THE PROGNOSIS

Dark-money groups have been going after Congress for trying to free Americans from burdensome surprise medical bills. Now Congress is going after them.

In an investigation launched yesterday, leaders of the House Energy and Commerce Committee are demanding answers from three private equity firms about their relationship with companies that staff doctor offices and emergency rooms around the country and are a source of unexpected bills that leave thousands of Americans in medical debt every year.

Two of the staffing companies — TeamHealth and Envision Healthcare — have been pouring millions of dollars into ads opposing legislation to reform the practice known as surprise billing, as detailed in this recent report by the New York Times. They’ve kept their staff and funding secret, making it hard to figure out who is behind the effort to stymie one of the most bipartisan efforts on Capitol Hill this year.

They contract with hospitals to supply them with emergency physicians and specialists. But they’re known for charging significantly higher rates when a patient gets care from a provider or hospital outside their plan’s negotiated network. 

“We are concerned about the increasing role that private equity firms appear to be playing in physician staffing in our nation’s hospitals, and the potential impact these firms are having on our rising healthcare costs,” Chairman Frank Pallone (D-N.J.) and ranking member Greg Walden (R-Ore.), wrote to private equity firms KKR & Co.; Blackstone Group; and Welsh, Carson, Anderson & Stowe. 

Tackling surprise medical billing appeared to have a lot of steam at the beginning of this year, as multiple committees in Congress worked on legislation laying out how out-of-network payments should be settled between insurers, hospitals and doctors. There was — and remains — a strong consensus among lawmakers and industry groups that patients shouldn’t have to pony up when they have to visit an out-of-network emergency room or get care from an out-of-network physician in an in-network hospital.

The effort hasn’t stopped — but it has been slowed by a tug-of-war between insurers and providers, who disagree over how best to resolve out-of-network bills.

And now these private equity firms have emerged as a secretive force trying to halt the effort entirely. The companies are the largest financial backers of a mysterious group called Doctor Patient Unity, which has spent more than $28 million on ads opposing surprise medical billing legislation.

“Doctor Patient Unity represents tens of thousands of doctors across the country who understand the importance of preserving access to lifesaving medical care and support a solution to surprise medical billing that protects patients,” Greg Blair, a spokesman for the group, told the Times, weeks after it was first contacted about the ads.

“We oppose insurance-industry-backed proposals for government rate setting that will lead to doctor shortages, hospital closures and loss of access to medical care, particularly in rural and underserved communities,” the spokesman said.

There’s a reason private equity firms have been snatching up provider companies. There’s a lot of profit to be made. In 2016, Blackstone Group bought TeamHealth for $6.1 billion. KKR bought Envision’s group ambulance subsidiary in 2017 for $2.4 billion. And last year, KKR acquired the rest of Envision for nearly $10 billion.

In the meantime, medical debt remains the top cause of bankruptcy filings in the United States, as there are few checks on doctors and hospitals charging exorbitant rates to patients. Pallone and Walden detailed a few patient stories in their letters to the firms:

— Sonji Wilkes confirmed the hospital where she delivered her son was in-network with her insurance plan. But after the baby required emergency care in the hospital’s neonatal intensive care unit, she received a $50,000 bill for his stay. She found out later the hospital had subcontracted the NICU to a third-party provider that wasn’t part of any insurance plan’s network.

— Stefania Kappes-Rocha went to the emergency room at Zuckerberg San Francisco General Hospital for a kidney infection. After spending the night in the emergency room and being sent home with ibuprofen, she was billed more than $27,000.

— Drew Calver received emergency treatment for a heart attack at St. David’s Medical Center. He was subsequently billed $108,000.

“Surprise billing has devastated the finances of households across America and this practice is increasing at an alarming rate,” the legislators wrote. “Every day we hear stories about families who have endured financial and emotional devastation as a result of surprise bills.”

AHH, OOF and OUCH

AHH: President Trump won't consider a House-passed universal background checks bill as part of a package of gun proposals he's expected to unveil this week, Politico’s Marianne Levine reports.

“Trump met again with aides Monday to discuss proposals to address gun violence,” Marianne writes. “While Trump will not support the House-passed universal background checks bill, he could still back a more limited form of background check legislation as well as so-called red flag laws. Sen. Richard Blumenthal (D-Conn.), who is working on a red flag bill with Sen. Lindsey Graham (R-S.C.) said background checks and red flag bills should go hand in hand.”

House Speaker Nancy Pelosi (D-Calif.) and Senate Minority Leader Chuck Schumer (D-N.Y.) have repeatedly urged the president to consider the measure. “We’re certainly willing to discuss the finer points of legislation with our Republican colleagues, but we made one thing clear to the president — the effectiveness of gun safety measures will be severely compromised if we allow the loopholes in our background check system to remain intact," Schumer said.

OOF: Officials in the largest jurisdiction in Maryland are introducing anti-vaping legislation today that could close 19 of the 22 vaping shops in the area by in part banning any shops within a half-mile of middle or high schools.

It’s the latest in a growing movement by local and state leaders trying to crack down on a booming youth vaping trend.

The “shops would be allowed to operate for 24 months after the zoning amendment went into effect but would then have to close or adapt their businesses” to abide by the legislation, our Post colleague Rebecca Tan reports. “... There have been 15 cases of ­vaping-related illnesses in Maryland. The lone victim from Montgomery was between 18 and 24 years old, county Health Officer Travis Gayles said, and experienced 'significant respiratory distress' but stabilized after a week in the hospital."

— Meanwhile California Democratic Gov. Gavin Newsom announced an executive order targeting vaping and e-cigarettes in the state. The order “directs the California Department of Public Health to spend $20 million of cannabis and tobacco tax revenue on a public information campaign about the dangers of vaping intended to build on the state’s existing anti-tobacco campaign,” the Sacramento Bee’s Sophia Bollag reports.

“It’s really unconscionable, folks that are producing those products, they sleep at night knowing what they’re doing to destroy the health of a generation,” Newsom told reporters. “The magnitude of what we’ve unleashed on the American public is yet to be determined.”

OOF: The ousted former president of Planned Parenthood has been in the middle of two months of tense negotiations over her severance after being fired from the organization in July. Leana Wen “accused the organization of withholding her health insurance and departure payout as ‘ransom’ to pressure her to sign a confidentiality agreement,” the New York Times’s Shane Goldmacher reported over the weekend.

Meanwhile, Planned Parenthood rebuffed Wen’s claims about her exit. “Dr. Wen’s recent allegations are unfortunate, saddening, and simply untrue,” Melanie Newman, Planned Parenthood’s senior vice president for communications, told the Times. “The attorneys representing the board have made every good faith effort to amicably part from Dr. Wen, and are disappointed that they have been unable to reach a suitable resolution regarding her exit package.”

“The internal drama comes as Planned Parenthood is increasingly under external political duress,” Shane wrote. “Last month, Planned Parenthood said it was withdrawing from the federal program that provides services to poor women rather than comply with a new Trump administration rule which forbids referrals to doctors who can provide abortions. The program, known as Title X, had provided $60 million annually to the group.”

INDUSTRY RX

— Drug dealers are pushing illicit steroids on social platforms, including Facebook, Instagram, YouTube and Twitter, sparking questions about how those companies monitor what’s on their sites, our Post colleague Cat Zakrzewski reports.

New research from an Internet safety nonprofit group Digital Citizens Alliance and cyberintelligence firm GiPEC found more than 100 examples of pages or posts on these platforms where drug dealers are pushing steroids and other drugs that are illegal without a prescription. The drugs are "found through searching for keywords like Human Growth Hormone or Humatrope."

“Even as recently as this week, more than a dozen Facebook pages, YouTube videos and an Instagram account were selling or promoting prescription steroids and other appearance enhancing drugs,” Cat writes. “After a Washington Post inquiry, the social media companies removed the pages and posts for violating their terms of service, which prohibit illegal drug sales.”

This has been an issue before. Digital Citizens Alliance first found in 2013 that steroids were being sold on YouTube, after which the platform said it cracked down.

— And here are a few more good reads: 

TRUMP TEMPERATURE
Fact Checker
The president says that 7,600 people have been fired in two years. But he falsely suggests none could be fired before a 2017 law.
Glenn Kessler
AGENCY ALERT
Rep. Andy Biggs (R-Ariz.) on Monday raised concerns over allegations of wrongdoing and retaliation against employees working to protect whistleblowers at the Department of Veterans Affairs (VA).
The Hill
HEALTH ON THE HILL
AARP’s white-haired “strike force” is on the offensive like never before, mounting a multimillion-dollar campaign against the drug industry.
Stat
PowerPost
The Maine Republican’s top Democratic opponent used a photo of Collins and Kavanaugh to raise money.
Mike DeBonis
MEDICAL MISSIVES
Health officials recorded no new cases of measles in the United States last week...
Reuters
The wide geographic spread of cases of vaping-related illness and the vast vape market are making health officials' investigation more challenging.
Stat
More than 3.3 million American women ages 18 to 44 were raped the first time they had sexual intercourse, according to a new study, and "all demographic groups reported substantial roles of forced sexual initiation."
CNN
OPIOID OPTICS
Here’s what the OxyContin maker’s Chapter 11 filing means and doesn’t mean.
New York Times
DAYBOOK

Coming Up

  • The House Appropriations Subcommittee on Labor, Health and Human Services, Education and Related Agencies holds a hearing on the mental health needs of children in HHS custody on Wednesday.
  • The House Veterans Affairs Committee holds a hearing on how barriers to hiring at VA impact patient care on Wednesday.
SUGAR RUSH

Sean Spicer isn’t the first person from Trump’s orbit to compete on ‘Dancing With the Stars’: