DCMedical News: Thursday, November 14, 2019
DCMedical News-DCMN
Washington, D.C.
Thursday, November 14, 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
Drug Pricing
The President wants “most favored nation” status for drug prices in the U.S., that is, lower here than prices in other countries—now an average of 180% higher; so says HHS Secretary Azar. Senator Schumer wants something more significant than a prohibition on patent gaming, so blocked the Cornyn-Blumenthal patent bill. Speaker Pelosi still wants her bill; Wendell Primus, the Speaker’s top health aide, said her bill is just right, not too left, not too right. "I also think when the I-word, the impeachment stuff, is completely behind us, whatever it turns out to be, that will also change the administration's opinion of some of this," said Primus.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Physician Self-Referral, New Regulations
CMS has proposed a rule (here) to “address any undue regulatory impact and burden of the physician self-referral law.” The intent is to propose “exceptions to the physician self-referral law for certain value-based compensation arrangements between or among physicians, providers, and suppliers.” Comments by December 31.
The proposed regulations continue the torturous history of §1877 of the Social Security Act, which prohibits physicians from making referrals for certain designated health services payable by Medicare to an entity with which he or she has a financial relationship, unless there is an “exception.” Regulations to implement the 1989 legislation came as proposed rulemakings in 1992 and 1998, the former (involving referrals to clinical laboratories) finalized in 1995, the latter divided into three stages, the first implemented in January 2001, the second implemented in March of 2004, and the third implemented in September of 2007. Further modifications were made in the physician fee schedule rules for 2010 and 2011, pursuant to changes in the Patient Protection and Affordable Care Act, and, more recently, in the “Transition to Value-Based Care” including the “Regulatory Sprint to Coordinated Care.”
Freestanding Emergency Departments (FrEDs) Increase Spending on Emergency Care
A study in Academic Emergency Medicine (here) finds that “Rather than functioning as substitutes for hospital-based EDs, FrEDs have increased local spending on emergency care in three of the four states’ markets where they have entered.” The states studied (Arizona, Florida, North Carolina, Texas) found a 3.6 % increase in emergency provider payments per insured beneficiary per additional FrED. Estimated out-of-pocket payments for emergency care also increased 3.6% in Texas, Florida and Arizona, but declined in North Carolina.
Direct Primary Care and HSAs
A bill reported by the Ways and Means Committee of the House on October 23rd would allow individuals who participate in “direct primary care service arrangements” to contribute to tax-exempt health savings accounts (HSAs). The CBO report on the bill (here) explains that contributions to HSAs would be allowed to be used for expenses where a “primary care practitioner provides primary care services to an individual for a fixed periodic fee, instead of billing through a health insurer for those services.” Excluded would be general anesthesia, prescription drugs other than vaccines, and some laboratory services. Price controls? Payments could not exceed $150 per month for covered individuals or $300 per month for families.
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
The Final Rule (here) for discharge planning brings to a close a four-year process (original draft rule proposed November 3, 2015) nominally addressing the circumstances under which a patient is discharged, based on their clinical requirements, support network, goals of care, and preferences. The regulations implement 2014 legislation (the “Improving Medicare Post-Acute Care Transformation Act,” or IMPACT). Extensive communication responsibilities of hospitals and other providers are detailed concerning the discharge planning process (e.g., “clarify expectations for how providers will address situations where a support person or a caregiver is uncooperative…”).
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
A Good Time to Be in Health Care and Health Insurance
Quarterly reports (9-30-3019) for HCA (here), UnitedHealth Group (here) and Humana (here) show revenue up, profit up.
Medicaid Section 1115 Work Demonstrations Will Lead to Coverage Loss and Provider Losses
The Commonwealth Fund and Dobson І DaVanzo report (here, chart here) that states imposing work requirements for Medicaid will result in fewer covered beneficiaries, reduced hospital revenues, increased uncompensated care, and lower (or negative) operating margins.
Commentary on Value-Based Care Continues Downward, as Value-Based Contracting Continues Upward
Jha and colleagues in JAMA (here) write that “The US national value-based agenda has been a series of well-intentioned programs that have failed to deliver the kinds of improvements that had been expected.” They suggest a focus on patients with high costs and poor health outcomes.
DRUGS AND DEVICES
State Action on Drug Prices
The National Academy of State Health Policy has gathered a 35-page list (here) of actions underway or taken by state legislatures in pursuit of lower prescription drug prices.
READINGS AND REFERENCES
No Charges for Parking in the NHS: One of ten high priority reforms promised by Labour
The National Health has been caught up in election controversies involving Brexit and President Trump. Dame Donna Kinnair of the Royal College of Nursing said all parties needed to support nursing, and that “nobody wants the NHS left open to a carve-up as a result of a post-Brexit trade deal.” From the Mirror (here), “The health service has become a key election battleground with Labour promising to end privatisation and protect the NHS from a post-Brexit trade deal with Donald Trump.”
State Telehealth Laws and Reimbursement Policies
The Center for Connected Health Policy has published a guide to state telehealth laws and reimbursement policies, here. The 440-page inventory focuses primarily on Medicaid fee-for-service and on managed care. The guide notes that reimbursement for remote patient monitoring (RPM) and “store-and-forward” services continue to be limited, with most payment going for live video. California and Connecticut Medicaid programs are distinguished in reimbursing for “eConsults.” Also changing, additions of the home and school as eligible originating sites in some states, the inclusion of “teledentistry” and substance use disorder services.
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: 15, 18, 19, 20, 21
December 3, 4, 5, 6, 9, 10, 11, 12
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.