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Just In | The Hill 

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–> A midday take on what’s happening in politics and how to have a sense of humor about it.* 

*Ha. Haha. Hahah. Sniff. Haha. Sniff. Ha–breaks down crying hysterically.

TALK OF THE MORNING 

Is the 12th vote the charm??:

I feel like a broken record writing this again, but the House is back again on Friday as negotiations continue to determine the Speaker. Day 4! 

McCarthy’s message this morning: NBC News’s Kate Santaliz tweeted video of Rep. Kevin McCarthy (R-Calif.) entering the U.S. Capitol on Friday morning. “We’re going to make progress, we’re going to shock you,” he told reporters. Watch

What’s been happening behind the scenes?: McCarthy has been negotiating with some of the Republicans who oppose his bid. But it remains unclear whether McCarthy’s concessions will be sufficient to convert enough of the detractors into voting for him. Where the negotiations stand

How many failed votes have we had this week?: On Thursday, McCarthy lost his 11th straight Speaker vote. 

Where McCarthy’s bid stands: 21 House Republicans voted against McCarthy in the 11th Speaker vote. He can only afford four defections.

C-SPAN livestream of the House floor: Watching lawmakers’ discussions and facial expressions is fascinating these days. 

Live blog of updates 

The House is a bit chaotic because of the standstill: The New Republic’s Grace Segers tweeted on Thursday night, “It would be way more convenient if the House were just in recess and they didn’t have to reconvene at 8pm and clear another motion to adjourn. But the House isn’t in recess, because no one controls the floor, because no one has actually been sworn in yet.”  

‘TRUMP’S CLOUT TAKES HIT FROM SPEAKER’S FIGHT’: 

Keep in mind that former President Trump called for Republicans to rally around McCarthy. How this could affect Trump’s power 

‘Chip Roy seizes his moment’: “The chaotic failure of House Republicans to elect a Speaker — so far — has had a silver lining for at least one member. Rep. Chip Roy (R-Texas), a leading opponent of Rep. Kevin McCarthy (R-Calif.), has seized the national stage.”  

What makes Roy stand out: “McCarthy allies see Roy as more inclined toward sincere, good-faith negotiations than other dissenters.” Read Niall Stanage’s full column

Happy Friday! I’m Cate Martel with a quick recap of the morning and what’s coming up. Did someone forward this newsletter to you? Sign up here. 

SIGHTS AND SOUNDS:

What it looks like outside the Speaker’s office these days: Video from ABC News’s Gabe Ferris 

Rep. Jimmy Gomez’s (D-Calif.) baby has been an MVP: Photo of Gomez baby-wearing, Photo of Gomez feeding his baby, And a photo of the duo doing an interview

^ OK, this photo is too cute: Gomez tweeted, “7th speaker vote fail. At this rate  

@JoaquinCastrotx’s daughter Anna Valentina and Hodge will be going to prom!” Photo of the House babies 

Rep. Jamie Raskin (D-Md.) brought some sass: “We never had to deal with this much chaos when George Santos was Speaker,” Raskin tweeted. 

Yes, this!: C-SPAN’s Craig Caplan tweeted, “Applause for the work of the House clerk Cheryl Johnson as the House Speaker election enters its 11th vote.” Photo

📊 News this morning 

The last jobs report of 2022:

“The final jobs report of 2022 showed U.S. employment growth slowing under the weight of higher interest rates and stubborn inflation, but not enough to derail a historically strong labor market.”

The numbers: “The U.S. added 223,000 jobs in December and brought the unemployment rate down to 3.5 percent, its level in February 2020, from 3.7 percent in November, according to the Labor Department.”

What these numbers mean for the economy: “While job growth slowed from November’s revised total of 256,000, December’s employment gain still came in above economists’ expectations—and without other warning signs of an overheating economy.”  

The Hill’s Sylvan Lane gives more context to Friday’s report 

‘EVEN A SOFT LANDING FOR THE ECONOMY MAY BE UNEVEN’:

“Small businesses and lower-income families could feel pinched in the months ahead whether or not a recession is avoided this year,” writes The New York Times’s Talmon Joseph Smith. The full read

🔥 Two years ago today 

Thinking about this day still sends a shiver down my spine: 

Two years ago Friday, a pro-Trump mob violently broke into the U.S. Capitol, ransacking the landmark and risking the safety of lawmakers, staff and journalists.  

This morning: House Democrats and one Republican held a moment of silence on the Capitol steps. Biden will hold an event this afternoon. 

‘IN PHOTOS: AN HOUR-BY-HOUR RECORD OF THE JAN. 6 CAPITOL RIOT’:

Axios published a series of photos last year to remember Jan. 6, 2021. It sends me right back to that day. Hour-by-hour photos from Jan. 6 

ON CAPITOL HILL THIS MORNING: 

CBS News’s Scott MacFarlane tweeted, “Counter protestors … some chanting ‘Insurrectionist losers’ and Jan 6 defendant supporters are getting into each others faces right now on East Front of Capitol. Growing police presence.” Watch

✈️ In other news 

Big yikes!: 

Southwest estimates that its holiday meltdown will cost the company roughly $725 million – $825 million.  

How the company estimates that figure: “Southwest said that it will lose up to $425 million in revenue on refunded flights alone. The company will also shell out huge sums to provide frequent flier points to customers and reimburse stranded travelers for their unexpected travel, lodging and food costs.” 

The gist of what happened: “In what experts called an unprecedented meltdown, Southwest’s scheduling systems went haywire after winter storms hit some of its hubs, preventing flight crews from getting to the right plane. The company had to shut down nearly two-thirds of its flights to get things under control.” The full story 

SOME SIGHTS AND SOUNDS FROM THE SOUTHWEST MELTDOWN OVER THE HOLIDAYS:

This is one excited passenger: NBC Chicago’s Noel Brennan tweeted, “After two canceled Southwest flights, Patrick Keane was finally reunited with his bag at Midway, and he let the entire airport know how it felt.” Watch his reaction 

Look at all of the bags — this is from the day after Christmas: Denver7’s Rob Harris tweeted a video of the unclaimed bags. “A visual representation of the disaster that is air travel at the moment. A Southwest Airlines rep just said over the intercom that bags are heading to final destination, even if the flight they were scheduled on is cancelled.” Watch 

More unclaimed bags in Tampa, Fla. 

A pilot handed out coffee to passengers: “We’re trying folks,” he told passengers. Video from WUSA 9’s Eric Flack

🦠 The COVID-19 numbers 

Cases to date: 101 million 

Death toll: 1,091,184 

Current hospitalizations: 41,297 

Shots administered: 665 million 

Fully vaccinated: 69.1 percent of Americans 

CDC data here.

🐥Notable tweets 

I see another NFT in the making: 

Check out the edited photo of President Biden, Vice President Harris and former President Trump that Trump posted on Truth Social this morning. Photo 

Oh no, we all know where this is going: 

Fox 5 DC’s Steve Chenevey tweeted, “National Park Service – ‘Do not go on the frozen reflecting pool’ … Guy on bike – ‘watch me.’” Video 

⏱On tap

The House is in. The Senate is out. President Biden and Vice President Harris are in Washington, D.C.

9 a.m.: Biden received his daily briefing. 

11:10 a.m.: Harris ceremonially swore in Bijan Sabet as ambassador to the Czech Republic. 

12:45 p.m.: Biden and Harris have lunch together. 

4:30 p.m.: Biden leaves for Delaware.

All times Eastern.

📺What to watch

Noon: The House meets again to vote for a speaker. Livestream 

12:45 p.m.: White House press secretary Karine Jean-Pierre holds a press briefing. Livestream 

2 p.m.: Biden marks the two-year anniversary of the Jan. 6, 2021, attack on the U.S. Capitol. Harris and second gentleman Doug Emhoff attend. Livestream 

Sunday morning: Rep. Hakeem Jeffries (N.Y.), the incoming House Democratic leader, will appear on NBC’s “Meet the Press.”

🍪 In lighter news

Today is National Shortbread Day.

And to get your weekend off to a fabulous start, here’s a baby who really appreciates the beauty and essence of birthday cake.

​12:30 Report, News Read More 

Just In | The Hill 

With no warning and no apparent sense of irony, on Dec. 23, the Centers for Medicare and Medicaid Services (CMS) surprised the medical community with a substantial change in the No Surprises Act (NSA).

The act, which was supported by the medical community, was passed to protect patients from unexpected out-of-network medical bills that they could not reasonably anticipate or avoid. On the Friday before the long holiday weekend, CMS stated that if providers wish to appeal an underpayment from health insurance companies by requesting arbitration (termed “independent dispute resolution” or “IDR”), the administrative fee they are required to pay would be increasing by 600 percent. This change was effective Jan. 1, four business days after the announcement. 

Surprise!

In 2022, the administrative fee was $50. Two months ago, CMS confirmed that the fee would remain $50 in 2023. A few days before the new year came the unexpected announcement that the fee was increasing to $350. 

While this change is relevant for all hospital-based medical specialties, it is especially meaningful for those of us in radiology. This is because almost all radiology claims are less than $350. Thus, if an insurer under-reimburses a physician, and the physician wishes to access the federal NSA independent dispute resolution process to settle the disagreement, the physician must pay a $350 administrative fee. This fee is separate from and in addition to the fee charged by the arbiter (which is several hundred dollars). That arbiter’s fee is paid by each side in arbitration but the winner in arbitration has their amount returned. The administrative fee is not returned. 

As a result of this fee increase, if an insurer under-reimburses for less than $350, it is not cost-effective for providers to request arbitration. If an insurer inappropriately pays $25 when they should have paid $100, the physician can request arbitration and pay $350. When the physician wins in arbitration, they will receive $75 from the insurer plus the return of the arbiter fee they paid, but they will not get back the $350. As a result, they suffered a net loss of $275 ($350-$75), plus the time value of the arbiter fee plus the resources they had to expend to file the case.

To make arbitration worthwhile, the amount recouped must be greater than the amount spent to win a determination. With the new administrative fee of $350, this is nearly impossible for many providers.

Why is CMS doing this? CMS stated that there was a greater number of arbitration submissions than anticipated. The system was overwhelmed, and they had to take action to cover their costs to manage the system. At a high level, CMS had two options:

Limit the need for providers to submit claims for arbitration. 

Limit the ability of providers to submit claims for arbitration. 

Instead of taking action to promote reasonable reimbursement by insurers, which would limit providers’ need to request arbitration, CMS chose the latter option. The $350 fee will accomplish their goal of limiting providers’ ability to access arbitration. It is worth noting that the No Surprises Act was painstakingly crafted to protect patients by promoting good-faith negotiations between providers and insurance companies, limiting the need for arbitration. If one side acted unreasonably, arbitration was available to correct the misbehavior. Of course, this system only works if both sides have access to unbiased arbitration. If there is no threat of review by a neutral third-party arbiter, insurance companies are free to reduce reimbursement rates at will. As medical practices absorb these additional cuts, services will be reduced or lost, impacting patients. 

There are at least three actions that CMS could take to alleviate this problem. First, CMS could widen the batching of claims for arbitration. Using the example above, if 10 claims that were under-reimbursed for an average of $75 each were bundled together for arbitration, that would be cost-effective. Although the law provides for flexibility with batching, in prior guidance CMS specified that there were strict limits on how claims could be batched together. As a result, instead of one submission containing 10 claims, practices often need to submit numerous individual claims for arbitration. The administration could address this unnecessary limitation on batching through rulemaking, making the arbitration process far more efficient.

Second, CMS could stipulate that the full administrative fee is paid by the losing party in the arbitration. This would allow the government to keep the fee that they claim is necessary to manage the program and penalize the loser in arbitration. This is also consistent with the way the law was established. The No Surprises Act was written such that the loser in arbitration pays the arbiter’s fee. If arbitration is truly balanced, this penalty serves as a mechanism to support reasonable behavior and promote network contracting. 

Finally, if the administrative fee was paid directly to the government by both parties at the time of submission, there might be no need to increase the fee. Based on the government’s recent report, they spent about $8.3 million but only received about $90,000 in administrative fees despite over 3,500 determinations. Using the $50 fee, which is $100 to the government because it is paid by both parties, and their report of over 90,000 submissions, the government could have over $9 million, more than covering their costs without a fee increase. Even accounting for ineligible submissions, if payments were made directly to the government, millions of dollars would be readily collected.

These options would help address the immediate threat to medical practices and their patients. Longer term, CMS should consider ways to promote balanced, good-faith negotiations between medical practices and insurers, limiting the need for providers to submit claims for arbitration.

With the support of the medical community, the No Surprises Act was passed to protect patients from surprise bills. CMS should show physicians the same respect.  

Richard Heller, MD, MBA, is a Chicago-based pediatric radiologist with Radiology Partners. He is their associate chief medical officer: communications and health policy, as well as the national director of pediatric radiology. He is a clinical associate at the University of Chicago Medical Center, Comer Children’s Hospital. His academic work focuses on the economics of healthcare and value-based reform, as well as the issue of out-of-network billing legislation.

​Healthcare, Opinion Read More