DCMedical News: Friday, March 2, 2018
DCMedical News
Washington, D.C.
Friday, March 2, 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.” Subscription information is found at the bottom of these pages.
THE BIG STORY TODAY IN HEALTH CARE
MedPAC: MedPAC (the advisory body to Congress on Medicare) met yesterday and continues today, on post-acute care, emergency room payment, dual-eligibles, readmissions reduction, and exercises in cost-effectiveness analysis and population-based quality measures (see Hospitals and Health Care Facilities, below). The membership is here, agenda here, schedule for the remainder of 2018 public meetings here.
MACPAC: The advisory body to Congress on Medicaid and on the Children’s Health Insurance Program (MACPAC) also met yesterday, continuing today; see Pharma, below. The membership is here, agenda here, meeting schedule here.
Money countdown: 21 days to the expiration of the current Continuing Resolution (government funding) and the expected delivery of appropriations bills for the current (FY 2018) and coming (FY 2019) years. CBO’s annual update on the budget and economic outlook will be released April 9, following the Congressional spring recess; the most recent edition can be found here.
DOCTORS AND OTHER HEALTH PROFESSIONALS
Low-level care? Dr. Martin Makary and colleagues in this week’s JAMA Surgery (here) on one of the most common surgical procedures in the world: “We propose that the annual proportion of knee arthroscopy procedures that are APM [arthroscopic partial meniscectomy]-only in patients with degenerative disease is a surgeon-level measure of appropriateness in surgical care. At best, APM represents low-value care that is common in the Medicare population.”
Former HCFA administrator, MedPAC Chair and Bush ’41 staffer Gail Wilensky in this week’s NEJM (here): “The proliferation of quality measures is imposing substantial burdens on clinicians, and many of these measures are regarded as poor proxies for quality or as not reflecting what is important to patients.”
Integrating primary care and behavioral health? Not so fast, if you need to share information about the patient. At MACPAC’s meeting held yesterday, extensive discussion took place concerning substance use disorder confidentiality regulations (at 42 CFR Part 2), presentation found here. Requirements of SUD information disclosure and HIPAA are in conflict, such that, for example, Medicaid agencies and managed care organizations can re-disclose information given to them without patient consent for payment and health care operations, but not for treatment purposes.
HOSPITALS AND HEALTH CARE FACILITIES
Post-acute care occupied a good portion of MedPAC’s presentations yesterday. One presentation on payment for “sequential stays in a unified payment system for post-acute care” can be found here. Another presentation, encouraging Medicare beneficiaries to use higher quality post-acute care, can be found here.
Supplemental Medicaid Payments: Not just a supplement any more. The March 1 – 2 meeting of MACPAC focused on the relative importance of base and supplemental Medicaid and CHIP payments to hospitals. Staff reported that supplemental payments in FY2016 actually constituted more than half of all Medicaid fee-for-service payments to hospitals. The 51% of “supplemental payments” was made up from DSH (18%), UPL-Upper Payment Limit (17%), Uncompensated Care Pool payments (9%), DSRIP (5%) and GME (2%). Payments from DSRIP and Uncompensated Care Pools can be made by states having such provisions in their § 1115 Waivers. The report on supplemental payments to hospitals (found here) has a useful summary graph of this information at the bottom of page five, as well as a helpful summary comparing DSH vs. UPL limits on the top of page six, followed by illustrative examples.
HEALTH INSURANCE, MEDICARE, MEDICAID, COMMERCIAL
Avalere produces a new report on Association Health Plans (AHPs), found here, a follow up to the Department of Labor proposed regulation (found here) which would expand eligibility for AHPs by re-defining the word “employer” as it pertains to employer health insurance plans. Avalere projects (a) healthier enrollees shifting to AHPs, resulting in premiums rising in the remainder of individual and small group markets; (b) 2.4 to 4.3 million enrollees in AHPs; and (c) premiums $119 to $4,100 lower than the small group market and $8,700 to $10,800 lower than annual premiums in the individual market by 2022. The lower premiums, according to Avalere, support less generous benefits. Actually, the impact might be greater: the Department of Labor estimated that 44 million people (NYT, here) may be eligible, based on the new definition of “employer.”
MLTSS and IDD: Do they go together? MACPAC discussed the Managed Long-Term Services and Supports (managed care for long-term populations) and its applicability (or lack thereof) for care and services for the Intellectually and Developmentally Disabled (IDD). The presentation (found here) notes that 23 states currently have MLTSS programs, but only 8 cover some or all of the services for IDD clients. The outsourcing, cost-cutting, “rebalancing” of MLTSS, in the view of those members of MACPAC who spoke, appear inapplicable to the needs of IDD clients. MACPAC consultant Health Management Associates in discussing moving IDD clients in MLTSS encountered “resistance from the IDD stakeholder community,” “difficulty with achieving cost savings,” and, in general, a population entirely different (24-hour care) from those receiving episodic services in MLTSS. (For readers interested in more historical background on the difficulty of using managed care organizations for IDD clients see http://pausebuttonforddsfiveyearplan.org.)
PHARMA
Operations of the Medicaid drug rebate program were the focus of a MACPAC presentation and discussion Thursday morning. The rebate program is described in detail here, see especially the lower half of page two for rebate calculations. Recommendations were made and accepted to govern the amount of rebates, and possibly to reclassify drugs whose rebates the manufacturer may not be managing appropriately.
EVENTS & MEETINGS
Your March Calendar:
March 2
8:30 a.m. MedPAC, advisory body on Medicare, Ronald Reagan Building, Horizon Ballroom, 1300 Pennsylvania Ave. Subjects today: cost-effectiveness analyses, population-based quality measures.
9:30 a.m., MACPAC, advisory body on Medicaid and the Children’s Health Insurance Program, at One Constitution Avenue, NE.
March 4
Federation of American Hospitals, annual policy conference, through March 6, agenda here,
HHS Secretary Azar Monday at 11:00 a.m.
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 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: 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