DCMedical News: Wednesday, April 11, 2018
DCMedical News
Washington, D.C.
Wednesday, April 11, 2018
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THE BIG STORY TODAY IN HEALTH CARE
Spending, More: Deficit sinks in, CBO director Keith Hall expresses concern re tax cuts and record spending, CBO report here, projected future in slides here.
The Committee for a Responsible Federal Budget (analysis here) says the $1 trillion deficits will emerge and continue indefinitely, with annual deficits becoming more than 5% of GDP, and total indebtedness at 96% of GDP by 2028. Extension of expiring tax cuts and continuation of current levels of spending would send the annual deficit to more than $2 trillion in 2028.
Spending Continued, Impact on Entitlement Programs: The CBO report that began this week’s discussion of spending on Monday shows health care program spending increase “moderate,” 3% for Medicare in 2018, 7% per year for 2019-2028. Medicaid spending in the CBO report is expected to increase 2% in 2018, 5.5% per year thereafter. Health insurance subsidies for the exchanges are expected to increase more than 20% in 2018, due to an increase in the “loaded” silver plan premium which was, in turn, meant to compensate for the loss of the Cost-Sharing Reduction reimbursements. (Silver loading may be disallowed for 2019, still uncertain). Following the 2018 increase, the ten-year average growth in exchange premiums is estimated to be 5%.
DOCTORS, NURSES, HEALTH PROFESSIONALS
California: Cost control bill amended and expanded, here, California Healthline report here, Associated Press/NYT here.
Big study on disease burden, variability by state: in JAMA, a major study of disease in the US from 1990-2016 (here). Summary of findings: “Between 1990 and 2016, overall death rates in the United States declined from 745.2 . . . per 100 000 persons to 578.0 . . . per 100 000 persons. The probability of death among adults aged 20 to 55 years declined in 31 states and Washington, DC from 1990 to 2016. In 2016, Hawaii had the highest life expectancy at birth (81.3 years) and Mississippi had the lowest (74.7 years), a 6.6-year difference. Minnesota had the highest HALE [healthy life expectancy] at birth (70.3 years), and West Virginia had the lowest (63.8 years), a 6.5-year difference. The leading causes of DALYs [disability adjusted life years] in the United States for 1990 and 2016 were ischemic heart disease and lung cancer, while the third leading cause in 1990 was low back pain . . . the third leading cause in 2016 was chronic obstructive pulmonary disease. Opioid use disorders moved from the 11th leading cause of DALYs in 1990 to the 7th leading cause in 2016, representing a 74.5% . . . change.”
Not us: Hospital emergency departments apparently contributed not much to the prescription opioid epidemic. The Annals of Emergency Medicine (here) reports that prescription opioids are really not an emergency department-created problem. A survey from the medical expenditure panel covering 1996 to 2012 found that the quantity of opioids prescribed increased by nearly 500%, but the percentage of those opioids being prescribed in the emergency department actually decreased from 7.4% in 1996 to 4.4% in 2012. The recommended intervention: changing the prescribing habits of the physician in the outpatient setting, office or clinic.
HEALTH INSURANCE, MEDICARE, MEDICAID
Exchanges: The 2019 final benefit and payment rule (here) makes more flexible the definition of Essential Health Benefits (EHBs), raises the bar for review of premium increases (10–15%), has additional eligibility checks for premium credits, eases up on medical loss ratio requirements, extends transitional policies through the end of 2019, and increases hardship exemptions, estimated to include more than a quarter of the participants (for example, living in counties with limited or no coverage options). The EHB “flexibility” includes opportunities to choose from 50 benchmark plans used by any state for 2017, choosing from the ten EHB categories used in any state plan or otherwise creating an EHB plan “equal to or greater than” the scope of benefits provided by the typical employer plan in that state. The individual mandate penalty was eliminated, but the statutory elimination doesn’t take place until 2019; the CMS April 9 hardship “guidance,” on the other hand (found here), takes effect immediately, and allows a two-year period for a potential retroactive exemption. All told, authority to craft exchange-based plans is being shifted to the states.
PHARMA
340B – Whatever happened? Providers continue to protest cutbacks in Medicare reimbursement. A different issue (same program) involves manufacturers, namely the proposed rules for financial penalty for manufacturers that “knowingly and intentionally overcharge covered entities under the 340B program.” A fifth delay in the effective day of a final rule on drug pricing has taken place on the penalties, originally from an effective date of March 6, 2017.
The Budget justification presented by the Health Resources and Services Administration (here) to the Appropriations Committee, in support of HRSA’s plans for the 340B program in FY 2019, says the following (section beginning at page 266): “Hospitals participating in 340B are not required to report on 340B savings or how these savings are used to benefit patient populations. The FY 2019 Request also proposes to reform the 340B Program through a General Provision in the L/HHS Appropriations Act that would require covered entities to report both the savings and their uses to HRSA, and provide HRSA with general regulatory authority.” HRSA reports that the 340B program now has 12,823 participating entities receiving discounts for services at 42,486 sites.
EVENTS & MEETINGS
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: 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