DCMedical News: Tuesday, March 13, 2018
DCMedical News
Washington, D.C.
Tuesday, March 13, 2018
THE BIG STORY TODAY IN HEALTH CARE
HHS Budget Hearing (see below, March 15, 10:00 a.m.), what to expect:
Modest increase in discretionary spending at HHS, compared to the original administration proposal (pre-Azar) of a $17 billion cut in the $87 billion budget for FY 2018, with a similar cut proposed for FY 2019.
Bigger news, overshadowing the discretionary funding, is proposed cuts over time to Medicare and Medicaid, with budget proposals attempting to find more than $1 trillion in savings between the two programs over ten years.
The projected savings are based on the assumption that Medicaid will become a block grant program with limited growth and limited contributions from the federal treasury.
Other parts of the HHS Budget: a $1.5 billion reduction in Temporary Assistance for Needy Families; reductions in the Social Services Block Grant program; proposed elimination of the $3.4 billion in Low Income Home Energy Assistance Program.
And, increases in opioid spending would come at the expense of block grants in the Substance Abuse and Mental Health Services Administration, and in reduction to the Health Resources and Services Administration workforce training programs.
The Budget Omnibus (including the HHS and all other appropriation bills) is scheduled for House action this week (eight Congressional working days left before expiration of the Continuing Resolution on March 23).
Before we board the Omnibus, here are the other passengers (Bipartisan Budget Act of 2018, P.L. 115-123, enacted February 9): (1) FY 2018 temporary continuing appropriations, (2) FY 2018 supplemental appropriations, (3) increase in the debt limit, (4) increases to the statutory spending limits for FY 2018 and FY 2019, (5) miscellaneous tax provisions, and (6) numerous provisions called at the time the “extenders,” extending or making changes to “mandatory spending programs.”
The last of these is explored in depth for the first time in a Congressional Research Service report (here) on the ACCESS Act, the “Advancing Chronic Care, Extenders, and Social Services Act” also known as “Division E of the Bipartisan Budget Act of 2018.” This Act includes provisions affecting Medicare, CHIP, public health, child and family service, foster care, Medicaid and miscellaneous social programs, producing a “net savings of $3.8 billion” over the coming ten-year period. The CRS report helpfully includes a CRS staff contact with email address and telephone extension. A prediction: almost no one reading this newsletter will be unaffected by the extensive changes in the 12 titles of the ACCESS Act.
DOCTORS, NURSES, HEALTH PROFESSIONALS
Fifty largest U.S. medical group corporate parents as measured by IQVIA (the former IMS Health combined with the former Quintiles), copy here. The IQVIA database includes “total physician affiliations” (number of physician “bridges” between providers and sites), “unique physicians” (individuals affiliated with an IDN) and “medical group count” (“number of physicians at the IDN’s outpatient centers”). Permanente is #1, with three times as many doctors as the VA, Sanford Health of Sioux Falls, #50. Also of interest, the totals by specialty (family medicine 86,155, endocrinology, 5,048, a total of twenty specialties measured in this group ranking).
HOSPITALS AND HEALTH CARE FACILITIES
Uh-oh! The Committee on Energy and Commerce (letter here) is asking CMS for an accounting of the effectiveness of hospital accreditation organizations. The letter notes that the latest CMS report to Congress showed that accrediting organizations doing surveys of hospitals had not reported 39% of the most serious deficiencies; the accreditors’ reports were compared to subsequent “validation surveys” by state health departments.
The letter to CMS has a helpful history of the Medicare Conditions of Participation (CoPs), only infrequently taught in hospital administration programs, but fundamental to Medicare and, arguably, to patient safety.
The Committee letter follows on a Wall Street Journal article (“Hospital Watchdog Gives Seal of Approval, Even After Problems Emerge,” from September 8, 2017 (article here). Letters from the Committee were also sent to the four hospital accrediting organizations which currently have contracts for such work with CMS: the Healthcare Facilities Accreditation Program (the osteopathic hospital accreditor, here), the Center for Improvement in Healthcare Quality (here), DNV (Det Norske Veritas) GL – Healthcare (here), and The Joint Commission (here). Perhaps the Committee staff knew this was National Patient Safety Awareness Week (March 11 – 17).
HEALTH INSURANCE, MEDICARE, MEDICAID, COMMERCIAL
WSJ front page (here) on “star shifting,” the managed Medicare carrier tactic, moving enrollees from low-rated plans into high-rated plans, to secure a larger bonus (at the four- or five-star level), without, of course, any change at all in the quality of care for the enrollees.
Iowa (not Idaho) checks in with STLDI. A campaign underway in Iowa to substitute Short-Term, Limited Duration Insurance for the PPACA-compliant brand includes an op-ed by CMS Administrator Seema Verma in The Des Moines Register (here). Iowa has also seen an initiative (here and here) in that state’s Senate to allow the Iowa Farm Bureau and the State’s Blue Cross plan to sell “health benefit plans,” technically (according to the sponsors) not insurance, and therefore not regulated by the Iowa insurance commissioner. The STLDI strategy in Iowa is also promoted for Idaho by Administrator Verma in her letter to Idaho Governor Otter (here), turning down Idaho’s home-grown, non-compliant plans, but talking up the STLDI alternative (Governor Butch Otter’s response here).
PHARMA
Alzheimer’s was the focus Monday for special Financial Times supplement, and a WJS editorial (here) on relaxing FDA requirements to encourage drug development. The verdict? No progress on the horizon.
“Right to Try” in the House (here), the Fitzpatrick bill, will be debated on the House floor today. “Right to Try” in the Senate (S204, here) passed the Senate in August of 2017. A “bill comparison report” is found here.
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.
2:00 p.m., CMS Webinar, "Hospital Improvement Innovation Networks and Hospitals Collaboration to Improve Quality of Care: 30-Day Mortality Measures," slides here.
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 15
10:00 a.m., Senate Health, Education, Labor and Pensions Committee (HELP), hearing on the
340B drug discount program, 430 Dirksen S.O.B.
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.
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Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com