DCMedical News: Wednesday, April 25, 2018
DCMedical News
Washington, D.C.
Wednesday, April 25, 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
IPPS Rule Preview: CMS publishes the preliminary FY2019 Inpatient Prospective Payment Rule for hospitals (IPPS, here, 1883 pages), in advance of the planned May 7 Federal Register publication. The CMS announcement is here, a brief summary of the rule here. In general, the rule proposes transparency (hospital price posting); promises higher Medicare inpatient funding (by $4 billion); drops 19 “quality” process measures. Comments will be due by June 25, more to come.
DOCTORS, NURSES, HEALTH PROFESSIONALS
Costly Disparities: Black patients were more likely to be discharged to institutions post operatively for hip and knee replacements, compared to discharges to home, but less likely to have the operations, even when covered by Medicare. Authors of a piece on these findings in JAMA this week (here) remind us how costly discharge disparities are: the “2013 Institute of Medicine report on geographic variation in health care spending in the United States that found variation in post–acute care use alone explained more variation in Medicare spending across regions than use of acute care, prescription drugs, diagnostic tests, and procedures combined.”
HOSPITALS AND HEALTH CARE FACILITIES
Moody’s Turns South on Hospitals: A Wall Street Journal report (here) on hospitals shows Moody’s concerned, especially with a financial metric (median operating cash flow margin) which has been a past guide, and is now at a decade low. (Moody’s bases its reports on the 160 hospitals with current Moody’s ratings, a top financial layer of the nation’s 4,950 hospitals. Operating cash flow margin is calculated by dividing a company’s operating cash flow, found on the statement of cash flows, by sales—net revenue—found on the income statement).
Some reasons for the falling margin: increased outpatient activity (competition for hospitals, outpatient care expensive for hospitals to produce); enrollment in PPACA of the previously uninsured has been harvested, is likely to erode, producing more bad debt; rising enrollment in Medicare, and especially in “managed Medicare” (Medicare Advantage) programs, underpaying hospitals; the “suddenly appearing” nurse shortage (Tenet giving $25,000 signing bonuses to nurses in some parts of the country) will put wage pressure on hospitals; transformers (CVS-Aetna, Walmart-Humana) will squeeze hospitals, may ease pressure on their own businesses (insurance, pharmacy benefit management).
HEALTH INSURANCE, MEDICARE, MEDICAID
Insurance Coverage, Census Bureau Report: The “Small Area Health Insurance Estimates” of the Census Bureau report (here) was published March 18. The work is characterized as “[T]the only source of data for single-year estimates of health insurance coverage status for all counties in the United States,” and describes “demographic and economic differences in health insurance status across states and counties, as well as trends in health insurance coverage.” Helpful charts, more at https://www.census.gov/library/publications/2018/demo/p30-03.html.
Short-Term Limited-Duration Insurance (STLDI): The comment period on the proposed rule (here) closed with 43 Democratic Senators objecting (here) and the Kaiser Family Foundation producing a new report (here).
Re-Branding: The much-maligned electronic health record (EHR) meaningful use incentive program is no more. As part of the FY2019 IPPS proposed rule CMS announced Tuesday that the EHR Incentive Programs is now the Promoting Interoperability (PI) Programs for eligible hospitals, critical access hospitals, and other Medicare providers.
PHARMA
Drug Prices: Delayed Presidential speech (ailing HHS Secretary Azar) may include Obama-era (here) proposal to put Part B drugs ($26 billion per year, two-thirds biologics) under Part D, enabling Part D plans to negotiate prices with manufacturers, so that the plans might stay within their monthly budgets. Possible trade-off for the manufacturers: limiting the scope of (and the number of eligible hospitals participating in) the 340B program.
Opioid Legislation: Senate HELP committee voted unanimously to approve a bill with 40 separate measures (see DCMN of April 19 and March 7, 8, 9, and 12). Two amendments will boost medication-assisted treatment (MAT), one providing grants for physicians in training to include MAT, the other boosting the number of patients a physician can treat through MAT (from 100 to 275).
EVENTS & MEETING
April 25
8:00 a.m., Roll Call, “Health Care Decoded,” decoding by Roll Call staff, some Members of Congress
and advocates.
1:00 p.m., House Energy & Commerce Subcommittee on Health meets to mark up some of the 60 bills on opioids developed or offered as a result of that group’s multiple hearings. The bills can be found at:
https://energycommerce.house.gov/markups/subcommittee-vote-on-opioid-legislation-and-h-r-5554/.
2:00 p.m., House Labor-HHS-Education appropriations subcommittee hearing on workforce programs.
3:00 p.m., The House Democratic Steering and Policy Committee holds a hearing on "Soaring
Prescription Drug Prices: A Bitter Pill to Swallow," rsvp to joy.lee@mail.house.gov, livestream at https://www.facebook.com/HouseDemocrats/videos/10155306726053548.
April 26
10:00 a.m., Ways and Means Subcommittee on Health holds hearing on “Identifying Innovative Practices and Technology in Health Care.”
Health Datapalooza (AcademyHealth, HHS), Washington Hilton, continuing April 27.
May 2
8:00 a.m. to 5:15 p.m. National Academy of Medicine Action Collaborative on Clinician Well-Being
and Resilience, Washington, DC.
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.
AcademyHealth, through June 26, Convention Center, Seattle, Washington.
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.
Additional April publication dates: 26, 27.
May publication dates: 7, 8, 9, 10, 11, 14, 15, 16, 17, 18, 21, 22, 23, 24, 25.
June publication dates: 4, 5, 6, 7, 8, 11, 12, 13, 14, 15, 18, 19, 20, 21, 22, 25, 26, 27, 28, 29.
July publication dates: 9, 10, 11, 12, 13, 16, 17, 18, 19, 20, 23, 24, 25, 26, 27, 30, 31.
August publication dates: 1, 2, 3.
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com