DCMedical News: Wednesday, September 14, 2022
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY Wednesday, September 14, 2022
Unpacking IRA
What is in the “Inflation Reduction Act?” The $739 billion bill (here) which passed 51-50 in the Senate August 7 and the House a week later, has far reaching provisions in energy, tax and health policy. Many of the health policy changes involve drugs, drug pricing and drug costs to consumers. Medicare would be allowed to negotiate with manufacturers the price of prescription drugs, first for a limited number, incrementally increasing over seven years. Ten drugs will be eligible for such price negotiation in 2026, 15 in 2027, 20 in 2029. The Secretary of HHS will make an offer for a maximum price, manufacturers will have 30 days within which to accept or counteroffer.
For Medicare beneficiaries, Part D members would have out-of-pocket costs for prescription drugs capped at $2,000 per year. Manufacturers would be required to rebate back price differences to Medicare (but not to private insurance plans) if they raise prices higher than the rate of inflation, the "inflation rebate."
All vaccines covered under Medicaid, CHIP and Medicare Part D would be free to beneficiaries with no deductibles, co-insurance or cost-sharing, beginning in 2023. The bill also provides a temporary 1% increase in federal Medicaid matching funds for states that already cover adult vaccine administration. InsideCMS reports that “Half of states cover all vaccines recommended by the Advisory Committee on Immunization Practices, and 15 states require cost sharing for vaccines . . . Adults enrolled in a state’s expanded Medicaid population are the only beneficiaries whose vaccines states are currently required to cover without cost sharing . . . More than half of general internal medicine physicians said they lose money when they administer vaccines to adult Medicaid enrollees.”
An implementation timeline developed by the Kaiser Family Foundation (here) illustrates government, drug manufacturer and beneficiary positions through 2029.
PPACA’s insurance subsidies, now set to expire, are extended three years. Higher subsidies in the American Rescue Plan (ARP) Act are preserved, as follows, from InsideCMS: “Policy enacted in the ARP offers more generous subsidies for people earning up to 400% of the federal poverty level compared to the ACA — including providing $0 premiums for those who make up to 150% of poverty and it also eliminates the ACA’s so-called subsidy cliff and limits the premium contribution to 8.5% of income for middle-class Americans. The enhanced subsidies, which supporters say helped lift enrollment in ACA marketplace plans to a record 14.5 million, were set to expire in December.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
The Work of Medical Practice
In 2021, doctors in physician-owned practices outproduced their hospital peers in six of the seven measured specialties, according to Medical Group Management Association's September 2022 report (here). A bigger pie: cardiac surgical volume increased, despite growth of TAVR (now 84% of aortic valve replacements, here). Wait times are increasing for specialists, for example a 48% increase over five years to see an orthopedic surgeon per Merritt Hawkins in a report on specialist availability (here). And now more than half of all primary care “providers” are not physicians (here).
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Bad Debt Grows From Skimpy Insurance
Crowe reports that the amount of bad debt stemming from patients with insurance increased more than five-fold in a three-year period and that almost 58% of patient bad debt in 2021 came from self-pay accounts after insurance, compared with about 11% in 2018. The firm noted “fewer payments from patients who are increasingly turning to high-deductible plans [whose high deductibles] they can't afford.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Final IPPS Increases Hospital Rates to Meet Salary Needs
CMS issues the final rule (here) for the Medicare Inpatient Prospective Payment Program, with a 4.3% increase for hospital rates. CQ reported that “CMS cited higher expected growth in compensation for hospital workers as part of the reason for the rate increase.” In the rule, “CMS also finalized a proposal to identify ‘birthing-friendly’ hospitals in an effort to reduce maternal deaths. Beginning in the fall, CMS will award the designation to hospitals that implement patient safety practices and complete other requirements.”
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
September 14, 15, 16, 19, 20, 21, 22, 28, 29, 30
October 11, 12, 13, 14, 17, 18, 19, 20, 21
November 14, 15, 16, 17, 18, 29, 30
Notes to Fred Hyde, MD, JD, MBA, news@dcmedicalnews.org