DCMedical News: Tuesday, May 15, 2018
DCMedical News
Washington, D.C.
Tuesday, May 15, 2018
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THE BIG STORY TODAY IN HEALTH CARE
Drug prices: Continued discussion of the President’s plan to control drug prices (here). Attention focused in particular on the 340B program. The President’s report (pg. 14 of the plan) said “In fact, the number of 340B hospitals grew from nearly 1,700 in 2011 to 2,479 in 2017. The number of non-hospital covered entities, off-site clinics or ‘child sites,’ hospital outpatient departments, and contract pharmacies also grew substantially. As a result, discounted drug purchases made by covered entities under the 340B program totaled more than $16 billion in 2016—nearly a 400% increase in purchases from 2009, with an estimated savings of $6 billion per year. The additional billions of dollars in discounted sales and the cross-subsidization necessary may have created additional pressure on manufacturers to increase list price.”
One solution: Reduction of 340B allowed amounts by $320 million in the 2019 OPPS rules. Another, a new version of “value” in value-based payment schemes (pg. 29), allows “manufacturers to exclude from statutory price reporting programs discounts [including 340B], rebates, or price guarantees included in value-based arrangements.”
Other pieces: HHS Secretary Azar says putting Part B drugs into Part D plans (so that the plans can negotiate prices) may be the most important part of the President’s plan (see pg. 10, 15-17, 26), FDA Commissioner Gottlieb hurries generic approval process.
MEDICARE, MEDICAID, COMMERCIAL HEALTH INSURANCE
Medicaid: New publications in April 2018 by MACPAC (the Congressional advisory body on Medicaid and the Children’s Health Insurance Program): State Approaches to Financing Social Interventions through Medicaid, at https://www.macpac.gov/publication. (52 searchable page listing of MACPAC publications, sample here.)
Growth of managed Medicaid: 2008, 70%, 2016: 86.2%. Medicaid enrollment in 2008, 46 million; in 2017, 74 million. Figures from Sanofi Payer Digest, found here.
HOSPITALS AND HEALTH CARE FACILITIES
Special Report: Hospice FY 2019 rates. Proposed rule published: May 8, 2018, here. Comments due: June 26, 2018
Overview: Updates the hospice wage index and payment rates, total increase of $340 million. Proposes to recognize physician assistants as designated hospice attending physicians, at 85% of the physician fee schedule, in addition to physicians and nurse practitioners. Proposes changes to the Hospice Quality Reporting Program, especially the “Meaningful Measures” (pg. 20935). Additional information: “Wage index addenda will be available only through the internet on our website at: (http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/Hospice/index.html).”
Background: Hospice care and services covered, pg. 20936. 1.5 million beneficiaries, $17.5 billion expense, 8% per year growth predicted. Neurological (Alzheimer’s) and organ-failure (lung, heart, brain) diagnoses have displaced cancer as the most frequent (top 20 most frequent hospice claims, see Table 2, pg. 20939). Average length of stay (total payment period) was 80 days in FY2017, average lifetime length of stay 96 days, but the median length of stay was 18 days. Average live discharge rates (pg. 20942) declined from 22% in 2007 to 17% in 2017. Extensive analysis of length of stay, and of visit hours, through pg. 20945.
FY2016 per diem payment amounts for the four hospice levels of care were $944.79 for Continuous Home Care (CHC), $161.89 for Routine Home Care (RHC), $167.45 for Inpatient Respite Care (IRC) and $720.11 for General Inpatient Care (GIP, all terms defined in the proposed rule). Wage index and payment update methodologies discussed pgs. 20950-1, resulting in proposed FY 2019 payments rates on pg. 20953. Changes in the hospice quality program are discussed beginning on pg. 20955.
An important but unrelated provision concerning possible CMS establishment of IT patient health and safety requirements for hospitals begins on pg. 20963.
PHARMA
VA and Telehealth: New VA rule, over-riding state licensure limitations, will allow providers to treat patients across state lines using telehealth, a critical element of a virtual care initiative launched last year. According to FierceHealth, “Currently, VA patients can receive care via telehealth by going to one of more than 700 community clinics that feature specialty services like telemental health and postsurgical consultations. Up until Thursday, physicians around the country could treat patients that visited those clinics, but licensing regulations prohibited them from performing a virtual visit in a patient’s home if it was outside the state where they held a medical license.” The proposed rule is here.
EVENTS & MEETING
May 15
9:00 a.m., Alliance for Health Policy (AHP) holds a media briefing on "Perspectives on the 2018 HHS Drug Pricing Guidance," at 1299 Pennsylvania Avenue, register with anguyen@allhealthpolicy.org.
9:00 a.m., Center for American Progress, 2018 Ideas Conference, all Dems, 999 Ninth St. NW, DC.
10:00 a.m., Senate HELP Committee, Oversight of 340B Drug Pricing Program, 430 Dirksen Building.
May 16
11:00 a.m., National Advisory Council on Nurse Education and Practice (Federal Register here).
Through May 18, “2018 Medicare Advantage Summit,” Better Medicare Alliance, Hyatt Regency on Capitol Hill, Washington, DC, three days’ agendas here.
May 17
Through May 18, American Bar Association Antitrust in Healthcare, Arlington, VA, 202-662-1090, $995.
May 22
9:30 a.m., Washington Post, “America’s Health Future,” Verma, Murthy, Eyles (AHIP), contact molly.gannon@washpost.com.
May 23
9:30 a.m., Bipartisan Policy Center, “Using Medicare for to Improve Chronic Care,” 1225 I NW, DC.
May 24
8:30 – Noon, Health Care Costs in America, Alliance for Health Policy, Kaiser/Jordan Conference Center, 1330 G Street NW, Washington, DC.
May 30
9:30 a.m. – 5:00 p.m., HHS Pain Management Task Force (open to the public), inaugural meeting, Federal Register meeting notice and task force membership here.
June 19
AHIP (America’s Health Insurance Plans) Institute & Expo, San Diego, through June 22.
June 24
HFMA (Healthcare Financial Management Association) Annual Conference, Las Vegas, through June 28.
AcademyHealth, through June 26, Convention Center, Seattle, Washington.
July 25
7:30 a.m. – 4:30 p.m., Medicare Evidence Development and Coverage Advisory Committee (MEDCAC), volume requirements for aortic valve replacements and percutaneous coronary interventions. Maria Ellis, MEDCAC, (410) 786-0309, maria.ellis@cms.hhs.gov. Federal Register notice here.
Aug. 20
Meeting of Medicare Advisory Panel on Hospital Outpatient Program (through August 21), APCs, OPPS, the works. Evaluation of Advanced Primary Care (APC) groups; packaging of Outpatient Prospective Payment System (OPPS). Information here (Fed Reg 5-3-2018), 7500 Security Boulevard, Baltimore, MD.
FOR REFERENCE
Members of the Senate (here) and Members of Senate Committees (here), Senate Calendar (here).
Members of the House with their House Committees (here), House Calendar (here).
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
DCMedical News is published every day that either the House of Representatives or the Senate is in session.
Past issues can be accessed by clicking on “View this email in your browser.” Subscription information is found at the bottom of these pages. Trial subscriptions may end without notice.
May publication dates: 16, 17, 18, 21, 22, 23, 24, 25.
June publication dates: 4, 5, 6, 7, 8, 11, 12, 13, 14, 15, 18, 19, 20, 21, 22, 25, 26, 27, 28, 29.
July publication dates: 9, 10, 11, 12, 13, 16, 17, 18, 19, 20, 23, 24, 25, 26, 27, 30, 31.
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com