DCMedical News: Thursday, October 31, 2019
DCMedical News-DCMN
Washington, D.C.
Thursday, October 31, 2019
DCMedical News is published every day both the House and the Senate are in session. The House and Senate adjourn their regularly scheduled sessions today. The next day on which both the House and the Senate are in session is November 12, when DCMN will resume publication. Subscription information below.
THE BIG STORY IN HEALTH CARE
Congressional Score, 0-0
Drug price control appears to be going nowhere (WSJ report here).
An attempt to reverse the §1332 “guidance” thought to allow state waivers to potentially un-do pre-existent condition protections provided in the Patient Protection and Affordable Care Act (here) failed in the Senate. CQ reports (here) that “Democrats are forcing the vote through the Congressional Review Act even though no states have sought to make the types of changes the administration is encouraging.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Physician Fee Schedule Final Rule Due
The “final rule” for determination of physician payments in calendar year 2020 under Medicare is due tomorrow. The 808- page proposed rule published in the August 14 Federal Register is here.
Health Capital Topics details the proposed changes (here), noting the rule “includes proposed updates to payment policies, payment rates, and quality provisions for services rendered under the MPFS [Medicare Physician Fee Schedule], as well as the proposed changes to the Quality Payment Program (QPP) established by the 2015 Medicare Access and CHIP Reauthorization Act (MACRA). The QPP is currently comprised of two tracks: (1) the Merit-based Incentive Payment System (MIPS); and, (2) advanced Alternative Payment Models (APMs). CMS estimates that 818,000 clinicians will be MIPS-eligible for the 2020 performance period, while between 175,000 and 225,000 clinicians will be Qualifying APM Participants. Additionally, CMS anticipates that MPS payment adjustments for 2020 will equal $584 million (which will be equally distributed between negative and positive payment adjustments), and APM payments will approximate $500-600 million. CMS’s proposed rule includes various updates to the MIPS and APM tracks, as well as a proposed new framework.”
An analysis of the current year’s (2019) physician fee schedule changes by the Healthcare Financial Management Association (HFMA) staff can be found here, a similar effort by the Medical Group Management Association here.
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Hospital OPPS Payment Rules to Change
The Outpatient Prospective Payment System final rule is also due November 1.
Posting of hospital prices, a renewal of the 28.5% reduction in payments for drugs under the 340B program (the Administration is appealing an unfavorable court decision) and a possible renewal of the “site-of-service” reduction for hospital-owned physician and other satellite offices (the Administration is considering whether to appeal another unfavorable court decision) may be included in the final rule. Payment updates for dialysis and home health providers are also part of the pending final rule. The proposed rule, from the August 9 Federal Register is here, and an analysis by HFMA staff is here.
CHS Reports on Q3
Community Health Systems’ CEO Wayne Smith reports (earnings call transcript from Seeking Alpha, here) that “Our current divestiture plan anticipates that the completion of divestitures of at least $2 billion of annual net revenue . . . These divestitures consisted of low single-digit EBITDA margin hospitals at good transaction multiples.” The result, “During the third quarter on a year-over-year basis our same-store admissions increased 2.4%. Our adjusted admissions grew 3.6%, and surgeries were up 4.6%. On the top line same-store net revenue growth was 4.1%.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Fraud Found in Alternative Health Plans (but how would you tell?)
The Commonwealth Fund reports (here) that insurance regulators are seeing fraud in alternative health plans (short term limited duration, association health plans, shared ministry plans) which cover inadequately or not at all the medical expenses of those who have purchased the plans. The authors write, “It has been two years since President Trump issued an executive order aimed at promoting and expanding skimpy health coverage products as an alternative to comprehensive health insurance. These changes to regulations combined with messaging from the executive branch about choice and freedom effectively opened the floodgates for increased marketing of alternative coverage options. These products typically fail to provide the comprehensive coverage guaranteed in plans compliant with the Affordable Care Act (ACA). In some cases, people are left burdened with high medical bills or find out their plans won’t cover their health care needs.” Given that the whole idea is to provide less extensive coverage at lower cost, the consumer may be receiving what they bargained for, or, in the alternative, “State regulators said consumers are purchasing plans without understanding their limits.” The Fund article has links to specific reports of fraudulent activity, by state.
DRUGS AND DEVICES
Portable MRI?
STAT reports (here) that “A serial entrepreneur wants his portable MRI to transform medicine.”
READINGS AND REFERENCES
What are the British Reading About Health and Medicines?
“Poll reveals majority believe lying Boris Johnson will sell off NHS services to US,” The Mirror, October 27, here.
“Universal healthcare no silver bullet without quality services,” Financial Times, October 30, here.
“Rich countries must pay more to achieve health for all in poorer countries. Trade association chief argues the case for differentiated pricing,” also in the Financial Times October 30, here.
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
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.