DCMedical News: Friday, April 20, 2018
DCMedical News
Washington, D.C.
Friday, April 20, 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
Some states reconstructing PPACA, while others deconstruct: California “pushing back” (here), generally. Other states seek stabilization of individual insurance markets through reinsurance (Wisconsin, via a waiver application, similar to waivers in Alaska, Minnesota and Oregon; also on the docket, Louisiana). Elimination of Cost-Sharing Reduction payment reimbursement boosted exchange premiums this year in Wisconsin, for example, by 44%, as predicted. New Jersey’s legislature has passed a state reinsurance and individual mandate program.
DOCTORS, NURSES, HEALTH PROFESSIONALS
Most ‘Quality’ Measures of “Uncertain Validity,” Says the American College of Physicians (ACP): A report in the New England Journal of Medicine (here) calls into doubt many of the “performance measures” proposed by “reformers” in the past 30 years. These 2,500 or so measures are used, according to the authors, “in various quality-reporting, accountability, and payment programs sponsored by commercial payers, government agencies and independent quality- assessment organizations.” They are the basis for the CMS aim to replace Medicare fee-for-service payments with payment based on “value.” Most of them, says this ACP group, are ineffective, inaccurate or otherwise of no use to patients.
The impact of this massive “disconnect” is difficult to calculate, according to the authors, noting that nearly two-thirds of American physicians believe that current measures do not capture the quality of care they provide, but each of those physicians is spending an average of $40,000 per year on performance reporting.
The NEJM article reports the work of the Performance Measurement Committee of the American College of Physicians put together to assess the validity of the measures. Of the measures chosen, the ones most likely relevant to ambulatory general internal medicine (the specialty represented by ACP), about a third were valid, a third were not valid, and a third were of uncertain validity. In professional journal understatement, the authors write that “The use of flawed measures is not only frustrating to physicians but also potentially harmful to patients. Moreover, such activities introduce inefficiencies and administrative costs into a health system widely regarded as too expensive.”
Street Level Observations: Medical Economics (here) reports “Fed up with technology, physicians leave the profession.” Others reduce hours. A primary care practitioner observes: “The demands of data entry, the use of that data to direct care and my overall uncertainly about how medical data was used in aggregate all helped poison the well from which my passion for serving my patients was drawn.” Moreover, it took “about four minutes of keyboard time for every minute of face-to-face time with a patient.”
HOSPITALS AND HEALTH CARE FACILITIES
Post-Acute Care: At its meeting April 5 – 6, MedPAC expressed concern about (and offered reform for) post-acute Medicare payment. A research letter in JAMA (here) describes current trends in post-acute care, beginning with DRG-based prospective reimbursement in 1983, which incentivized hospitals to reduce length of stay and increased use of institutional post-acute care, making that latter category “a major Medicare expenditure.”
The JAMA study (of 138 million hospital discharges) found that roughly 20% went to skilled nursing facilities, 4% to inpatient rehabilitation facilities, and the remainder home. Over the time period studied (2000 – 2015), there was a 5 percentage point increase in hospital discharges going to post-acute care facilities, and a corresponding decrease of discharges to home. Length of stay in hospitals went down during this period, length of stay in post-acute care went up. The authors summarize: “Despite its proliferation, there is little evidence that post-acute care improves key patient outcomes – preventing rehospitalizations or improving functional recovery.”
That Risk-Free Screening: Another study, this one in the American Journal of Infection Control (here), finds that inadequate reprocessing and insufficient drying of endoscopes leads to residual organic material in an average of 49% of the scopes, with some samples as high as 85%.
HEALTH INSURANCE, MEDICARE, MEDICAID
Medicare for More, or All: The Washington Post (here) focuses on “Medicare” as a key word in bills proposed this year by Democratic legislators. Senators Murphy (CT) and Merkley (OR) propose Medicare Part E, for individuals or employers, with a premium tax credit, including traditional Medicare benefits and new benefits for mothers and children. The bill can be found here, a summary here.
Trade-offs: Wall Street Journal “Bare-Bones Health Policies Are Cheaper than ACA Plans – and Riskier Too,” (here), the subject of increased scrutiny. Consumer representatives to the National Association of Insurance Commissioners issue a report on limited plans (here). And the Kaiser Family Foundation (KFF) issues a sober assessment, “Proposals for Insurance Options That Don’t Comply with ACA Rules: Trade-offs In Cost and Regulation” (here).
Highlights of the KFF report: the benchmark premium for a 40-year-old has not cost the 40-year old much more for four years, $121 in 2014, $127 in 2018. The premium tax credits for the 40-year old have ballooned, on the other hand, from $152 in 2014 to $378 in 2018. The KFF paper discusses Short-Term Limited-Duration plans, the Association Health Plans, and the Farm Bureau exemptions. Bottom line for the cost-sensitive: “Once repeal of the ACA individual mandate penalty takes effect in 2019, the net cost differential between regulated and less-regulated coverage will be even greater.”
Meanwhile, a challenge by 18 state Attorneys General (in a letter to the Department of Labor here) focuses on allowing self-employed workers to join Association Health Plans. The Department of Labor estimated (in the proposed rule, here) that AHPs might attract as many as 44 million people.
PHARMA
Transformative therapies: Pharma reps (especially for cancer drugs) have been pressing for higher hospital inpatient reimbursement, to accommodate their “transformative” treatments. Axios reports that cancer hospitals have been lobbying for the same thing, specifically focused on CAR-T cell therapy. The likely place to see such a proposal would be the hospital Inpatient Prospective Payment rule for 2019, expected later in April.
EVENTS & MEETING
April 24
2:00 p.m., CMS Long-Term Services and Supports Forum, call-in (800) 837-1935, Conf. ID: 32640817
April 25
8:00 a.m., Roll Call, “Health Care Decoded,” decoding by Roll Call staff, some Members of Congress and advocates.
May 3
8:30 a.m., HRSA, Advisory Committee on Training in Primary Care Medicine and Dentistry, continuing
on May 4th; conference call-in number: (800) 857-9729, Passcode: 1318150.
Description and additional information in the Federal Register, here.
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.
May 16
11:00 a.m., National Advisory Council on Nurse Education and Practice (Federal Register here).
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: 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