DCMedical News: Thursday, October 24, 2019
DCMedical News-DCMN
Washington, D.C.
Thursday, October 24, 2019
DCMedical News is published every day both the House and the Senate are in session. Subscription information below.
THE BIG STORY IN HEALTH CARE
House Drug Bill Stalled
Approved by a third House Committee (Ways & Means), drug price control legislation (H.R. 3, here) will not be acted upon until at least mid-November, says Bloomberg Health Law. The bill seeks “To establish a fair price negotiation program, protect the Medicare program from excessive price increases, and establish an out-of-pocket maximum for Medicare part D enrollees, and for other purposes.”
Budget and Appropriations Stalled
The National Association of Medicaid Directors reports (here) that “Resolving federal funding for the next fiscal year remains Congress's top priority for the remainder of this legislative session - and signs indicate that work is stalling . . . significant policy disagreements within various appropriators' jurisdictions suggest another Continuing Resolution (CR) to fund the federal government is likely when the current CR expires on November 21. Depending on whether Congress makes more progress by that date, a new CR could be relatively short term to buy time for the finishing touches on an omnibus spending package, or it could be a longer-term CR going into 2020. At this stage it is not yet clear what the direction will be. On the Medicaid front . . . the open policy question is whether there will be delays or modifications to scheduled Disproportionate Share Hospital (DSH) cuts.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Cardiac Rehab Value
Attention value-based purchasers: a study in this week’s JAMA Cardiology (here) reports that of “Medicare beneficiaries undergoing cardiac valve surgery in 2014, 43% participated in cardiac rehabilitation programs after discharge. Enrollment in cardiac rehabilitation was associated with a 34% relative decrease in hospitalizations within 1 year of discharge and a 4.2% absolute (61% relative) decrease in 1-year mortality risk.”
Diabetes Outstripping Supply of Treating Physicians
A study in JAMA Cardiology (here) contends that “Cardiologists appear well positioned to participate in diabetes care given their numbers and distribution relative to diabetes cases. The burden of diabetes nationally appears to be outpacing access to endocrinologists in the United States, especially in certain states,” and that cardiologists may have an impact on diabetic patients, since “Hospitalization for acute cardiovascular care may represent a teachable moment for counseling, screening, risk factor modification, and treatment initiation.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Republican Study Committee Issues Health Plan
In sixty-eight pages, with 179 footnotes, the Republican Congressional leadership group’s plan (here) distinguishes affordable health care from health insurance coverage. “The current system guarantees individuals can get insurance coverage, but it does so at the expense of affordability, plan retainment, access to quality care, and availability of doctors- all things that are important to those that are chronically ill. Moreover, it exacerbates the issue of pre-existing conditions by disincentivizing people from getting coverage before getting sick.” The document is entitled “A Framework for Personalized, Affordable Care, Health Care Plan Part One.”
Anthem Reports Growth, Profit, in Q3
Anthem’s CEO reported (earnings call transcript here) that “Anthem's third quarter operating revenue increased a robust 15% over the prior year quarter to $26.4 billion. Medical membership across all of our businesses increased by 1.1 million consumers served with our risk businesses accounting for nearly 90% of total growth.” Operating profit for the third quarter was 5.8%, y-t-d $1.2 billion, up 23% from a year ago.
Limits on Doctor Pensions in England’s NHS Lead to Limits on Patient Care
Doctors in England’s National Health are limiting hours according to the Financial Times (here), to avoid 100%+ taxation rates secondary to changes in their pensions introduced in 2016. “The latest evidence of the impact of the pensions issue on patient care has emerged from NHS trust board notes covering September and October, which showed that of the 61 hospitals examined, 30 were blaming longer waiting times in cancer diagnosis, ophthalmology and radiology on the pensions shake-up, as consultants and senior staff turned down extra shifts or reduced their hours to avoid additional charges.”
READINGS AND REFERENCES
Proposed Rules for CY 2020, Physician Fee Schedule and Outpatient Quality Measures
HFMA analysis of the proposed (July 19) calendar year 2020 rule, “Revisions to Payment Policies under the Physician Fee Schedule and Other Changes to Part B Payment Policies; Medicare Shared Savings Program Requirements; Medicaid Promoting Interoperability Program Requirements for Eligible Professionals; Establishment of an Ambulance Data Collection System; Updates to the Quality Payment Program; Medicare Enrollment of Opioid Treatment Programs and Enhancements to Provider Enrollment Regulations Concerning Improper Prescribing and Patient Harm; and Amendments to Physician Self-Referral Law Advisory Opinion Regulations,” Part I here, Part II (quality) here.
U.S. House of Representatives:
Members at https://www.house.gov/representatives
Committees and Members at https://www.house.gov/committees
U. S. Senate:
Members at https://www.senate.gov/general/contact_information/senators_cfm.
Committees and Members at https://www.senate.gov/committees
House and Senate 2019 Calendar of Regularly Scheduled Sessions, here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
October publication dates: 28, 29, 30, 31
November publication dates: 12, 13, 14, 15, 18, 19, 20, 21
December 3, 4, 5, 6, 9, 10, 11, 12
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.