DCMedical News: Thursday, May 17, 2018
DCMedical News
Washington, D.C.
Thursday, May 17, 2018
DCMedical News is published every day either the House or the Senate is in session. Want to subscribe? See below. Add our new domain (dcmedicalnews.org) to your white list. Welcome to our new “courtesy trial” recipients.
THE BIG STORY TODAY IN HEALTH CARE
Back to the future: In physician payment and in health insurance design (see below).
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Veterans Choice: Passed in the House, the bill now goes to the President, who has expressed support. The bill provides funds for the “Choice” program, but, to temper concerns about privatization, also includes new money for physician recruitment in the VA system.
Guidelines and Quality Measures: Funding for the “National Guidelines Clearinghouse” ends on July 16th of this year. AHRQ (the Agency for Healthcare Research and Quality), which runs the guidelines, announced the shutdown (here). The “quality era” of the last 25 years in American health care was characterized by guidelines, industrial-style measures for “best practices.” The guidelines came from thousands of professional, advocacy and scientific organizations. They were a response to the growth of specialization in medicine; to the various malpractice crises; to the studies of calamity in medicine, especially in hospitals (for example by Troyen Brennan, now CMO of CVS, and colleagues in the New England Journal Medicine in 1991); to “To Err is Human,” (1999) and its follow-on activities from the National Academy of Sciences; and to the commercialization of quality metrics through Consumer Reports, the Institute for Healthcare Improvement, JD Power, Leapfrog and others. Most studies of patient safety indicate that little has changed, while most studies of physician burnout indicate that the collection of information to satisfy one or another metric is a significant issue.
MEDICARE, MEDICAID, COMMERCIAL HEALTH INSURANCE
Back to the future, continued: This month CMS Administrator Verma (see DCMN of May 7, CMMI RFI, here) essentially endorsed balance billing for Medicare beneficiaries (“direct provider contracting”); the country is closer to traditional indemnity health insurance coverage for those without pre-existent conditions (“Great Plans Coming in Four Weeks,” here), and Health Affairs has announced (another) big symposium on health cost, keynoted by Stuart Altman, President Richard Nixon’s top health aide. Altman poignantly noted the lost opportunities of the Nixon era in a Globe profile (here): “If we had passed something in the Nixon administration, nobody would have questioned it,” Altman said. “Back then, everybody had a plan for universal coverage. America was much more ready for it then.”
HOSPITALS AND HEALTH CARE FACILITIES
Geographic variation: Interested? So is CMS, the latest available resources here.
Screws in Oklahoma: Big issue (cost), small story (orthopedic screws), $15,076 for four of them at a hospital in Oklahoma. Consultant Rick Louie (hospitalpricingspecialists.com) reports that the price of two bone to bone screws in that state range from $39.34 up to $28,000, here, but in Texas up to $434,000. Find your hospital (Excel, sortable) here.
Special Report: Inpatient Rehabilitation Facility FY 2019 rates. Proposed rule published: May 8, 2018, here. Comments due: June 26, 2018.
Overview: Establishment of rates (Prospective Payment System, PPS) for Inpatient Rehabilitation Facilities (IRFs) for the coming year. Consistent with the design of other “prospective” rate setting rules, this one espouses reduction in paperwork, removing “face-to-face” requirements for rehabilitation physician visits, and expanding the use of nurse practitioners and physician assistants. New reporting requirements, however, “Meaningful Measures,” are found on pg. 20974. A total of 1,124 IRF facilities treating 401,760 patients are affected.
Background: The overall payment rate methodology for IRFs began in FY 2002. The website address for calculations is http://www.cms.gov/Medicare/Medicare-Fee-For-Service-Payment/InpatientRehabFacPPS/index.html, and contains items pertinent to analysis of the IRF PPS. Non-physician practitioners are discussed in the proposed rule on pg. 20998 ff.
Rates: Weights and lengths of stay by Case-Mix Groups are found on pgs. 20979-81. Resulting actual payments are found on pgs. 20985-6. Overall impact an estimated $75 million in increased federal payments, and an estimated $50 million plus in cost/paperwork reduction.
PHARMA
Opioid legislation not the only story: The Department of Justice is emphasizing criminal (sample here), and False Claim Act suits (sample here). Yale researchers claim IV (vs. oral) administration of narcotics to hospitalized patients is more likely to produce addiction, here. Reuters reports (here) IQVIA (formerly IMS and Quintiles) ‘mis-overestimates’ prior years’ sales of fentanyl (casting doubts on reports of subsequent years’ decline in sales). Vermont’s Governor signs drug import legislation, still needing HHS approval.
READING, PUBLICATIONS
Modern Healthcare infographic (here) on projected shortages of health care professionals, by their respective advocacy groups.
EVENTS & MEETING
May 17
Through May 18, American Bar Association Antitrust in Healthcare, Arlington, VA, 202-662-1090, $995.
May 21
2:30 p.m., Committee for a Responsible Federal Budget, and the Concerned Actuaries Group, hold a conference call briefing, beginning at 2:30 p.m., on "American Health Care: Rethinking the Challenges, Opportunities and Possibilities" register at 202-596-3597 info@fixthedebt.org.
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: 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