DCMedical News: Wednesday, February 28, 2018
DCMedical News
Washington, D.C.
Wednesday, February 28, 2018
To our new readers: This is an independent newsletter, published every day that one or another House of Congress is in session. Past issues can be accessed by clicking on “View this email in your browser.” For non-subscribers, the courtesy copy period ends with today’s newsletter. We hope you have enjoyed your free trial period editions; subscription information will be found at the bottom of these pages.
THE BIG STORY TODAY IN HEALTH CARE
The big story in Washington: Privatization, in Medicaid (here), Medicare (here and here), Veterans’ Care (here), care for the intellectually and developmentally disabled (here), even innovation (here) and pandemic preparation (here), as well infrastructure and public works generally. (See also a Financial Times feature 2-27 on the sale of British infrastructure to foreign sovereign investment funds, here).
DOCTORS AND OTHER HEALTH PROFESSIONALS
Doctors and immigration issues: a two-sided coin, with evidence of the importance of IMG physicians from other countries for American medical care here, and of the MD-brain drain from other countries to American residency programs here.
Is health care a jobs program? David Cutler reflects on jobs and health cost in this week’s JAMA, found here. “The bad news is that health care employs a wealth of nonclinical workers. In the medical system as a whole in 2016, there were 22 times as many nonphysician and nondentist workers as there were physicians and dentists.” But with regard to recent employment growth, “About 27% of the increased employment is personal care aides . . . Another 25% of the increased employment is among RNs. The bulk of the new RNs work in hospitals, but employment is also expanding in physicians’ offices, outpatient care centers, and home health agencies. Part of the growth of RNs is skill upgrading.” Still, in the medical system as a whole, 37% of employees were nonmedical, business managers, office assistants.
HEALTH INSURANCE, MEDICARE, MEDICAID, COMMERCIAL
Obamacare Deconstruction, Continued: Twenty red states filed suit to challenge the constitutionality of the Patient Protection and Affordable Care Act, Complaint found here. The theory: that the penalty in NFIB v. Sebelius (5-4, Chief Justice Roberts the decider, found here) for people who didn’t buy health insurance was found to be constitutional as part of the congressional power to tax, but, if there is no tax, there is no mandate.
Wonder where those new HCPCS codes come from? Here you go: CMS announces (in thirteen pages, found here) the 2018 meeting dates for the Healthcare Common Procedure Coding System revisions. (HCPCS, pronounced hic-pics, is the coding methodology for purchased items and health services, companion to the AMA-CPT system for professional work). CMS will receive testimony concerning its preliminary coding and payment determinations for all new public requests for revisions to HCPCS. May 14-17 is or drugs, biologicals and radiopharmaceuticals and imaging agents; June 1-2 for DME and orthotic and prosthetic supplies, with plenty of preliminary deadlines for registration, submission of testimony, etc.
PHARMA
Opioid action: Senators sponsor “CARA-2,” (Comprehensive Addiction and Recovery Act, a second recent act for opioid legislation, the first coming in the 21st Century Cures Act, found here, see pp. 18ff) with funds for addiction treatment but a three day limit on opioids for acute pain; Attorney General creates a new enforcement task force.
Other drug news: CVS, serving 90 million people through its in-house PBM, gets warm reception in House hearing concerning its proposed acquisition of Aetna; hospitals continue to battle for reversal of 27-40% cut in 340B drug profits.
ASIDES
Medicaid: Big difference of opinion on the use of §1115 waivers to “reform” the Medicaid program. The waiver is meant to “waive” what would otherwise be the requirements of the statutes and regulations governing Medicaid (eligibility, enrollment, provider networks, payment), in order to foster experiments in the states.
States seeking such waivers now intend to use them (as demonstrated by the Kentucky and Indiana waivers) as a vehicle to reform the Medicaid program, for example by introducing work (here) or service requirements of beneficiaries. Some state Medicaid programs are heavily dependent on demonstration waivers, for example nearly the entire Arizona program. Others (New York, where the Medicaid director has just announced he is leaving) have a “due bill” (a “Delivery System Reform Incentive Payment” program which “pre-spent” Medicaid funds during the period 2014-2018 which would otherwise be needed, given budget neutrality, in 2019 and beyond). States don’t really use the waivers to study, evaluate or report on innovations anyway, says the GAO (report here, KHN comment here). Section 1115, the most common waiver, is a fragile vehicle, originally added to the Social Security Act in 1962, prior to the passage of Medicaid (1965), and meant (on its terms) to allow states to undertake experiments with “social insurance.”
EVENTS & MEETINGS
February 28
1:00 p.m., Health Subcommittee (Energy & Commerce) hearing, “Combatting the Opioid Crisis,” first of three, schedule and witness list at https://energycommerce.house.gov/subcommittee/health-115th-congress/.
March 1
8:30 a.m. MedPAC, advisory body on Medicare, Ronald Reagan Building, Horizon Ballroom, 1300 Pennsylvania Ave, continuing March 2. Subjects on the 1st: Unified payment for post-acute care, hospital ED services, dual-eligibles, readmission reduction. On the 2nd: cost-effectiveness analyses, population-based quality measures.
9:30 a.m., MACPAC, advisory body on Medicaid and the Children’s Health Insurance Program, continuing March 2, at One Constitution Avenue, NE.
March 6
8:30 a.m., Roll Call/CQ News, “Health Care Decoded,” with representatives of CVS, AdvaMed, Kaiser, the
Governors, et al, register at: http://go.cq.com/2018HealthCareDecoded_01.RegistrationPage.html.
9:00 a.m., Health Affairs on advancing health equity, at the National Press Club, 15 or more journal article authors, focus on the March 2018 Health Affairs issue.
9:30 a.m., Brookings, “What’s Ahead for the Individual Health Insurance Market?”--various think tankers.
Information at http://www.brookings.edu.
March 7
8:00 a.m., AHIP National Health Policy Conference, program on opioids featuring FDA Cmsr. Gottlieb, Deputy AG Rosenstein, register at https://www.ahip.org/policy-2018-registration-policies/.
March 13
2:00, CMS webinar (flyer here) on 30 day mortality measures in the Hospital Improvement Innovation Networks, Hospitals Collaboration to Improve Quality of Care.
March 16
11:00 a.m., AHRQ, National Advisory Council for Healthcare Research and Quality, by WebEx,
information at https://www.ahrq.gov/news/events/nac/.
March 26
PTAC, Physician-Focused Payment Model Technical Advisory Committee, continuing March 27, information at www.regonline.com/PTACMeetingsRegistration or livestream at www.hhs.gov/live.
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).
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
DCMedical News is published every day that either the House of Representatives or the Senate is in session.
March publication dates: 1, 2, 5, 6, 7, 8, 9, 12, 13, 14, 15, 16, 19, 20, 21, 22, 23.
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com