DCMedical News: January 26, 2018
DCMedical News
Washington, D.C.
Monday, January 29, 2018
THE BIG STORY TODAY IN HEALTH CARE
The President’s State of the Union address, tomorrow (9:00 p.m. EST), including infrastructure plans. In the absence of significant new federal money, and in the face of relative penury among the states, “public-private partnerships” may emerge big winners. (See “leaked” infrastructure draft here, the word “private” appearing 12 times in conjunction with investment. See also British Medical Journal editor on private finance initiatives in the UK, under “Other Publications,” below.)
Thursday at the Greenbrier: The President meets with Republican Members of the House and Senate.
DOCTORS
Looking for a road map to coming HHS activity? Look no further than the section on “Regulatory burden” in the 37 page report, “HHS Year of Accomplishment, 2017,” (YOA, found here). In this document, the Department highlights steps taken to cut the regulatory burden on doctors and hospitals. Keep an eye especially on the “RFI” (Request for Information) process, an “informal” invitation for comment which may subsequently become the basis for official letters, directives and proposed rules in 2018. The RFI process received negative publicity when Politico reported that CMS had published 80 comments selectively out of over 10,000 received in response to an RFI on coverage of contraception and the care of transgender patients. (A sample RFI, this one on regulatory burdens associated with the Patient Protection and Affordable Care Act, can be found here.)
Among the items cited, “Through the end of Fiscal Year (FY) 2017, for the first time in many years, the net regulatory burden imposed on the economy by HHS rules went down,” and “HHS initiated an ongoing review of rules, regulations, and guidance promulgated by the previous administration under the Affordable Care Act, and has so far taken 39 separate actions to bring down costs as part of this effort.”
“HHS undertook a major review of regulations that affect the provision of care and the doctor-patient relationship, consulting with provider groups to determine what is raising the cost of care, lowering the quality of care, burdening their practices, or interfering with their relationships with their patients. So far, that process has included: Withdrawing 70 of the previous Administration’s regulatory actions; Taking 68 deregulatory actions and only including 27 regulatory ones in the Fall 2017 Unified Agenda; and Initiating reviews of more than 20 percent of FDA’s total regulations as part of an ongoing review of the entirety of the agency’s regulations.”
Also, “Holding secretarial roundtables and more than 200 meetings involving senior HHS staff and more than 30 organizations representing over 1 million medical practitioners. CMS launched its ‘Patients Over Paperwork’ initiative, highlighting its efforts to reduce regulatory burden. As a part of this initiative, Administrator Verma traveled to eleven cities in nine states to host listening sessions on the impact that regulatory burden has on providers, doctors, and clinicians.”
Here, (CMS on 2016 National Health Expenditures), parenthetically, is what Ms. Verma says keeps her up at night.
HOSPITALS
The Year of Accomplishment also had something to offer for hospitals, as follows:
“CMS’s finalized OPPS rule includes a provision that would alleviate burdens rural hospitals experience in recruiting physicians by placing a two-year moratorium on the direct supervision requirement currently in place at rural hospitals and critical access hospitals.”
“CMS proposed and finalized a rule to update 2018 Medicare payment and policies when patients are admitted into hospitals, with numerous actions to support the patient-doctor relationship in healthcare; reduce regulatory burdens on providers; and promote transparency, flexibility, and innovation in the delivery of care. As one example, the rule reduced the number of electronic clinical quality reporting measures from eight to four.”
“CMS proposed a one-year regulatory moratorium on the payment policy threshold for patient admissions in long-term care hospitals while the agency continues to evaluate long-term care hospital policies.”
“CMS’s final rule for the Quality Payment Program (QPP), the new program for paying clinicians that CMS is required to implement, included a number of policies to ease the transition for clinicians. CMS decreased the number of clinicians required to participate and added an option to help small, rural practices join together to share the responsibility of complying.”
HEALTH INSURANCE, MEDICARE, MEDICAID, COMMERCIAL
Finally, HHS was also busy on Medicaid matters in the Year of Accomplishment, as follows:
“CMS approved 26 state demonstration waiver actions for state Medicaid programs in 2017. These include two new demonstration programs, eight extensions, and 16 amendments across the following states: Alabama (3), California (2), Delaware, Florida (2), Iowa (2), Massachusetts, Mississippi, Missouri, Montana (2), New Jersey (2), Oklahoma, Pennsylvania, Texas (2), Utah (2), Virginia, West Virginia, and Wisconsin. CMS approved the first ever 10-year Medicaid waiver, building on the Administration’s commitment to reduce administrative burdens and partner with states to improve the Medicaid program and the people it serves.”
And the YOA also included these matters (using the RFI protocol, see above) concerning Medicare, Medicare Advantage and Medicare Part D (for Drugs):
“CMS released an RFI to welcome continued feedback on Medicare Advantage and Part D, soliciting ideas for regulatory, sub-regulatory, policy, practice, and procedural changes to better accomplish transparency, flexibility, simplification and innovation in the programs.”
“CMS released an RFI regarding the Affordable Care Act’s restrictions on physician-owned hospitals and what the role for these facilities ought to be in the health system.”
“In June, CMS released an RFI to solicit public comments on how to create a more flexible, streamlined approach to the regulatory structure of the individual and small group insurance markets.”
COMMUNITY HEALTH CENTERS
A different accomplishment, noted by the House Energy and Commerce Committee, addressing Community Health Center/Federally Qualified Health Center funding, (CHCs/FQHCs were not included in the funding-the-government Continuing Resolutions so far, authorization for the CHC program having expired last September).
“Walden Sets the Record Straight on Community Health Center Funding” [excerpts reprinted from Committee documents]
“Following the longest and most generous extension of the Children’s Health Insurance Program (CHIP) in its 20-year history, partisan Democrats are once again casting blame. Energy and Commerce Committee Chairman Greg Walden (R-OR) took to Morning Consult to set the record straight.”
“The latest attack? Republicans cruelly cutting funding for community health centers. This couldn’t be further from the truth,” wrote Chairman Walden.”
“The House acted on November 3, 2017, passing H.R. 3922, the CHAMPIONING HEALTHY KIDS Act, providing a two-year extension of Community Health Center funding, in addition to funding for other public health priorities.”
“To put it plainly, Republicans support community health centers and are continuing to work to fund the program for the long term. I know the ongoing debates have not been easy on the workers at these facilities and the families that rely on them for vital medical care, and I share their frustrations,” concluded Chairman Walden. “It is our goal to provide certainty to the millions of people who rely on community health centers as soon as possible, and we hope our Democratic colleagues will finally join us in doing so.”
EVENTS & MEETINGS
Your January & February Calendar:
January 29: 8:30 a.m. COGME, the Council on Graduate Medical Education, at https://hrsa.connectsolutions.com/cogme-council/, also January 30
January 31: 10:00 a.m. to 11:30, Bipartisan Policy Center https://bipartisanpolicy.org/events/, Policy Roadmap for Individuals With Complex Care Needs (stars, including Burke, Feder, Mann)
February 1: 9:00 a.m. Health Affairs, kick-off for cost control series, sponsored by National Pharmaceutical Council
February 5: 8:30 a.m., Academy Health holds its National Health Policy Conference at the Marriott Marquis, Washington, D.C. See web site (https://academyhealth.confex.com). “Getting serious about health costs” is the subject at 11:00 a.m. Monday, chaired by a representative of the National Pharmaceutical Council (!) Continues through February 6. Cost to attend $1,315.
OTHER PUBLICATIONS
BMJ: January 25, 2018, an editorial (here) in the British Medical Journal entitled “Failure of the private finance initiative . . . was predictable and predicted.” Former editor of chief of the journal writes, “In 1999 TheBMJ called the private finance initiative (PFI) “perfidious financial idiocy,” and in 2017 the Office for Budget Responsibility described it as a ‘fiscal illusion.’ Now a data driven report from the National Audit Office shows that PFIs have been more expensive than the use of public financing for the building of hospitals, schools, and other public buildings and has mostly not realised the benefits hoped for. Published in the same week as the collapse of Carillion, a large company fulfilling PFI contracts, the report has helped propel private financing and provision of public services high on the political agenda.”
NEJM: January 25, on physician burnout, a subject ordinarily covered in depth by physician-friendly organizations (The Physicians Foundation, Doximity), not the mainstream.
Healthcare Financial Management: January 2018: article on refiling of cost report worksheets, finding “refiling is a common practice; only 43 percent of cost reports over two years old are not refiled reports, with 34 percent having been refiled once and 23 percent having been refiled two or more times.” Also, “Any healthcare leaders or researchers who use cost reports for benchmarking and comparative analysis should be aware that any work performed using information from these sections may be subject to revision by the providers.” Definitive? Probably not!
For reference:
Members of the Senate (here) and Members of Senate Committees (here), Senate Calendar (here).
Members of the House with their House Committees (here), House Calendar (here).
DCMN: Publication dates for the remainder of January: 30, 31. Past issues may be accessed as follows: at the top of this e-mail, click on “View this email in your browser,” then click on “Past Issues.”
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Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com