DCMedical News: Tuesday, April 17, 2018
DCMedical News
Washington, D.C.
Tuesday, April 17, 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
State watch: New Jersey passes an individual mandate and state reinsurance bill (here).
States and Medicaid: some helpful numbers re-sent from Pew, on federal grants to the states shifting to health (here), the percentage of state grants in health going to Medicaid (here), and a graphic showing health grants in Medicaid (here).
DOCTORS, NURSES, HEALTH PROFESSIONALS
High blood pressure: ACC/AHA square off against ACP, AAFP in hypertension re-definition to lower systolic Blood Pressure (BP), 140 to new level of 130 mm Hg. New article in JAMA Internal Medicine (here) summarizing risks of the re-definition (the focus of the American College of Physicians and the American Academy of Family Physicians) and benefits (the focus of the American College of Cardiology and the American Heart Association) says this: “For most adults newly classified as having high BP under the ACC/AHA guideline (the 80% of those newly diagnosed who have <10% 10-year risk), there is no incremental benefit in CVD [cardiovascular disease] risk reduction, but potential incremental harms from disease labeling, and, for those who meet the threshold for drug treatment, from adverse drug effects.”
If at first . . . : And then there is the challenge of accurate BP measurement: in the same journal, a report (here) shows that repeated measurement (with BP dropping 8-11 mm overall) may be as good as taking a blood pressure drug. “[T]he observed decrease remains clinically important, comparable with that associated with addition of an antihypertensive medication. As the health care system moves toward value-based care initiatives, such as accountable care organizations and shared savings programs, implementing routine repeated measurement for an initially elevated BP may contribute to improved decision making around HTN [hypertension] management and should be considered a standard component of programs to improve BP control.”
Budget, or diet?: Austin Frakt weighs in with a NYT report (here) on Maryland Hospital global-budgeting, the optimistic RTI report (here), the non-so-optimistic-peer-reviewed JAMA IM article here. Many excellent references from Frakt, balanced.
HOSPITALS AND HEALTH CARE FACILITIES
Heart Transplant Centers: a study in the Journal of the American College of Cardiology finds that if you build it, you may overuse it: “There is wide variation in the treatment practices of adult heart transplantation centers. Competition for transplantable donor hearts is associated with the potential overtreatment of hemodynamically stable candidates. Overtreatment may compromise the fair and efficient allocation of scarce deceased donor hearts.” (Abstract, here).
Home health, DME services: Another follow-on to the famous CMS Administrator Seema Verma March 14, 2017 letter (here) to the nation’s Governors is a new guidance (here) promising to be “flexible” in the now-two-year-delayed home health rules (here) requiring face-to-face interactions between doctors ordering home health and their patients. “The final rule requires that for the initial ordering of home health services, the physician must document that a face-to-face encounter that is related to the primary reason the beneficiary requires home health services occurred no more than 90 days before or 30 days after the start of services. The final rule requires that for the initial ordering of certain medical equipment, the physician or authorized NPP must document that a face-to-face encounter that is related to the primary reason the beneficiary requires medical equipment occurred no more than 6 months prior to the start of services.” The “guidance” introduces exceptions, modifications, and potential for further delay.
HEALTH INSURANCE, MEDICARE, MEDICAID
ACOs: Some (relatively junior) House members (per InsideHealthPolicy) are asking CMS to ease up on “type 1” Medicare Accountable Care Organizations (ACOs), that is, give them a third three-year cycle of modest rewards and no risks. This in the wake of HHS Secretary Azar indicating that he had found the performance of the type 1 or Shared Savings Organization-ACOs “underwhelming.”
MACPAC: meets this week (see below, Events & Meetings, agenda here): subjects include social determinants of health, adequacy of resources for opioid treatment, the CMS proposal for (reduced) monitoring of the adequacy of fee-for-service Medicaid provider networks and the managed long term services and supports (MLTSS) program. On Friday the group discusses the evaluation of §1115 waivers and the hospital upper payment limit (UPL) program.
PHARMA
Opioids: The House Subcommittee on Health will hold a “round-table” discussion (primarily involving family members of overdose victims) this Thursday at 10:30 a.m. The Subcommittee event will follow up on three hearings pertaining to the opioid crisis, and possible legislation solutions, including patient safety, enforcement, prevention and payment issues. Background from these three hearings (specific proposals, findings) can be found here.
Drug prices: The President unwraps a plan to control drug prices April 26. FDA Commissioner Gottlieb tells community oncologists that cost-sharing of cancer drugs is too large a burden for patients. HHS Secretary Azar considers whether to allow Massachusetts (pioneer for Obamacare) to offer a limited drug formulary in that state’s Medicaid program. Many or perhaps all of the President’s proposals are outlined in a 2019 budget fact sheet (here) from the Office of the President.
EVENTS & MEETING
April 19
9:30 a.m., MACPAC: the Medicaid and CHIP Payment and Access Commission (MACPAC) is on Thursday, April 19 from 9:30 a.m.–3:45 p.m. and Friday, April 20 from 9:00 a.m.–11:45 a.m. at the Ronald Reagan Building and International Trade Center’s Horizon Ballroom. MACPAC’s April meeting covers a broad agenda, with sessions ranging from social determinants of health, to Section 1115 waiver evaluations, to provider payment policy. The Commission also reviews two chapters in its forthcoming June Report to Congress on Medicaid and CHIP, on access to substance use disorder (SUD) treatment and managed long-term services and supports (MLTSS).
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: 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