DCMedical News: Thursday, March 22, 2018
DCMedical News
Washington, D.C.
Thursday, March 22, 2018
THE BIG STORY TODAY IN HEALTH CARE
Health insurance stabilization kicked off the Omnibus: With two days remaining until expiration of the Continuing Resolution which funds the federal government, any “Obamacare fix” through premium stabilization (Cost-Sharing Reduction payments, reinsurance) has been omitted from the Omnibus budget bill. The bill (here) is 2,232 pages, the Labor-HHS-Education highlights are here, 9 pages.
Health issues per se did not play a part in the final bill, with these exceptions: an increase for opioid addiction prevention and treatment; an increase in childcare development block grants; and $2 billion for Veterans Affairs hospital maintenance and construction.
The package must pass by Friday midnight under current funding rules.
DOCTORS, NURSES, HEALTH PROFESSIONALS
The Health Subcommittee of the House Ways and Means Committee held a hearing Wednesday on implementation of MACRA physician payment policies. Representing CMS were Demetrios Kouzoukas, Principal Deputy Administrator, and Dr. Kate Goodrich, CMO. The opening statement by Chairman Roskam is here.
Issues raised include the following: the fate of bundling, why CMS was unbundling bundled payment plans and thereby “undermining” value-based payment (Mr. Levin); accommodation to rural areas (Ms. Sewell), to which Mr. Kouzoukas noted rural use of low-volume threshold, virtual groups and hardship exemptions; transportation in rural areas (Ms. Sewell); paperwork (Ms. Jenkins); unintended payment conflicts (Ms. Chu), with a Next Gen ACO in her district inadvertently encountering coordination of benefits issues; payment for mental health providers (Ms. Chu); Stark laws and the way in which they are obstacles to coordinated care (Mr. Marchant); and what should the Committee be thinking about for the next five years (Mr. Roskam), to which the response was patient-centered, value-based initiatives, “patients over paperwork.”
Some on the outside (MedPAC Report to Congress, here, see Chapter 15) are recommending significant change in MACRA, especially the elimination of MIPS, while others (see Merrill Goozner, here) think it’s much too soon.
Do physician ratings count? A study in JAMA Surgery this week (here) indicates that the larger the practice of more than 600 urologists in California, the lower the rating; as the practices got larger, the ratings got lower. Cause? Effect? Are ratings irrelevant?
HEALTH INSURANCE, MEDICARE, MEDICAID
Health insurers doing well: health insurers have accommodated Affordable Care Act ups and downs, according to a White House report (here) and story (WSJ, here). The report of the Council of Economic Advisors indicates that, in the four years since the main provisions of the health law were implemented, health insurance stocks have increased by 272%. The Council says some of those gains involve managed Medicaid, some involve the premium and Cost-Sharing Reduction subsidies, and some involve the impact of the tax law changes.
Managed health insurance: In a separate report (here), Deloitte has analyzed the performance of health care plans in Medicare Advantage (MA) and Medicaid managed care, 2011 – 2016. Here are the significant findings:
The government programs now account for 46% of all fully insured revenue of the health plans;
They also produce 57% of their entire underwriting gains;
Aggregate plan revenue in Medicaid managed care increased from $64 billion in 2011 to $207 billion in 2016;
The largest plans did best in MA, the top two plans generating 80% of the underwriting gains and almost half of the aggregate revenue. In Medicaid managed care, the top three plans had 80% of the underwriting gains;
Variations in the success of the larger plans over the smaller began to widen in 2014.
HCPCS Coding and Payment Determination Meetings: CMS publishes (here) a correction I the Federal Register, as follows: Tuesday, June 5 at 9:00 a.m., Durable Medical Equipment, Orthotics and Prosthetics; Wednesday, June 6 at 9:00 a.m. is a continuation of DME and O&P.
PHARMA
Energy & Commerce Subcommittee on Health background paper, “Combating the Opioid Crisis: Prevention and Public Health Solutions,” here.
TECHNOLOGY
CMS at HIMSS, explanation of Quality Payment Program Year 2 (here), Advanced APMs (here).
EVENTS & MEETINGS
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, flyer here).
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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March publication dates remaining: 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