DCMedical News: Wednesday, October 30, 2019
DCMedical News-DCMN
Washington, D.C.
Wednesday, October 30, 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
Can the States Step in?
Georgetown University’s Sabrina Corlette and Emily Curran point out [here] that “some states have stepped up to ensure that preexisting-condition protections are part of state law. Since February 2018, when the suit [Texas v. U.S.] was filed, 13 states have acted to preserve the ACA’s protections for their residents, while four states already have laws in place.”
Also, Vox reports that “The races for governor this November in Kentucky, Mississippi, Louisiana, and Virginia haven’t attracted nearly as much attention as next spring’s presidential primaries, but they are hugely important to hundreds of thousands of voters without access to health care. Leaders in the four states have rejected or put tough restrictions on extremely generous federal matching funds allocated under the Affordable Care Act (ACA) to extend their Medicaid programs to cover families earning up to 133 percent of the federal poverty level. Next week [November 5, election day], depending on who becomes governor in these states, that could change or solidify.”
Deficits, Debt and the Economy
The Congressional Budget Office (CBO) has delivered an update (here) on the federal budget, 2019-2029. In brief, “In CBO’s projections, the federal budget deficit is $960 billion in 2019 and averages $1.2 trillion between 2020 and 2029. Over the coming decade, deficits . . . fluctuate between 4.4 percent and 4.8 percent of gross domestic product (GDP), well above the average over the past 50 years. Although both revenues and outlays grow faster than GDP over the next 10 years in CBO’s baseline projections, the gap between the two persists.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Private Equity and Health Costs in the Spotlight
Commonwealth Fund leaders publish (here) in the Harvard Business Review, “The Role of Private Equity in Driving Up Health Care Prices.” The AMA publishes (here) a guide for practitioners, how to evaluate private equity and other investor proposals. The House Energy & Commerce Committee (here) begins an examination of the role of private equity firms in promoting “surprise” (out-of-network) bills. Your Bain on private equity in health care (here), 64 pages of the positive side.
Is a Cardiology Consult in Hip Fracture Patients a “Low Value” Service?
A study in the Journal of Hospital Medicine (summary here) reports that “Patients who received preoperative subspecialty consults (about one third of the cohort) rarely received major recommendations by consultants (<5% of consults). About 90% of all consults were to cardiology. Patients with subspecialty consults were more likely than those without consults to have time to surgery of longer than 24 hours (76% vs. 41%) or longer than 48 hours (23% vs. 10%), longer hospital length of stay (median, 6 vs. 5 days), and higher 30-day readmission rate (13% vs. 7%).”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
CMS Announces Value Based Purchasing Results for FY 2020
“More hospitals will have an increase in their Medicare payments than will have a decrease. In total, more than 1,500 hospitals (over 55 percent) will receive higher Medicare payments . . . For fiscal year (FY) 2020, the law requires that 2 percent of the payments for all participating hospitals be withheld and redistributed to the hospitals based on their performance on a previously announced set of quality and cost measures. We estimate that the total amount available for value-based incentive payments in FY 2020 will be approximately $1.9 billion.”
CMS announcement here, table of hospital VBP “adjustment” factors for FY 2020 here (listed by CMS Certification Number/Provider ID; crosswalk provider ID to hospital name at https://data.medicare.gov/widgets/xubh-q36u).
HCA Thrives in Q3
HCA reported on its third quarter, in which revenues increased to $12.7 billion, compared to $11.5 billion in the third quarter of 2018. Adjusted EBITDA was $2.285 billion, compared to $2.096 billion in 2018. ED visits were up 4%, inpatient surgery up 2.2% and outpatient surgery up 2.6% with same facility revenue per equivalent admission up 2%. SEC 8-k filing here. Earnings call transcript (Seeking Alpha, here) has CEO Sam Hazen noting “The strongest same facilities growth in volume we have seen in over the past 17 quarters,” and that “On a same facilities basis, revenue grew by approximately $700 million or 6.3%. We had broad based volume growth across most service categories and it was balanced across our markets with growth in 13 or 14 domestic divisions.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
July Medicaid and CHIP Enrollment, here.
DRUGS AND DEVICES
Safety of the Pharmaceutical Supply Chain in Question
Today (October 30) The Subcommittee on Health of the Committee on Energy and Commerce will hold a hearing entitled, "Safeguarding Pharmaceutical Supply Chains in a Global Economy.” Hearing announcement here, briefing memo from the Chair here. STAT reports (here) that “In generic drug plants in China and India, data falsification is still a problem.” Bloomberg has a cover story (here), “Can You Trust Generics?” (answer: Nope).
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: 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.