DCMedical News: Friday, March 16, 2018
DCMedical News
Washington, D.C.
Friday, March 16, 2018
Past issues of DCMN (and linked source documents) can be accessed by clicking on “View this email in your browser.”
THE BIG STORY TODAY IN HEALTH CARE
There are five congressional working days remaining before expiration of the Continuing Resolution on March 23. No resolution as yet on health policy issues, no publicly available draft bill, no votes in the House today, nothing in the Senate.
Budget: What’s at Stake
Health Insurance Stabilization: Sen. Alexander briefing paper (here) for premium reduction, reinsurance, §1332 flexibility, copper plan (catastrophic), interstate health insurance compacts, C-SRs and more.
Medicare: Sequestration (reduction in what otherwise would be ordinary provider payments, now 2%) looks like a flexible slush fund, to be extended (with projected “savings”), or enlarged. Because Medicare is such a large program, seemingly minor changes in provider payments yield a great deal of flexibility for other expenditures. The President’s budget proposed $554 billion in savings.
Medicaid: Block grants look like a “non-starter.” Many believe that it was enlargement of the Medicaid program (now 74 million enrollees during the course of a year) which defeated attempts to repeal Obamacare. If not achieved through legislation, block grants may de facto become a significant part of CMS’ Medicaid waivers for states.
Graduate Medical Education: Another “block grant” in the Administration budget, combining Medicare, Medicaid and miscellaneous smaller graduate medical education programs, for a “savings” of $48 billion. The major impact would be in cities and states with the highest number of residents, especially New York, which receives 20% of the nation’s GME funds.
DOCTORS, NURSES, HEALTH PROFESSIONALS
Site of Service, Oncology:
A letter in JAMA Oncology (here) notes the migration of chemotherapy from doctors’ offices to hospital outpatient departments, and the higher cost of the latter. The difficulty of just getting the facts: the study cannot distinguish stage or grade of cancer, any differences in quality, or whether the higher HOPD price is due to a “facility fee.”
Another variable is class of payer. A review of cancer care to MediCal (Medicaid in California) patients 1997-2014 brought a response in the same journal (here). “Publicly insured patients had poorer cancer-specific survival than patients with private insurance or Medicare.” In addition, “For 7 of 8 tumor types evaluated, other public insurance (again, 74% MediCal) had poorer survival than private insurance (melanoma is particularly called out).” Do payments to physicians matter? “One reason for poor outcomes may be limited physician access. MediCal controls costs partly by poorly paying physicians. MediCal pays physicians only 52%—about half—of what Medicare pays. Consequently, many physicians decline to accept MediCal patients.”
AMA statement to a House Judiciary Subcommittee in opposition to the CVS-Aetna merger (here). “We are concerned that the proposed merger has the potential to worsen competition (or reduce hopes for amelioration) in three poorly performing markets: PBM services; local health insurance markets; and many local retail pharmacy markets.”
HOSPITALS AND HEALTH CARE FACILITIES
Acute Myocardial Infarction (AMI), Heart Failure (HF), improvements, or not:
More on the limitations of data, and the possible irrelevance of current quality metrics: mortality trends for AMI and HF differed markedly between 2009 and 2015, study here. Acute myocardial infarction mortality among both baseline poor performers and other hospitals fell significantly, whereas a small improvement among baseline poor performers in HF was offset by an increase in mortality in the remainder of hospitals.
HEALTH INSURANCE, MEDICARE, MEDICAID, COMMERCIAL
MedPAC (Congressional advisory body on Medicare) sent its March 2018 report (563 pgs., here) to Congress. Transcript of March 1 MedPAC meeting here.
MACPAC (Congressional advisory body on Medicaid and CHIP) has sent its 2018 report to Congress (here), addressing managed care, telehealth and disproportionate share hospital (DSH) payments. The group says states should be allowed to require beneficiaries to be enrolled in a Medicaid “managed care” plan, without having to ask for federal permission to do so. Total Medicaid and CHIP enrollment report by state and program here.
Deep in the MA and Part D weeds: the Chairs (and a total of 40 members) of the Health Subcommittees of Ways and Means and Energy and Commerce write (here) to HHS Secretary Azar and CMS Administrator Verma concerning the Advanced [sic] Notice and Call Letter regarding changes in MA and drug programs planned for calendar year 2019.
You make it to Medicare-eligibility and you have it made, right? No more health insurance nonsense. But “not so” says Kaiser in a survey (here) showing the financial burden on Medicare households to be 14% of income, compared to 6% for non-Medicare. Higher numerator (health care expense), lower denominator (household income), both at work.
PHARMA
USC researchers publish a study in JAMA (here) and a white paper (here) showing copayments are frequently higher than the actual cost of drugs.
Kudos to Axios and their articles (here and here) on pharmacy benefit managers, and on success in procuring a sample (36 page!) Express Scripts contract (here), the thrust of which is to make sure that no information concerning drug discounts and rebates is disclosed, ever.
National Academies publishes a study on “Making Medicines Affordable,” here.
EVENTS & MEETINGS
Your March Calendar:
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 21
9:00 a.m., Energy and Commerce Health Subcommittee begins two days of hearings (bills here) on “Combating the Opioid Crisis: Prevention and Public Health Solutions,” 2123 Rayburn H.O.B., continuing March 22 at 10:00 a.m.
2:00 p.m., House Ways and Means Health Subcommittee, hearing on the implementation of MACRA’s physician payment policies, 1100 Longworth H.O.B.
March 22
1:30 p.m., Competition and Consolidation, Webinar sponsored by Alliance for Health Policy, AHCJ, NIHCM, worth a listen (Tom Scully, Chapin White).
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: 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