DCMedical News: Monday, May 7, 2018
DCMedical News
Washington, D.C.
Monday, May 7, 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
The price of drugs: the President is scheduled to make his statement on drug prices and proposals for their reduction tomorrow, May 8. The Court of Appeals for the DC Circuit Friday heard more about the 30% cut in 340B drug program reimbursement, AHA brief here, HHS brief here, AHA reply brief here, much of it an argument about the court’s jurisdiction over rate setting (as opposed to individual payment decisions). Legislation is pending to block the $1.6 billion reduction. HRSA announced (Federal Register, today, here) further delay (to July, 2019) in the 340B ceiling price and penalty rule, says the President’s drug-cost containment plan will address the price ceiling issue.
Spending: activity in appropriations bills will increase this week, together with speculation concerning the possibility of executive branch rescissions (spending hold-backs, explained here in a Committee for a Responsible Federal Budget publication).
DOCTORS, NURSES, HEALTH PROFESSIONALS
Back to the Future: Direct pay to doctors by Medicare beneficiaries is an “innovation” offered by the CMS Center for Medicare and Medicaid Innovations (CMMI), through a “Request for Information,” (RFI), here, comments due by May 25. The general idea is that, rather than increasing Medicare fee-for-service payments, CMS would give permission to providers to balance bill beneficiaries, without the provider having to leave the Medicare program. The “Direct Provider Contracting” (DPC) RFI asks these questions (pgs. 4ff.): Can the doctor be an independent, or should all of this be done through an organization? Should the doctor be required to have EHR technology, etc., in order to participate? What about Medicaid state plans and DPC? How about a Per-Beneficiary Per-Month (PBPM), aka capitation, payment mechanism?
DPC is an acronym also used for Direct Primary Care in the private sector. See JAMA opinion piece “Is Direct Primary Care a Game Changer?” here. Observers have noted the link of insurance complexity to physician burnout, especially to high-deductible health plans: Wharton’s Guy David observes, “If you have a high-deductible health plan, you’re going to pay out of pocket for primary care anyway,” so DPC “just becomes a win-win for patients and providers.” Forbidden so far: payment for DPC through Health Savings Accounts (HSAs).
Emergency Physicians: ACEP (the American College of Emergency Physicians) loses (for the moment) in its fight to avoid limitations on out-of-network balance billing. The Treasury, Labor and Health and Human Services Departments filed (Federal Register, May 3rd, here) a response to the District Court’s August 31, 2017 decision that PPACA limits on out-of-network payment for emergency care were arbitrary and insufficiently transparent. The Departments had proposed that a “Greatest of Three” (GoT) test be imposed on health plans, to compel them to provide a “reasonable amount” of payment before the patient becomes responsible for out-of-network balance billing amounts. The “Three” in GoT would include (a) the in-network negotiated amount, (b) the amount for emergency services calculated using the same method that a health plan uses for other out-of-network services, or (c) the amount that Medicare would pay.
The original regulations (from PPACA) were published in August of 2010. ACEP had responded as follows: “Insurers know that emergency physicians will see everyone who comes to the ED due to EMTALA responsibilities, and many leverage that fact to impose extremely low reimbursement rates . . . This forces the physicians to balance bill the patients, which often results in an unsatisfactory experience for everyone but the insurer.” ACEP suggested using FAIR Health, as in New York and Connecticut, proposed in other states. The Departments dismissed arguments that they should create their own methodology (contending that the result would not be as transparent or as accurate as those done by the health plans) and ignored ACEP’s suggestion that the FAIR Health database be used.
HOSPITALS AND HEALTH CARE FACILITIES
Big news for labor in hospitals: University of California system to be struck today through Wednesday by AFSCME, over wages and outsourcing. The strike, also involving University Professional and Technical Employees and the California Nurses Association, may be short-circuited by the courts, or by negotiated resolution. (Becker’s report here.)
HEALTH INSURANCE, MEDICARE, MEDICAID
Update on the Uninsured: Report from Commonwealth shows (slides here) uninsured rate among working adults 15.5%, 26% for those with income at 250% or less of the federal poverty level, ($61,500 for a family of four); 22% in states not expanding Medicaid, compared to 11.4% in states which expanded Medicaid; 14% among Republicans, compared to 9% among Democrats; highest in southern states (21%), compared to 11% in the Midwest.
Delivery System Reform Incentive Payment programs: CMS (based on work by Mathematica Policy Research) sends out interim findings on DSRIP §1115 Waiver experiments, with special focus on California, New Jersey and Texas (CMS version here, Mathematica version here). The bottom line: “No consistent impacts on outcomes in the study states” but “Impacts might be detectable in later years.”
PHARMA
Avik Roy on what the President might do, what the Congress might do, concerning drug prices, here in Forbes, here in a paper for the Foundation for Research on Equal Opportunity.
READINGS
The Economist cover story, “An Affordable Necessity,” here, on health in the world.
Bureau of Labor Statistics jobs report for April, here, 24,000 more health care jobs, 305,000 for the year, 70% of the increase occurring in ambulatory care.
EVENTS & MEETING
May 7
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.
10:00 a.m. House Way and Means Health Subcommittee Hearing on “The Current Status of and Quality in the Medicare Advantage Program,” 1100 Longworth House Office Building.
May 9
1:00 - 2:15 p.m., CMS Webinar: Participation Criteria for Year 2 of the Quality Payment Program, Registration: https://engage.vevent.com/rt/cms/index.jsp?seid=1091.
House Energy & Commerce Committee mark-up of 60 bills involving opioids, continued on May 17.
May 16
11:00 a.m., National Advisory Council on Nurse Education and Practice (Federal Register here).
May 22
9:30 a.m., Washington Post, “America’s Health Future,” Verma, Murthy, Eyles (AHIP), contact molly.gannon@washpost.com.
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.
Aug. 20
Meeting of Medicare Advisory Panel on Hospital Outpatient Program (through August 21).
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.
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.
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com