DCMedical News: Monday, April 16, 2018
DCMedical News
Washington, D.C.
Monday, April 16, 2018
DC Medical News is published every day either the House or the Senate is in session. Want to subscribe? See below. Add our new domain (dcmedicalnews.org) to your white list. Welcome to our new “courtesy trial” recipients.
THE BIG STORY TODAY IN HEALTH CARE
Re-shaping the Patient Protection and Affordable Care Act (PPACA, Obamacare) at the federal level:
Today the final rule is published in the Federal Register (here) for calendar year 2019 Medicare policy and technical changes for MA, Medicare fee-for-service, Part D and the PACE program.
Tomorrow the final rule (“Notice of Benefit and Payment Parameters”) will be published (preliminary print here) for state flexibility and reduction of regulatory burdens, according to CMS. (See below under health insurance for more.)
April 9 CMS sent (here) its 2019 letter to issuers on federally-facilitated exchanges, and also published (here) liberal hardship exemption rules to address the concerns of those facing limited health insurance options. Finally, also on April 9, (here) the agency issued a bulletin allowing additional transition periods for some individual and small group policies to become “ACA-compliant.”
DOCTORS, NURSES, HEALTH PROFESSIONALS
Cancer chemotherapy (report from JAMA Oncology here): grew from 6% of infusions taking place in hospital outpatient departments (HOPD) in 2004 to 43% in 2014. Commercially insured patients treated in physician offices had half the drug expense ($1,466 in-office to $3,799 for the HOPD location), half the “day level spending” (at $3,902 in-office vs. $7,973 in-HOPD) and half the six month treatment episode expense, ($43,700 in-office vs. $84,660 in the HOPD). The authors note that they could not demonstrate that the hospital “facility fee” was at fault, or that there were or were not quality or other differences. They urged commercial health insurers to follow Medicare’s lead in lowering the “site-of-service” differential between payments to physicians in-office and payments to hospitals in HOPDs. (See CMS final rule fact sheet 11-1-2016, with yellow highlights, here.)
HOSPITALS AND HEALTH CARE FACILITIES
Rick Louie (hospitalpricingspecialists.com, here) alerted clients to the Surgeon General’s admonition (here) that everyone should have Naloxone available. Louie’s firm did a survey of 3,624 hospitals and found that (in the top 25) the price ranged from $548 to $3,712 (the Martin Luther King Community Hospital).
HEALTH INSURANCE, MEDICARE, MEDICAID
The Benefit and Payment Parameters rule for 2019 will be published in the Federal Register tomorrow together with the calendar year 2019 letter to issuers in the federally facilitated exchanges. The CMS fact sheet on the rule is found here. In addition to plan benefits, eligibility and enrollment, the rule sets rate review provisions, the medical loss ratio (MLR), SHOP exchange rules and PPACA risk adjustment. A three part series by Katie Keith in Health Affairs is found here (rule, benefits), here (rate review, MLR) and here (risk adjustment).
EVENTS & MEETING
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.
April 19
10:00 a.m., Senate Finance Committee hearing on opioids, Medicare and Medicaid.
May 6
American Hospital Association Annual Membership Meeting (Washington, DC), through May 9.
May 8
Subcommittee on Oversight and Investigations (House E&C) will hear testimony from the chief executives of AmerisourceBergen, Cardinal and McKesson, concerning pill dumping in W. Virginia and other matters.
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: 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