DCMedical News: Tuesday, April 10, 2018
DCMedical News
Washington, D.C.
Tuesday, April 10, 2018
DC Medical News is published every day either the House or the Senate is in session. Want to subscribe? See below.
THE BIG STORY TODAY IN HEALTH CARE
Spending: House and White House initiatives are underway to roll back part of the $1.3 trillion spending bill, in domestic (non-defense) areas. A temporary freeze on funding could come under the Impoundment Control Act of 1974, and a rescission (the majority vote in both houses) must take place within 45 days. No congressional action equals no change in spending. CBO report (here) and slide deck (here) show that the deficit for the current year will be $804 billion, for next year $981 billion, $1 trillion in 2020 and $1.5 trillion in 2028. But Senators are reportedly cool to backtracking on commitments.
States: More on the states, especially California (Assembly Bill 3087, found here), and a Los Angeles Times report found here. The nation/state is going after health care costs, with a bill unveiled Monday which would create an independent commission to set prices for hospital stays, physician visits, and other medical services covered by commercial payers, based on Medicare rates. The findings would not affect rates paid by Medicare and Medicaid, although the global budgeting idea is influenced by Maryland’s all-payer program, begun in 2014. (Under that program, fixed payments to hospitals are required, the same prices paid by private and public insurers).
Otolaryngologist Dr. Theodore Mazer, on behalf of the California Medical Association, indicated that the bill would “likely cause an exodus of practicing physicians.” Legislators may be sensitive to a recently released Berkeley (Petris Center) report on consolidation in hospital and insurance marketplaces (found here). The report found that of 54 surveyed counties 44 were “highly concentrated” hospital markets, 7 of which, the report contends, warrant “concern and scrutiny” by anti-trust authorities. In the six years (2010-2016) studied, there was a 15% increase in physicians working for a hospital or health system, 29% increase of specialist physicians.
More on consolidation: Gawande and others (here and here) write in JAMA about risks to patient safety secondary to health system expansions.
HEALTH INSURANCE, MEDICARE, MEDICAID
2019 Benefit and Payment Rule: Final rule published (here) in Federal Register Monday, CMS fact sheet (here), Commonwealth Fund conclave slides explaining what to look for (here). More erosion of PPACA: CMS guidance on expanded hardship exemptions for individual mandate, here.
STLDI: The comment period for the proposed rule on short-term, limited duration health insurance (STLDI) ends April 23rd. A Commonwealth Fund publication (here) discusses state regulation, based on a survey of ten states, concerning consumer protection in the absence of ACA requirements. The proposed rule is here.
Hospital quality incentives under Medicare: MedPAC is souring on the connection of Medicare payments to “quality of care” received by the program’s beneficiaries (see also Washington Post, February 20th, here). At its meeting April 5, comments from Commission Members supported the staff slide presentation (here), namely that the hospital quality payment programs contain too many overlapping metrics, rely on condition-specific readmission as opposed to all-condition measures, include process measures unrelated to outcomes, and further rely on provider measures that are inconsistently reported. Dr. David Grabowski of Harvard Medical School was particularly focused on the imprecision, overlap and general lack of impact of current Medicare “quality” measures.
The staff proposal would merge the Hospital Readmissions Reduction Program (HRRP), the hospital Value-Based Purchasing (VBP) program, and eliminate the Inpatient Quality Reporting Program (IQRP) and Hospital-Acquired Conditions Reduction (HACRP) reporting program. In place of these four would be the “HVIP” or Hospital-Value Incentive Program.
Medicaid: Hospital utilization dropping, even in the absence of “delivery system reform.” The HCUP (Hospital Cost and Utilization Project) statistical brief #235, dated January 2018, recently released, found here, tracks medium-term utilization. From 2000 to 2015, inpatient stays dropped 25% in the Medicare population. In the second half of that period, Medicaid was the top payer for patients under age 18, also dramatically increasing for patients aged 18 to 44 (74% increase) and 45 to 64 (68% increase).
EVENTS & MEETINGS
April 10
Becker’s Hospital Review, Annual Meeting, Chicago, through April 14.
April 11
Energy and Commerce Subcommittee on Health, final hearing on opioid crisis, focus on insurance coverage, payment issues, provider concerns.
April 11
Ambulatory Surgery Center Association meeting, Boston, through April 14.
April 16
8:45 a.m. (continuing through April 18), National Advisory Committee on Rural Health and Human Services, The Saratoga Hilton Saratoga Springs, NY, notice here.
May 6
American Hospital Association Annual Membership Meeting (Washington, DC), through May 9.
June 19
AHIP Institute & Expo, San Diego, through June 22.
June 24
HFMA Annual Conference, Las Vegas, through June 28.
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.
April publication dates: 10, 11, 12, 13, 16, 17, 18, 19, 20, 23, 24, 25, 26, 27.
May publication dates: 7, 8, 9, 10, 11, 14, 15, 16, 17, 18, 21, 22, 23, 24, 25.
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com