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With Katherine Ellen Foley

FEE SCHEDULE DROPS — CMS released its highly anticipated proposed physician fee schedule last week, and it quickly drew applause — and scorn — from industry groups.

The 1,920-page document lays out how the agency proposes to pay doctors in the Medicare system in 2024. CMS touted it as a win for health equity, price transparency and behavioral health.

Here are some of the most noteworthy proposals:

— Doctor pay cut: The Biden administration proposes cutting Medicare payments to doctors by 3.3 percent next year, which drew criticism from doctor groups. They argue it would hurt efforts to bolster primary care doctors’ pay and prospects for value-based care. Such cuts could also hurt Accountable Care Organizations.

The move underscores the bind CMS faces as it tries to balance incentivizing doctor behavior with its obligations to cutting spending. It comes as both parties in Congress eye how to improve physician pay to reverse a trend of practices closing or merging with hospitals.

Still, industry groups supported other proposals, including a new add-on payment for primary care doctors treating complex conditions and other changes to how doctors in value-based arrangements get paid.

— Hospital price transparency: The agency proposes significant changes to the way hospitals post prices for their services, so consumers can understand them and competition would increase, which could reduce costs.

Hospitals aren’t currently required to post their prices in any standardized way. CMS proposes adopting a template.

— Telehealth: CMS proposes bolstering telehealth payment rates for virtual providers caring for patients in their homes.

The agency says doctors need additional compensation because they offer a significant amount of telehealth while maintaining their physical offices. CMS doesn’t expect its costs will rise substantially despite proposing higher provider payment rates.

CMS also took further steps to facilitate telehealth access through the end of 2024 — when Congress’ extension of eased telehealth rules is set to expire — to applause from industry groups.

— Remote patient monitoring: The agency proposes allowing federally qualified health centers and rural health clinics to bill separately for remote patient monitoring, arguing it “reflect[s] the additional resources necessary” for the services. But it keeps in place regulations limiting billing for remote monitoring for “established” patients, or those using the technology before the public health emergency’s end.

Other significant proposals included:

— Paying for intensive outpatient care provided by opioid treatment programs beginning Jan. 1, implementing Congress’ will

— Creating a new benefit category for intensive outpatient care

— Permitting doctors to fulfill requirements that they supervise the provision of certain medical services virtually through 2024

What’s next: The agency is taking comments on the proposal through Sept. 11.

WELCOME TO MONDAY PULSE. What legislation do you think could move before August recess? And is there anything flying under the radar in the fee schedule? Let me know at [email protected]. And don’t forget to send tips to Daniel Payne, your regular Pulse host, at [email protected].

TODAY ON OUR PULSE CHECK PODCAST, host Kelly Hooper talks with Megan Messerly, who describes how Indiana Gov. Eric Holcomb convinced a bipartisan majority in his state’s legislature to boost public health funding this year by 1,500 percent, overcoming opposition from fellow Republicans angry about the government’s response to Covid-19.

FTC SIGNALS HEALTH CARE CRACKDOWN — The Federal Trade Commission announced Friday that it’s withdrawing two guidance documents on antitrust issues in health care, saying they’re “outdated.”

The Justice Department withdrew the same documents in February.

The FTC said the health care market has significantly changed in the past 30 years, making the old guidance no longer appropriate. Instead, it will lean on general antitrust principles.

“The Commission’s extensive record of enforcement actions, policy statements, and competition advocacy in health care provide more up-to-date guidance to the public,” the FTC wrote.

What the guidance said: The Clinton-era statements, created in collaboration with health care industry leaders, defined how the antitrust enforcers viewed anticompetitive behavior and explained how industry could share data under certain narrow conditions called “safety zones” without triggering regulatory problems.

At the time, regulators also believed that data-sharing might lead to lower health care costs for patients.

Response to DOJ move: Some in the health care industry weren’t happy with the DOJ’s decision in February, saying it would hurt innovation and strays from precedent.

NEW ALZHEIMER’S DRUG DATA TO BE PRESENTED — Eli Lilly will release highly anticipated data on a late-stage trial of its Alzheimer’s drug, donanemab, today at the Alzheimer’s Association International Conference in Amsterdam, Katherine reports.

In May, the company released top-line results that said the therapy — which works similarly to the recently approved Leqembi — “significantly slowed cognitive and functional decline.” The company is publishing more details from that study at the conference.

The FDA rejected Lilly’s bid for accelerated approval for donanemab earlier this year on the grounds that too few trial participants had received the drug for 12 months, saying it wanted to see more data on the effects of taking the drug longer term.

CHAIRS WANT CMS TRANSPARENCY — House Energy and Commerce chair Cathy McMorris Rodgers (R-Wash.) and Ways and Means chair Jason Smith (R-Mo.) led a letter to CMS Friday calling for more transparency from CMS on how it weighs Medicare national coverage determination requests.

National coverage determinations set out how Medicare will cover certain items and care nationally and leans on evidence review.

“Today, however, there are an unknown number of review requests pending before the agency, with unknown time intervals for each review, and an unknown methodology for how these requests are prioritized. Consequently, patients are waiting for access to items and services without any visibility into the government’s decisionmaking process or a means to anticipate when such products may be available to them,” the lawmakers wrote.

The lawmakers asked CMS for a list of items awaiting a national coverage determination and a plan for updating the NCD dashboard, which they say hasn’t been updated in nearly three years.

Why it matters: The request comes as lawmakers have been critical of the agency’s limited national coverage determination for Alzheimer’s treatments and takes their scrutiny to another level.

CMS didn’t respond to a request for comment.

988 UPDATE — 988, the mental health hotline, received 2.7 million calls between July 2022 and May 2023 and nearly 741,000 chats and 607,000 texts, according to a new KFF analysis.

The report also found that:

— Rates of the hotline being answered in-state varied substantially, from 55 percent in Alabama to 98 percent in Mississippi. Since states decide how to run their own programs, the discrepancies could reflect differences in investment, KFF said.

— There’s momentum in states for 988 fees on cell phones to help cover the cost.

— Answer rates increased over time, and more people reached out.

Karen Bowling will serve as 340B Health’s new board of directors chair. She’s the executive vice president of government affairs at West Virginia University Health System.

Francisco Rhein will be chief health informatics officer at the Federal Electronic Health Record Modernization Office.

Healthcare Brew looks at how Oregon responded to wildfire smoke, including sending air purifiers to people at risk.

POLITICO’s Sophie Gardner zeroes in on maternal mortality.

Healthcare Dive looks at CMS’ struggles with data quality in its health equity push.