelsea Cirruzzo | | | With Megan R. Wilson PROGRAMMING NOTE: We’ll be off next week for the holidays but back to our normal schedule on Tuesday, Jan. 2.
| | |  The CDC uses artificial intelligence to detect tuberculosis in lung X-rays. | AP Photo/Lefteris Pitarakis | HOW HHS USES AI — With the race from health care companies to develop and use artificial intelligence, it shouldn’t come as a surprise that HHS is using AI, too, Chelsea reports. As federal officials scramble to regulate artificial intelligence in health care, they can also shape how AI works in their day-to-day operations, according to Suresh Venkatasubramanian, a data and computer science professor at Brown University. “A lot of government agencies don’t do in-house development,” said Venkatasubramanian, who recently worked for the Biden administration and co-authored the blueprint for the AI Bill of Rights, which aims to protect against AI misuse. “They purchase software from vendors. And so, agencies have the power to decide who they procure from, under what guidelines, what rules. They’re able to shape the expectations for software and the guardrails on it.” HHS is one of the top agencies using AI — fourth only to NASA and the Commerce and Energy departments — according to a recent Government Accountability Office report, which looked at reported, implemented and planned AI uses by department. Here are 4 ways HHS is using AI: 1. Food and Drug Administration: The FDA is implementing an AI platform trained on data from 1,500 clinical trials to write clinical study reports using Phase I and II study data. According to HHS’ AI use cases inventory, the AI can “mimic the subject matter experts,” including clinicians and statisticians, to decipher the study design and interpret the results. 2. Administration for Strategic Preparedness and Response: An ASPR spokesperson pointed to several programs that use AI at the agency, including EmPOWER, which offers first responders a downloadable voice-controlled app that can tell them how many Medicare beneficiaries with electricity-dependent medical devices are in the area. 3. National Institutes of Health: The NIH uses a tool that predicts the priority level and area of research for grant applications and then ranks incoming submissions using the AI’s analysis, allowing highly ranked applications to be reviewed first, according to the HHS AI use cases inventory. 4. Centers for Disease Control and Prevention: The CDC uses AI and machine learning to improve surveillance testing. Its tools detect tuberculosis in chest X-rays and identify cooling tower locations from aerial imagery to help prevent or controlLegionella outbreaks. The agency is also looking into an open-source AI model to improve transcriptions. WELCOME TO WEDNESDAY PULSE. We came across a great gift idea for people in health care. Reach us at bleonard@politico.com or ccirruzzo@politico.com. Follow along @_BenLeonard_ and @ChelseaCirruzzo. TODAY ON OUR PULSE CHECK PODCAST, host Lauren Gardner talks with POLITICO health care reporter Alice Miranda Ollstein, who reviews significant developments surrounding abortion over the past year amid ongoing political turmoil and breaks down what to expect heading into 2024.
| | | | | | | A message from PhRMA: PBMs decide if medicines get covered and what you pay, regardless of what your doctor prescribes. PBMs say they want patients to pay less, yet they often deny or limit coverage of lower-cost generics and biosimilars. Instead PBMs cover medicines with higher prices so they make more money. Learn more. | | | | | | | 
The fees for government arbitration to settle disputes between insurers and health care providers over out-of-network billing have been finalized. | Jacquelyn Martin/AP | FEES DROP — The Biden administration has finalized long-awaited fees insurers and hospitals have to pay for government arbitration for disputes over out-of-network charges, POLITICO’s Robert King reports. Neither providers nor insurers were pleased with the implementation of the 2021 No Surprises Act, which aims to protect patients from surprise medical bills when they’re unwittingly treated by an out-of-network provider and which is where the arbitration process stems from. House Ways and Means Committee Republicans have also raised concerns. Regulators have been overwhelmed with requests to resolve disputes — over 20 times more than anticipated. If insurers and provider facilities can’t agree, they consult a third-party arbiter. On Monday, the government revealed for the first time how it calculates arbitration fees. A single dispute is between $200 and $840. For a batch of disputes, the fee is $268 to $1,173. If a batch is more than 25, an extra fee of $75 to $250 will be added. The rates will apply after the rule starts in January. A federal ruling in August shot down the federal government’s fee process, leaving hospitals and insurers waiting to see what the fees would be. Agencies will update fees every year.
| | AUDIT OF NIH AUDITS — The NIH didn't ensure that foreign grant recipients compiled or submitted mandatory audit reports, two federal watchdog reports released Tuesday said, POLITICO’s Erin Schumaker reports. HHS’ inspector general examined foreign grant recipients with annual HHS funding of $750,000 or more, the threshold for audit. Recipients had to submit 109 annual reports to the NIH during the 2019 and 2020 fiscal years, but the NIH didn’t receive 81 of them. The NIH’s follow-up wasn’t timely in close to three quarters of cases, one watchdog report found. A separate inspector general report found that the NIH didn’t consistently ensure grant recipients made corrections promptly based on audit findings. The response: The watchdog recommended four actions to address the problems, which the NIH said it agreed with. The agency expects to complete them by September 2024. Why it matters: The NIH awarded hundreds of millions of dollars to foreign grant recipients in fiscal 2022, and its handling of such grants is under fire following a previous watchdog report. That report found that the NIH didn't effectively monitor its grants to the research group EcoHealth Alliance, saying it improperly used grant funding and failed to obtain scientific documentation from China’s Wuhan Institute of Virology, which it oversaw. Most federal government agencies believe the Covid pandemic likely originated with an infected animal, but at least two agencies back the theory that it might have begun with a lab accident at the Wuhan lab.
| | | | PREVENTING ILLNESS FROM SETTING SAIL — The CDC has new guidance for cruise ships to prevent and manage outbreaks of respiratory illness, close to four years after the start of the Covid pandemic stranded thousands of travelers at sea, Chelsea reports. “Many cruise ship travelers are older adults or have underlying medical conditions that put them at increased risk of complications from these respiratory virus infections,” the agency said Monday. Among several recommendations, the agency says cruise ship operators should consider screening embarking passengers for viral respiratory illness symptoms and a history of exposure or testing positive for Covid and, if possible, deny boarding to sick passengers. The agency also recommends that the crew stay up to date on vaccinations. For passengers who get sick, the CDC recommends certain isolation guidance depending on the severity and timing of the illness and masking.
| | | | A message from PhRMA:   | | | | | FIRST IN PULSE: TRANSPARENCY IN THE SPOTLIGHT — PatientRightsAdvocate.org — the nonprofit group with splashy ads about health price transparency featuring rapper Fat Joe — has a new report illustrating the vast variations in cost for common services, Megan reports. The group said it examined data from hospitals in 10 states and found the maximum in-network rate negotiated with insurance plans for five procedures — including cesarean sections and cataract surgeries — was, on average, almost 11 times higher than the minimum negotiated rate for the same service within the same hospital. For example, an appendectomy in one New York hospital could cost anywhere from $1,960 to $63,271 — 32 times higher than the minimum negotiated rate for the same service within the same hospital. Price variations were even more stark between hospitals in the same state, with the maximum negotiated rates averaging 31 times the minimum. PatientRightsAdvocate.org has pushed legislation to codify Trump-era hospital and insurer price transparency rules. The House recently passed a health package that includes bolstered disclosure requirements, and Sen. Mike Braun (R-Ind.) introduced bipartisan legislation with similar policies last week. The American Hospital Association pushed back on the report’s premise, saying it oversimplifies the negotiations between providers and insurers and misconstrues the reality of factors contributing to price variations in hospitals — including labor costs and complexity of care. The rates “often do not reflect what is actually paid” by patients because of adjustments that occur, Ariel Levin, AHA’s director of policy, said in a statement. The figures also don’t “reflect individual patients’ expected cost-sharing amounts,” she said.
| | | | Amy Abernethy is leaving Verily, where she has been chief medical officer. She will lead a nonprofit in Texas to bolster evidence generation.
| | | | A message from PhRMA: PBMs decide if medicines get covered and what you pay, regardless of what your doctor prescribes. PBMs say they want patients to pay less, yet they often deny or limit coverage of lower-cost generics and biosimilars. Instead PBMs cover medicines with higher prices so they make more money. Learn more. | | | | | The FDA has approved the first test leaning on DNA to gauge if a person is at higher risk of opioid use disorder. Healthcare Dive reports on a California hospital deal falling apart after FTC scrutiny. POLITICO's Holly Otterbein reports that Rep. Dean Phillips, the Minnesota Democrat running for president, is putting his name on the progressive-supported Medicare for All bill. House Ways and Means Democrats released a report on health care’s role in climate change.
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