DCMedical News: Thursday, April 19, 2018
DCMedical News
Washington, D.C.
Thursday, April 19, 2018
DCMedical 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
Spending: Appropriators look to May and June for mark-up of twelve bills (“Omnibus” vs. “Minibus,” see DCMN of 4-18). Senate majority leader unenthusiastic about White House legislative/rescission proposal. Unknown: CBO says sequestration (for example, Medicare) not needed for FY2018, but unknown what OMB will say. OMB chief Mulvaney tells the House appropriators that “packages” of rescission requests will come and, per 1974 budget law, will freeze spending for at least 45 Congressional days, possibly for longer.
Opioids: House Energy & Commerce Health Subcommittee schedules mark-up for April 25, deliberations kicked off last night with special order evening House session. More than 60 bills in the House. CQ reports that the Senate HELP Committee (Health, Education, Labor & Pensions) will consider one large bill on the 24th. Hors de combat: HHS Secretary Azar (diverticulitis, hospitalized over the weekend, later readmitted). (For previous reports and materials on proposed opioid legislation see DCMN of March 7, 8, 9, 12.) Separately, the Senate Finance Committee (see Events & Meetings, below) holds a hearing today on the impact of the opioid crisis on Medicare and Medicaid.
DOCTORS, NURSES, HEALTH PROFESSIONALS
Mental Health: California Health Care Foundation finds that only one-third of Californians in need of mental health care receive it (“Mental Health in California: For Too Many, Care Not There,” here, infographic here).
State health: Continued harvest of findings from the study of the Institute for Health Metrics and Evaluation on state-specific health outcomes between 1990 and 2016 (here) shows this highlight: If you lived (during this period) in Kentucky, New Mexico, Oklahoma, West Virginia or Wyoming, your probability of dying between the ages of 20 and 25 increased by more than 10%, at the same time national death rates per 100,000 people declined from 745 to 578 (here).
Doctors and Skilled Home Health Care: Researchers sponsored by the National Institute on Aging and National Institute of Mental Health published a study on doctor certification of Medicare skilled home health care (SHHC, here) in the Annals of Internal Medicine. The focus is care coordination, important because of the “complex medical, functional and social needs of patients,” 3.4 million of whom accounted for $17.7 billion of Medicare skilled home health services in 2014. The medium for coordination, the CMS Form 485 (CMS-485) is generally developed by a home health clinician, typically a nurse, “who develops an SHHC plan of care that is transmitted to the physician for review and certification.” The form “[S]erves as the primary means of communication between the physician and the SHHC agency.” The physician’s signature is required for the home health agency to receive payment from Medicare. Study results: Half the physicians spend less than one minute reviewing the CMS-485 before certification, another 21% spend at least two minutes, 80% “rarely or never changed an order on the CMS-485.” On the other hand, “[T]he mean reported ease of contacting the SHHC agency was 4.7 on a scale of one to ten (easy to difficult).
HOSPITALS AND HEALTH CARE FACILITIES
Jobs and Health Care: Skinner and Chandra (here) link health care employment growth and the future of U.S. cost containment in JAMA. They note, “From December 2007 to December 2017, the health care sector has added 2.8 million jobs, or nearly 1 in every 3 new jobs in the United States.” They cited the Altarum April 3rd labor brief (here). In plotting employment data against high health care spending, there is a nearly linear relationship between the proportion of jobs in health care in a state and health care spending per capita in that state. They summarize: “[T]he point remains that efforts to reduce costs are unlikely to be successful without scaling back job growth in health care.”
At the top, Massachusetts, with the highest proportion of jobs in health care, and the highest spending. At the bottom, Wyoming, with the fewest proportion of jobs in health care, and the lowest spending. The remedy? Not “shortsighted policies like hiring freezes” or even “reduce excess salaries for hospital administrators,” both of which would have only a “trivial effect on the billion-dollar budgets of large hospitals.” They suggest a focus on “[R]estraining overall hiring by right-sizing jobs to employees who can best perform them at the lowest cost or by closing inefficient facilities.” They argue against the “urge to expand employment using unexpectedly healthy profit margins” because it is “easier to create new positions than it is to lay off workers in a less sanguine future.”
Politics and health care jobs: One difficulty in a strategy of restraint, of course, was outlined by Cooper and colleagues (NBER Working Paper, August 2017), in which they describe the link between Section 508 of the 2003 Medicare Modernization Act, providing a pathway for hospitals to apply to have Medicare payment rates increased, and the resulting payment increases. The result was “more patients, increased payroll, [more] hired nurses, added new technology, raised CEO pay.” Cooper and colleagues went on to note that the lucky MMA 508 hospitals formed the “Section 508 Hospital Coalition” and that members of Congress with a 508 hospital in their district “received a 22% increase in total campaign contributions and a 65% increases in contributions from individuals working in the health care industry in the member’s home state.”
California: Attorney General decides (here) that patients struggling to pay medical bills should have help through hospital charity care funds, denying requests from hospitals (which had cited health insurance availability under PPACA) to be freed from charity care obligations. The specific requirements in California law govern charity care when a non-profit hospital merges with or is acquired by another non-profit or by a for-profit company. That requirement is separate from PPACA Section 501(r) and other aspects of federal non-profit hospital law requiring (unspecified) charitable care (as reflected in Schedule H, Form 990) for free or discounted care or community service. Another symptom of patient needs in California: a bill to expand Medi-Cal to undocumented patients moves forward, but with no means of payment identified. UC Berkeley Labor Center reports such expansion would cover more than 1 million people.
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: 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