DCMedical News: Tuesday, March 6, 2018
DCMedical News
Washington, D.C.
Tuesday, March 6, 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
The States: Medicaid work waivers now approved for Arkansas (found here), Kentucky and Indiana. State-sponsored substitutes for the “individual mandate” falter. Iowa joined Idaho in planning state-approved but non-PPACA compliant skinny health insurance plans but push-back to short-term and association plans grows, examples from American Academy of Actuaries (here), Georgetown scholars (here), and the Urban Institute (here).
The Budget and the countdown: 13 Congressional work days remain before expiration of the current Continuing Resolution (government funding) and the expected delivery of appropriations bills for FY 2018 and FY 2019. A $1.2 trillion spending bill for FY 2018 (the “omnibus”) will appear in draft soon; increases expected for opioid treatment, veterans and medical research, but offsets (“CHIMPs”—Changes in Mandatory Programs, for example Medicare and Social Security) may be controversial.
PPACA: Democratic House leaders released a bill (here), the “Undo Sabotage and Expand Affordability of Health Insurance Act of 2018,” proposing to add to the omnibus. Features: elimination of income cap for premium tax credits, expansion of eligibility for Cost-Sharing Reduction payments and establishment of a national reinsurance program.
DOCTORS AND OTHER HEALTH CARE PROFESSIONALS
BPCI-Advanced: So, doctor, you thought you might want to join in the latest “bundle” application by CMS? You probably knew that “For Convener Participants that include both ACH and PGP Episode Initiators in their application and subsequent agreement with CMS, only the physicians under the PGP Episode Initiators on the PGP List will be assessed for purposes of the QP determinations and will be assessed as a group” [actual language from CMS]. But there was more—your 19-page FAQ, here.
No fee left behind: MACs are notifying doctors that their fees will increase if they live in some parts of Illinois, Minnesota, Wisconsin, New York, Maine and New Hampshire. From National Government Services’ bulletin, “Congress passed the Bipartisan Budget Act of 2018 on 2/9/2018, changing the Medicare physician fee schedule and the processing of Medicare services. Section 50201 of this Act has made a change to the work Geographic Practice Cost Index (GPCI) floor, effective retroactive to 1/1/2018. Any area that previously was in an area with a work GPCI of less than 1.000 will be impacted. The Act issues a floor of 1.000 to the work GPCI which will cause any fee schedule for any service in those areas to increase.”
HOSPITALS AND HEALTH CARE FACILITIES
The Financial Times “big read” this morning (here) was on U.S. health care, where “Authorities are investigating whether companies aggravated shortages of saline, a relatively simple but vital medical product, to boost profits.” The Federal Trade Commission and state attorneys general (NY, CA) are investigating Baxter Health Care, Hospira Infusion Systems and B Braun, who account for virtually all saline bag manufacture in the U.S. As supplies tightened, the wholesale price of a bag of saline, according to the FT study, doubled from $1.77 in 2014 to $4.04 today, compared to the $2 the National Health Service pays for the same product. Baxter tactics allegedly included “tying,” that is, Baxter was “unable to guarantee the hospital’s existing supply of saline unless it signed a new five-year contract that required it to also buy other ‘consumables’ used to deliver the solutions, like intravenous tubes and taps.” This particular hospital, unnamed, resisted, indicating that it would need to retrain nurses involved in intravenous care, but emails show “the Baxter rep becoming increasingly pushy as the hospital tried to stall.”
Big Kaiser/USA Today study on surgery center safety, finding 260 patients over four years who have died after outpatient surgeries, a small fraction of those who, however, have died from surgical mishaps in hospitals. Medicare is increasingly citing surgery centers for patient assessment (risk of complications), problems with equipment, and training. In general, the centers have problems similar to those found in hospitals, many more complex procedures now being performed on an ambulatory basis.
Six Senators seek input from hospital and insurance groups concerning price transparency, here.
Secretary Azar tells the Federation of American Hospitals to expect change. His comments focus on “interoperability,” price transparency, using Medicare and Medicaid to “drive change in delivering care,” and removing regulations that “hinder private innovation.”
HEALTH INSURANCE, MEDICARE, MEDICAID, COMMERCIAL
American Academy of Actuaries checks in to oppose Idaho plans for non-PPACA-compliant health insurance, letter found here. The actuaries caution against adverse selection which would result from healthier individuals buying less expensive plans. Letter criticizes potential fragmentation under Idaho’s state-based health benefit plans, as steps which would increase PPACA premiums and reduce pre-existing condition protection. The letter cites a 2017 RWJ study (here), “Marketplace Pulse: Leaky Risk Pools Sink Markets,” with tables (here) showing key policy risk factors, adverse market outcomes and key structural risk factors by state.
MedPAC: Two items not addressed because the second day of the March MedPAC meeting was called due to weather. First, population-based quality measures (preventable admissions, home and community days), slides here. These two proposed new population-based quality measures for the Medicare program are (1) potentially preventable admissions, a HEDIS measure in units of “ambulatory care sensitive condition admissions per 1,000 beneficiaries over age 67,” and (2) “home and community days” (HCDs), the number of days in a year that beneficiaries are alive and out of health care institutions. Also planned for the second day of the MedPAC meeting was a primer on cost-effectiveness analysis, found here.
PHARMA
Tax cuts will have no effect on the cost of health care, according to a feature in Axios. Reporters analyzed 4th quarter financial reports and investor calls and found that 21 health care companies collectively expect to gain $10 billion in tax savings in 2018, with the money going toward share repurchases, dividends, acquisitions and paying down debt. For UnitedHealth, accounting for a quarter of the $10 billion total, most of its windfall is going to investors and executives. A health policy observer told Axios: “Companies lower prices on shoes, phones, cars (comparatively or versus inflation) to get your business. Health care pricing doesn’t work that way. So the natural pressure to use the tax code to lower pricing…isn’t there in health care.”
HealthSprocket had a nice summary of the Part D portions of the Bipartisan Budget Act of 2018 as follows:
“The coverage gap (“donut hole”) closes in 2019 instead of 2020, at which time beneficiaries will have 25% coinsurance requirements for their prescriptions instead of 30%.
The manufacturers’ brand-name drugs discount in the coverage gap will increase from 50 to 70 percent beginning in 2019.
Biosimilars – previously not included - will be treated the same as other brand-name drugs in the Part D coverage gap, beginning in 2019.
The Part B and Part D premium contributions for beneficiaries with modified adjusted gross incomes over $500,000+ for individuals or $750,000+ for couples will increase from 80% to 85%.
Eligibility to participate in the Medicare VBID Model for interested plans expanded from three to all states by 2020.”
EVENTS & MEETINGS
Your March Calendar:
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: 7, 8, 9, 12, 13, 14, 15, 16, 19, 20, 21, 22, 23.
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com