DCMedical News: Friday, July 29, 2022
DCMedical News is published every day both the House and the Senate are scheduled to be in session. The August Congressional recess begins today. Publication of DCMedical News will resume September 13.
THE BIG STORY Friday, July 29, 2022
End-of-Session Actions
Drug Price Negotiation, Climate Change Mitigation, Obamacare Premium Subsidies
The Hill reports (here) that “A day after Sen. Joe Manchin (D-W.Va.) stunned Washington by endorsing hundreds of billions of dollars for President Biden’s domestic agenda, House Democrats are rallying behind the nascent package as a crucial — if incomplete — strategy for tackling the climate crisis and easing working class economic strains. Across the broad spectrum of the diverse caucus, Democratic lawmakers are praising the surprise arrival of Manchin’s proposal, saying it takes great strides to help ensure health care access, fight climate change and bring fairness to the tax code.”
“The enthusiastic reception from House Democrats across the caucus suggests the bill will have an easy time passing through the lower chamber, even with the Democrats’ slim majority and the high likelihood that no Republicans would support the proposal . . . the timing of Manchin’s endorsement — after a year of frustrated inaction and just months before the midterms — has contributed to the vigorous show of support from Democratic lawmakers.” Congress may come back the week of August 8 for final passage. Axios reports that “Passing a reconciliation bill that addresses climate change, prescription drug reform and health insurance still faces obstacles and isn't a foregone conclusion . . . The pharmaceutical industry is also fighting the plan to wring $288 billion from drug companies by allowing Medicare to directly negotiate the price of prescription drugs.”
Telehealth Extension
CQ reports (here) that “The House Wednesday approved a bill that would allow Medicare to continue to cover telehealth services through the end of 2024. Most Medicare telehealth coverage, temporarily expanded during the COVID-19 pandemic when patients were unable to visit doctor's offices, is slated to expire 151 days after the end of the public health emergency, which was just extended into October by the Biden administration. The bill (HR 4040), which passed 416-12, would ensure the extension remains in place through 2024. Allowing coverage for a few more years would allow more time to gather data so lawmakers can decide if Medicare should permanently pay for telehealth services.”
“The bill would also allow Medicare to pay for audio-only telehealth services, including for behavioral health. Before the pandemic, Medicare rarely paid for audio-only telehealth. And it would allow the Health and Human Services Department to expand the types of providers who are eligible for Medicare telehealth payments and allow federally qualified health centers and rural health clinics to be reimbursed for telehealth services.”
Prior Authorization by Medicare Advantage Plans
In the “Improving Seniors’ Timely Access to Care Act of 2022’’ the House may soon act to “establish requirements with respect to the use of prior authorization under Medicare Advantage plans, bill here. The bill was approved by the House Ways and Means Committee, but no action has been taken yet in the Senate.
CQ reports (here) that the “Bill that would revamp Medicare Advantage plans' use of prior authorization after a government watchdog found that such plans sometimes delayed or denied access to services covered by Medicare . . . The report found some plans also denied payments to providers for some services that met both Medicare coverage rules and billing rules. Under the bill, which has 306 co-sponsors, plans that require providers to seek approval for payment of services before covering them would have to accept requests from providers electronically — a priority for groups like the American Medical Association and American Hospital Association that argue that electronic requests would speed up the time it takes for insurers to make coverage decisions.”
“Insurers would also be required to issue ‘real-time’ decisions for commonly approved services. For all other services, plans would have to issue decisions within 24 hours for urgent matters and within seven days for nonurgent matters . . . Traditional Medicare rarely uses prior authorization, but it is widely used by Medicare Advantage plans to reduce costs. However, providers argue prior authorization requirements are burdensome and delay care.”
“The bill would also require plans to release troves of information about their use of prior authorization, including data on how often requests are approved and denied and the criteria for making those decisions. Plans would also be required to annually report to HHS a list of all items and services that were subject to prior authorization during the previous plan year.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Doctors and Unions
An essay in JAMA (here) notes that “The consolidation of hospital systems and physician practices under a single corporate umbrella has resulted in major structural changes to the practice of medicine. In 2012, 60% of practices in the US were physician-owned, 23.4% of practices had some hospital ownership, and only 5.6% of physicians were direct hospital employees. After a surge in acquisitions of physician practices over the decade, and in response to the COVID-19 pandemic, the fraction of physicians employed by hospitals or health systems reached 52.1% and 21.8% by other corporate entities in 2022, for a total of an estimated 74% of practicing physicians. Many physicians now are employed by consolidated corporate healthcare systems that span many different communities and increasingly are spread across multiple states. This rapid transformation has largely followed an aggressive strategy, put forward by hospital and corporate leadership, that seeks scale and exploits market power. However, it is also a strategy that is increasingly at odds with the interests of the physicians working in these organizations.”
Also, “The strategic differences are revealed in a variety of important policy differences, spanning from payer contracting strategies, compensation incentive structures, and service line prioritization. These differences suggest the potential for growing challenges for US medicine.”
The authors note, “Unions are not a panacea. They are a tool available to certain physician employees and can be sought as a response to growing tensions within large hospital systems.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
OPPS Rule Published, Comments by September 13
In the Federal Register July 26 (here) CMS published a “Proposed rule [which] would revise the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for Calendar Year (CY) 2023 . . . In this proposed rule, we describe the changes to the amounts and factors used to determine the payment rates for Medicare services paid under the OPPS and those paid under the ASC payment system. Also, this proposed rule would update and refine the requirements for the Hospital Outpatient Quality Reporting (OQR) Program, the ASC Quality Reporting (ASCQR) Program, and the Rural Emergency Hospital Quality Reporting (REH) Program. We are also proposing updates to the requirements for Organ Acquisition, Rural Emergency Hospitals, Prior Authorization, and Overall Hospital Quality Star Rating. We are establishing a new provider type for rural emergency hospitals (REHs), and we have proposals regarding payment policy, quality measures, and enrollment policy for REHs. Finally, we are soliciting comments on the use of CMS data to drive competition in healthcare marketplaces, and an alternative methodology for counting organs.”
READING & REFERENCES
Select Coronavirus Public Health Resources and References may be found here.
Monkeypox resources, CDC (here), JAMA Patient Page (here).
Side-by-Side Overview of Therapeutics Authorized or Approved for the Prevention of COVID-19 Infection or Treatment of Mild-Moderate COVID-19 (here).
2022 CQ Congressional Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
August, Congress adjourned, no editions of DCMN
September 13, 14, 15, 16, 19, 20, 21, 22, 28, 29, 30
October 11, 12, 13, 14, 17, 18, 19, 20, 21
Notes to Fred Hyde, MD, JD, MBA, news@dcmedicalnews.org