DCMedical News: Wednesday, December 1, 2021
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY Wednesday, December 1, 2021
Stopgap Spending, Health Provisions
CQ reports (here) that “Negotiators are closing in on a fairly clean stopgap spending bill running into at least late January, but differences remained Tuesday over its duration as Republicans pushed for a more distant end date. Unrelated policies that backers were hoping to attach seemed to be dropping out of the mix. Multiple people with knowledge of the talks said several health care provisions are not expected to be included due to differences over offsets. Specifically, fixes for Medicare cuts set to take effect Jan. 1 — including reductions to physician payments and reimbursements for clinical laboratory services as well as broader across-the-board cuts —are unlikely to ride along with the continuing resolution.”
“Congress took several steps to alleviate the burden on health providers in the depths of the COVID-19 pandemic this year and last. Across-the-board Medicare cuts totaling 2 percent, which initially took effect in fiscal 2013, were suspended three times starting in March 2020 (PL 116-136, PL 116-260, PL 117-7), running through the end of this year. In late 2020, Congress added $3 billion for a one-year, 3.75 percent physician payment boost to stave off scheduled cuts; that increase expires Dec. 31. Meanwhile Medicare cuts under the pay-as-you-go law would total 4 percent next year, so all told physicians could be facing a nearly 10 percent hit to their reimbursements without action.”
Vaccine Mandate for Health Workers Halted
Bloomberg reports that “A federal court in Louisiana on Tuesday blocked the Biden administration from enforcing a vaccine mandate for health-care workers nationwide—except for in 10 states that already face an injunction order. The preliminary injunction [here] by the U.S. District Court for the Western District of Louisiana marks the second victory for opponents of the mandate, which requires health workers to get vaccinated by Jan. 4, 2022. The court found that the government lacked the statutory authority to issue the rule.”
HOSPITALS AND OTHER HEALTH CARE FACILITIES
High Need, Vulnerable Population in Medicare Advantage Hospice Care Experiment
A discussion in JAMA (here) summarizes the promotion of Medicare Advantage plans by CMS leaders and staff to assume responsibility for hospice services. In “value-based” experiments, “Hospice services are paid for and overseen by Medicare Advantage [plans], unlike the existing structure that carves out hospice services from Medicare Advantage. In the carve-out approach, when Medicare Advantage enrollees elect hospice, their hospice benefits are provided under traditional Medicare coverage and are not overseen by the Medicare Advantage plan.”
“Proponents of the Medicare Advantage carve-in suggest it has the potential to reduce fragmentation, produce new opportunities for coordination, and create new programs for patients at the end of life by consolidating accountability under Medicare Advantage. However, older adults, and particularly those with serious illness, whose end-of-life experiences would be shaped by Medicare Advantage under the carve-in, may potentially be at risk to receive lower-quality care because of the incentives to control the costs of care in Medicare Advantage plans.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
SCAN Opens In-Home, Virtual, For-Profit Affiliate
SCAN Health Plan, with 220,000 enrollees in California, Nevada and Arizona, has opened an in-home, virtual, care provider, Welcome Health, a for-profit company which will have SCAN itself as an “anchor client,” but which will also be sold to and through other Medicare Advantage plans. Modern Healthcare notes (here) that “Welcome joins a rapidly growing list of providers focused on the Medicare Advantage market. The number of medical clinics targeting chronically ill seniors has grown rapidly in recent years, including by operators like ChenMed, Oak Street Health and Partners in Primary Care. Such arrangements typically involve the providers taking full financial risk for Medicare Advantage members' care in return for fixed monthly payments based on the patients' health status. The privatized form of Medicare costs the government more than traditional, fee-for-service Medicare, and a recent Commonwealth Fund study found Medicare Advantage doesn't reduce the frequency of hospital and emergency department visits compared with traditional Medicare enrollment.”
The virtual and in-home services may be fighting cutbacks by the states, unwilling to extend pandemic licensure relaxation, or Medicaid reimbursement, for telehealth, according to a report (here) in The Wall Street Journal. “States are curbing access to telehealth services that were expanded during the pandemic, prompting some doctors and businesses to lobby for a permanent expansion of remote care that they say some patients need.”
“Most states over the past two years allowed residents to conduct some medical appointments virtually or by phone, by setting rules that required insurers to pay the same for virtual visits and in-person appointments and by eliminating requirements for in-person check-ins. Insurers also expanded coverage of telehealth appointments during the pandemic. The provisions helped patients avoid exposure to Covid-19 and alleviated some of the pressure on overtaxed healthcare workers.”
DRUGS & DEVICES
Califf Disclosure Letter
FDA Commissioner-designate Robert Califf’s eight-page recusal letter (here) shows direct interests or board or advisory board positions in Verily Life Sciences, Amyriad Pharma, Centessa Pharmaceuticals, Clinetic, Inc., Cytokinetics, Inc., Basking Biosciences, Inc., Bitterroot Bio, Inc., Clinical Research Forum, Inc., Medicxi Ventures, LLP, and a variety of university positions.
In addition, Cardiff pledged to divest (within 90 days) his equity investments in Acme United Corporation, Agnico Eagle Mines Limited, Amgen, Inc., Anika Therapeutics, Inc., B & G Foods, Inc., Bristol-Myers Squibb company, Carrier Global corporation, Dime Community Bancshares, Inc., Discovery, Inc., Enersys, Exelixis, Inc., Fastenal company, Franchise Group, Inc., Gilead sciences, Inc., Goldman Sachs Group, Inc., Greenhill & Co., Inc., InterDigital, Inc., Interpublic Group of cos., Inc., John B. Sanfilippo & Son, Inc., Kinder Morgan, Inc., Mastech Digital, Inc., Mastercard, Inc., Moelis & Company, Newell Brands, Inc., OREOK, Inc., People's United Financial, Inc., Pitney Bowes, Inc., Pretium Resources, Inc., Principal Financial Group, Inc., Prudential Financial, Inc., QUALCOMM, Inc., Service Properties Trust, Silvercrest Asset Management Group, Inc., TESSCO Technologies, Inc., Toll Brothers, Inc., Trecora Resources, United Parcel Service, Inc., Visa, Inc., Walgreens Boots Alliance, Inc., WisdomTree Investments, Inc., and his bond investment in Avnet, Inc., B&G Foods, Inc. Barclays Bank, PLC, Bellsouth, LLC, BlackRock TCP Capital Corporation, Deutsche Bank, AG, Freeport-MCMORan, Inc., General Electric, Goldman Sachs Group, Inc., Host Hotels & Resorts, Inc., JPMorgan Chase & Co., Kinder Morgan, Inc., Kraft Heinz Foods co., Lamar Media corporation, National Fuel Gas company, New York Community Bancorp, Inc., ONEOK, Inc., Owens & Minor, Inc., Plains All American Pipeline, LP, Service Properties Trust, Starwood Hotel & Resorts, Tanger properties, LP, Western Union Company, and Williams Companies, Inc.
READINGS & REFERENCES
“The Dismal History of Big Infrastructure,” The New York Times, 11-28-2021 here.
“The Inside Story of the Pfizer Vaccine,” The Financial Times 12-1-2021 (here).
Select Coronavirus Public Health Resources and References may be found here.
Select Coronavirus Public Health Resources and References may be found here.
2021 CQ Congressional Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
December 2, 3, 6, 7, 8, 9, 10
January 10, 11, 12, 13, 18, 19, 20, 21
February 1, 2, 3, 4, 7, 8, 9, 28
Notes to Fred Hyde, MD, JD, MBA, news@dcmedicalnews.org