DCMedical News: Thursday, March 8, 2018
DCMedical News
Washington, D.C.
Thursday, March 8, 2018
THE BIG STORY TODAY IN HEALTH CARE
The Omnibus Budget bill:
House action scheduled for March 15. The potential hold-up? “Policy riders.”
A one-page, unlabeled, “White House” memo (found here) gives (1) hope for inclusion of Cost-Sharing Reduction payments and reinsurance in the “Omnibus” budget bill due March 23, eleven Congressional working days away, but also (2) notes that a variety of Administration priorities will come along, including codification of Short-Term, Limited-Duration health insurance plans, also allowing them to be renewed beyond a year; change in the PPACA ratio which currently limits premium charges to older enrollees to three times the charges to younger, to five to one; and expansion of HSAs.
HOSPITALS AND HEALTH CARE FACILITIES
VA in the news. Yesterday’s New York Times (found here) details shenanigans in the director’s office and the White House, a story broken initially by The Economist (found here). More generally, the VA faces another push to privatize services, see Health Affairs blogs here and here. The last major privatization push (in the Clinton administration) was to enroll Veterans in managed care organizations (MCOs); skepticism about MCOs (e.g. “As Good As It Gets,” 1997) helped change the course of debate, and also helped change MCO tools (gatekeepers, other limitations on medical care).
Now privatization generally (making medical care available outside of the VA’s system) is promoted. In the mid-90s, in response to the MCO push, the VA developed an entirely new approach to primary care, hospital-based outpatient centers, many of them physically adjacent to community hospitals. VA facilities represent “stranded capital,” many of its 153 large medical centers located in states which are not as populous as they were 50 years ago.
HEALTH INSURANCE, MEDICARE, MEDICAID, COMMERCIAL
A report in JAMA (here) on which hospitals did the best with the first year of mandatory bundling for hip and knee surgery (the CCJR, Comprehensive Care for Joint Replacement, program). They were larger, with higher volume, nonprofit, teaching and integrated with a post-acute care facility.
Many organizations unhappy with the proposed rule for Association Health Plans, including the American Cancer Society (letter here), AHIP (letter here), the National Partnership for Women and Families (letter here).
UnitedHealth’s pharmacy discount announcement (see DCMN 3-7) here.
PHARMA
Irony: A study in JAMA this week (here) reports “Treatment with opioids was not superior to treatment with nonopioid medications for improving pain-related function over 12 months. Results do not support initiation of opioid therapy for moderate to severe chronic back pain or hip or knee osteoarthritis pain.”
Remarkably, few such controlled studies of opioids have been attempted. The article notes: “Long-term opioid therapy became a standard approach to managing chronic musculoskeletal pain despite a lack of high-quality data on benefits and harms. Rising rates of opioid overdose deaths have raised questions about prescribing opioids for chronic pain management.” This study is bound to add weight to the “pushers in white coats” arguments, and to the consequences of misleading, aggressive or seductive marketing of opioids to physicians.
FDA Commissioner Gottlieb asks AHIP members to cover biosimilars (biologic generics). He said prices were “rigged,” and that insurers—by failing to cover less expensive biosimilar products--were boosting prices unnecessarily.
CMS Administrator Verma leads a big CMS contingent at HIMSS in Las Vegas, promising more meaning in meaningful use, more inter- in interoperability.
EVENTS & MEETINGS
Your March Calendar:
March 13
1:00 p.m., The Alliance of Community Health Plans (ACHP) holds a briefing on "The Value of
Medicare Advantage, rsvp to achpcommunications@achp.org, 2203 Rayburn Bldg.
March 14
2:00 p.m., Open Payments “National Provider Call.” Provider (physician and teaching hospitals especially) chances to review the “sunshine law payment” methodology, to be followed (April 1-May 15) by the dispute period. Publication of payments for 2017 takes place in June.
Info at openpayments@cms.hhs.gov or call 1-855-326-8366
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. Past issues can be accessed by clicking on “View this email in your browser.” Subscription information is found at the bottom of these pages. Trial subscriptions may end without notice.
March publication dates remaining: 9, 12, 13, 14, 15, 16, 19, 20, 21, 22, 23.
April publication dates: 9, 10, 11, 12, 13, 16, 17, 18, 19, 20, 23, 24, 25, 26, 27
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com