DCMedical News: Wednesday, November 13, 2019
DCMedical News-DCMN
Washington, D.C.
Wednesday, November 13, 2019
DCMedical News is published every day both the House and the Senate are in session. Subscription information below.
THE BIG STORY TODAY IN HEALTH CARE
THE BIG STORY IN HEALTH CARE
The Administration unveiled an attack on blue state Medicaid programs (see below), with focus on Medicaid supplemental payments (Disproportionate Share Hospital or DSH, and upper-payment limits), now 17% of total Medicaid payments to providers.
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
“Project Nightmare” Puts Spotlight on Ascension Business Practices
Google and Ascension have undertaken a project exposed on the front page of Tuesday’s Wall Street Journal (here) which has, thus far, compromised the medical records of tens of millions of patients, without their consent. While routine and wholesale violation of privacy may be expected from tech giants, the new story puts a focus on Ascension, the nation’s largest chain of Catholic hospitals. The Journal reported, “Neither patients nor doctors have been notified. At least 150 Google employees already have access to much of the data on tens of millions of patients, according to a person familiar with the matter and the documents.”
Ascension has been in the spotlight in the past for questionable business practices, including abusive billing (here, one of six volumes of a report by Minnesota Attorney General Lori Swanson on Accretive, a company begun primarily by Ascension, subsequently renamed R1 RCM Inc.). Ascension has also been in the news for the failure of its costly experiment to develop an academic medical center in the Cayman Islands jointly with the Indian hospital chain Narayana (here and here), and for retiring CEO Anthony Tersigni’s pronouncement (here) that not as much money will be made in the hospital field in the future as has been made in the recent past.
Regional Focus on Hospital Monopolies
The Indiana Business Journal reports that, over the past two decades, health costs have gone from below to much-higher-than-average in that State, according to a study by Prof. Michael Hicks of Ball State University (here). The highest profit for a hospital in Indiana was 49% (Parkview Wabash). The tenth most profitable hospital had a profit of 19%.
Kaiser Family Foundation Publishes Study of Hospital Expense per Inpatient Day
The study (here, sorted also by government, nonprofit and for-profit hospitals) is “based on information from the 2017 American Hospital Association Annual Survey, include all operating and nonoperating expenses for registered U.S. community hospitals, defined as public, nonfederal, short-term general and other hospitals. The figures are an estimate of the expenses incurred in a day of inpatient care and have been adjusted to reflect an estimate of the volume of outpatient services, according to the Kaiser Family Foundation.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Seema Verma Reviews Coming Medicaid Proposals, “Program Integrity Proposed Rule”
CMS head Seema Verma reviewed (here) Medicaid proposals which might be made by states seeking Medicaid block grants. She claims that “rising cost of Medicaid has increased the need for value-based care.”
Simultaneous with her remarks to the National Association of Medicaid Directors (here), Ms. Verma unveiled a proposed “program integrity rule” (“fact sheet” here, proposed rule here) in advance of Federal Register publication, (see pgs. 53ff for provisions of the proposed rule and pg. 184 for a list of subjects covered by the proposed rule).
The NAMD also discussed recent Kaiser Family Foundation publications, including a summary of enrollment and spending growth (here), a view from the states of key Medicaid policy changes (executive summary here, changes here, tables here), and a new MACPAC report on Medication Assisted Treatment and utilization management thereof in the Medicaid program (here).
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
November publication dates: 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.