DCMedical News: Tuesday, October 29, 2019
DCMedical News-DCMN
Washington, D.C.
Tuesday, October 29, 2019
DCMedical News is published every day both the House and the Senate are in session. Subscription information below.
THE BIG STORY IN HEALTH CARE
Medicare-Advantage-for-All
“Open enrollment” is underway, an annual opportunity for commercial Medicare Advantage (MA) plans to sway traditional, fee-for-service Medicare beneficiaries to join up. The Kaiser Family Foundation (here) reports that 22 million people (34% of Medicare enrollees) are currently in such MA plans. For 2020 (the current sign up period, ending December 7, is for coverage beginning January 1, 2020) 3,148 Medicare Advantage plans will be available for individual enrollment, an increase of 414 plans since 2019. “The average beneficiary will be able to choose among 28 plans in 2020, up from 24 in 2019.” CQ News reports (here) that the President’s October 3 Executive Order on Medicare (here) is intended to boost private (MA) plan enrollment. “The order encourages innovations in [Medicare Advantage] plan design, such as promoting medical savings accounts, telehealth, new treatments and additional services traditional Medicare doesn't cover. The order also directs the Centers for Medicare and Medicaid Services to develop a pilot program for Medicare Advantage plans to let patients share in savings accrued through higher quality care — including through cash rebates.” CQ notes that plan rules adopted in April of 2018 (here) may impose auto-enrollment of newly eligible seniors into MA plans.
The attraction? MA plans represent certain profit to health insurers. An August review in Health Affairs (here) found that “When a beneficiary joins MA, Medicare spends more, on average, than it would have if the patient had remained in traditional Medicare”; that MA plans select or are selected by healthier seniors, “Patients who switched from traditional Medicare to Medicare Advantage between 2015 and 2016 had 13.4 percent lower spending at baseline (in 2015) than patients who remained in traditional Medicare, adjusting for health risk”; and that MA plans benefit from increased reimbursement which follows aggressive coding to produce “risk adjustment.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Cardiometabolic Mortality Improvements Slow, Other Improvements Plateau
A JAMA review (here) notes that “While cardiovascular disease (CVD) death rates declined by approximately 36% from 2000 to 2014, CVD remains the leading cause of mortality among US adults. Annual declines in CVD mortality slowed between 2011 and 2014 (0.7% fewer CVD deaths per year), and it appears unlikely that strategic goals from the American Heart Association (20% reduction by 2020) will be achieved.” In addition, “These findings demonstrate a continued but slower decline in AAMR [Age-Adjusted Mortality Rate] for heart disease, a plateau in mortality rates from stroke and diabetes, and an increasing AAMR for hypertension . . . between 2010 and 2017. Racial disparities in cardiometabolic causes of death persisted.”
AMA Physician Practice Benchmark Survey
This year’s survey of practice arrangements (here) shows that “In 2018, 31.9 percent of physicians worked in a practice that belonged to a medical home, 38.2 percent to a Medicare ACO, 26.3 percent to a Medicaid ACO, and 39.0 percent to a commercial ACO. Participation in each of the four care delivery models increased significantly from 2016 by 5 to 7 percentage points. Overall, 53.8 percent of physicians reported participation in at least one ACO type in 2018, up from 44.0 percent in 2016. The data also show that physicians reporting at least some payment from APMs such as pay-for-performance and shared savings has been on the rise. Overall, 63.1 percent of physicians worked in practices that received at least some revenue from an APM. However, because many APMs build on the FFS model, an average of 70 percent of practice revenue comes from FFS while only 30 percent comes from APMs; these shares have been consistent since the Benchmark Survey was first conducted in 2012.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Ambulatory Surgery Center Surveys Lax, Finds OIG
In a report on CMS’ oversight of surgery centers (OIG report here, MedPage coverage here), the HHS Office of the Inspector General found that “Dozens of states, some of them very large, didn't meet Medicare's requirement that they survey their ambulatory surgery centers (ASCs) at required intervals to assure they met safety protocols, such as infection control or anesthesia administration, and many facilities went without any state survey for at least 6 years.” This despite the fact that “From 2006 to 2017, the number of ASCs grew by 25 percent, from 4,490 to 5,603 ASCs” and that “The Centers for Medicare & Medicaid Services’ (CMS) primary oversight tool for ensuring the health and safety of patients at ASCs is the survey and certification process.” OIG itself had not reviewed CMS’ ASC survey performance since 2002.
By What Multiple Do Payments to Hospitals by Commercial Health Insurers Exceed Medicare Payment for the Same Services? 204%? 220%? 240%? And With What Variation, Hospital-to-Hospital, State to State? 1397%? Read on.
Pick a number, says a summary of research and proposed remedies (here) in JAMA. “Regardless of whether the United States adopts Medicare-for-all, recent state and employer action suggests that it may move toward ‘Medicare-reference-pricing-for-more.’ Using some multiple of fee-for-service Medicare rates as a common standard for assessing and setting commercial insurer prices increases institutional accountability and public awareness. Higher-paid hospitals are forced to justify their generous payment levels and important public conversations occur regarding health care value and funding priorities.”
CVS Marches In, but Walgreens Boots Marches Out
Bloomberg Law reports that Walgreens Boots Alliance will close 157 of its retail clinics by year’s end. The clinics offered vaccinations, health tests and care for minor injuries. Some 220 such in-store clinics operated by outside health organizations will remain open. LabCorp blood testing will remain in 600 of the 9,000 Walgreens stores.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
MACPAC Is Back in Town
The Medicaid and CHIP Payment and Access Commission (meeting notice here, agenda here) meets this Thursday and Friday in Washington. For a review of past discussions, the meeting transcripts are here for September, here for April and here for March, the last three meetings of this advisory body to Congress.
READINGS AND REFERENCES
U.S. House of Representatives:
Members at https://www.house.gov/representatives
Committees and Members at https://www.house.gov/committees
U. S. Senate:
Members at https://www.senate.gov/general/contact_information/senators_cfm.
Committees and Members at https://www.senate.gov/committees
House and Senate 2019 Calendar of Regularly Scheduled Sessions, here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
October publication dates: 30, 31
November publication dates: 12, 13, 14, 15, 18, 19, 20, 21
December 3, 4, 5, 6, 9, 10, 11, 12
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.