DCMedical News: Monday, March 5, 2018
DCMedical News
Washington, D.C.
Monday, March 5, 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
Money countdown: 14 Congressional work days remain before expiration of the current Continuing Resolution (government funding, current Resolution found here) and the expected delivery of appropriations bills for the current (FY 2018) and coming (FY 2019) years.
The “omnibus” budget could include the Alexander-Murray proposal for Cost-Sharing Reduction payments or funds for state reinsurance programs.
The Committee for a Responsible Federal Budget reported (here) Friday as follows: “Our projections show that under current law, trillion-dollar deficits will return permanently by next year and debt will exceed the size of the economy within a decade . . . the country will be facing a $2.4 trillion deficit and debt of 113 percent of Gross Domestic Product (GDP) by 2028. These projections show a fiscal situation that is clearly unsustainable.”
MedPAC (the advisory body to Congress on Medicare) canceled the second day of their two-day meeting Friday (due to high winds in Washington), as did MACPAC, the advisory body to Congress on Medicaid and on the Children’s Health Insurance Program.
HOSPITALS AND HEALTH CARE FACILITIES
MedPAC received a report in slides on the Hospital Readmissions Reduction Program (HRRP) March 1. The report (found here) shows that raw readmission rates declined for each condition covered by HRRP (AMI, CHF, Pneumonia, COPD, hip and knee replacement), generally by 1 to 4%. ED visits and “observation status” both increased 2010-2016, but the report contends that there was no relationship to HRRP. “Raw” mortality rates appear to have increased for CHF and for non-HRRP conditions, but not the “risk adjusted” rates. Demonstration results from Colorado and Washington programs for care coordination appear contradictory.
MedPAC also received a report on ED use by Medicare patients, slides here. In brief: Medicare ED use grew 14% 2010-2016, compared to all ED growth (7%) and Medicare physician visits (4%), levels 4 and 5 (billing, intensity) growing the fastest. Stand-alone EDs: estimated 550-600 in the nation, two-thirds of them hospital-owned off-campus EDs (OCEDs, can bill Medicare), one-third freestanding (no Medicare billing). Rural policy option: 24/7 emergency department in outpatient-only (no beds) hospital.
HEALTH INSURANCE, MEDICARE, MEDICAID, COMMERCIAL
AHPs: the comment period on the proposed change in the definition of “employer” (proposed rule from January 5 Federal Register found here) ends tomorrow (March 6). Changing the definition of “employer” for purposes of regulating health insurance plans would enable potentially widespread use of Association Health Plans. “Members” of such plans need not be employed in the same company, in the same trade or at any common location. Sample comment in opposition to the proposed rule, from the New York State Health Foundation, found here.
Dual eligibles: MedPAC received a brief report (here) on the 14 demonstrations currently underway in 13 states (two in NY).
PHARMA
Opioids:
House Ways and Means leaders note with alarm older (Medicare) patients on opioids, one in three Part D enrollees receiving an opioid prescription in 2016 based on a report from OIG in July, found here. They make recommendations in a letter to the administration (found here) to prevent opioid abuse in the elderly.
340B:
More interest appears in the Senate concerning this drug discount bill. Iowa’s Senator Grassley has introduced a simple three page bill (found here) which would require participating hospitals to disclose how much they pay for drugs. The program has become a wide-spread subsidy for hospital operations. Accountability for the profits to hospitals from buying low and selling (being reimbursed) high is a major issue, hence Senator Grassley’s interest.
Other proposals: that of Senator Bill Cassidy (R-LA) which would prevent any new hospitals from entering the 340B program unless the facility is located in a rural area; bills from Reps. Chris Collins (R-NY) and Larry Bucshon (R-IN) which would change which patients’ drugs are eligible for the program, and also pause any new hospital enrollment in the program.
A CMS rule took effect January 1, with significant 340B cuts (estimated at 27% on average, as much as 40% in some hospitals) in the rates which CMS will use to pay hospitals for the discounted drugs. A federal judge in late December tossed out the lawsuit of the American Hospital Association that sought an injunction, subsequently appealed by the AHA.
OTHER PUBLICATIONS & READINGS
From the Commonwealth Fund: a survey of American views on participation in health insurance plans. “At the end of 2017, 14 percent of adults ages 19 to 64 were uninsured, the same as six months earlier . . . [this is] well below the 20 percent uninsured rate seen just prior to the ACA’s first open enrollment period. Uninsured rates are highest among low-income adults, Latinos, the unemployed, employees of small firms, and residents of states that have yet to expand Medicaid.” (Report here.)
Absence and the heart: the latest Kaiser Family Foundation poll (here) on PPACA, finds an increase in the share of the public who say they have a favorable view of the Affordable Care Act (ACA), from 50 percent in January 2018 to 54 percent this month. This is the highest level of favorability of the ACA measured in more than 80 Kaiser Health Tracking Polls since 2010.
From the Journal for Healthcare Quality : Medicare's Hospital-Acquired Condition Reduction Program (HAC-RP) reduced hospital payments by $364 million in fiscal year 2016 . . . “Due only to chance, 18.0% of penalized hospitals would escape penalty on repeated measurement.”
EVENTS & MEETINGS
Your March Calendar:
March 5
Federation of American Hospitals, annual policy conference, agenda here, HHS Secretary Azar Monday at 11:00 a.m., continuing March 6.
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: 6, 7, 8, 9, 12, 13, 14, 15, 16, 19, 20, 21, 22, 23.
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com