DCMedical News: Monday, May 21, 2018
DCMedical News
Washington, D.C.
Monday, May 21, 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
Background to Social Programs: The CDC reports (here) that the U.S. birth rate declined to a 30-year low in 2017, with total births of 3.9 million babies, a 2% reduction from 2016, the lowest since 1987. This is a significant threat to Medicare, Medicaid and Social Security programs which rely on revenues from the working population to support the retired population. The general fertility rate for women age 15 - 44 was the lowest in the history of the report, declining from 70 births per 1,000 just before the 2008 recession to 60 births per 1,000. The “total fertility rate” in the U.S. for 2017 (a measure of how many children a woman is expected to have in her lifetime) was the lowest since 1978, falling 3% to 1.76 children, still rich in comparison to 1.46 in Japan and 1.57 in China (2015).
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Maryland Model Extended for Care Outside the Hospital: CMS has approved an extension (current program due to expire 12-31-2018) and expansion (from hospital-only to outpatient expenses) of the Maryland all-payer model. The expanded program will begin January 1, 2019, and extend through 2023. Governor Hogan’s statement is here. Ohio was not so lucky, turned down (CMS letter here) on its §1332 Waiver request (deemed incomplete). CMS told Ohio officials that the “State plan, among other things, must provide coverage that is at least as comprehensive and affordable as that provided under Title I of PPACA, and must provide coverage to at least a comparable number of its residents as the provision of Title I of PPACA would provide,” and, in addition, said Ohio gave “no reason” for its waiver application.
New in the ED: Treatment of substance disorder in the emergency department. Pioneered at Yale-New Haven (here), now at Mass General where “38 of the 43 physicians in [the ED] completed the 8-hour training course required by federal law to qualify for waivers to prescribe and dispense buprenorphine” (report here).
Continued discussion of the quality of quality metrics: Challenges in cardiac care quality measures (in JAMA Cardiology, here). Solutions: more research, more IT, a Chief Evidence Officer, to accompany the Chief Experience Officer, the Chief Population Health Management Officer and others. Challenges in fairness and complexity of MIPS payments (in AMA materials, here). Solution: a comprehensive paperwork strategy. Challenges in real practice (in NY Times Sunday magazine, here). Solution: evaluating the value in the physician-patient relationship.
MEDICARE, MEDICAID, COMMERCIAL HEALTH INSURANCE
Special Report: Inpatient Prospective Payment System, Hospitals, Critical Access Hospitals, FY 2019. Publication date: May 7, 2018. Comment due date: June 25, 2018.
This is the first part of a multi-part series on the Hospital Inpatient Prospective Payment System (IPPS) FY 2019 proposed rule. Preliminary publication in an 1883 page format is here, final Federal Register publication in a 480 page format is here. Reference to page numbers in this series will be to the 480-page Federal Register document.
Overview: Readers will know that this “prospective payment system” proposed rule is both complex and important. The table of contents (pg. 20165-6) indicates more than 100 major topics involving the organization, structure and function of the modern American health care payment system, especially focused on hospitals. Each day’s excerpt in DCMN will focus on the major issues, taken in order from the table of contents.
Preamble: (From pg. 20166), “This proposed rule would make payment and policy changes under the Medicare inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals as well as for certain hospitals and hospital units excluded from the IPPS. In addition, it would make payment and policy changes for inpatient hospital services provided by long-term care hospitals (LTCHs) under the long-term care hospital prospective payment system (LTCH PPS). . . We are proposing to establish new requirements and revise existing requirements for quality reporting by specific providers (acute care hospitals, PPS-exempt cancer hospitals, and LTCHs) that are participating in Medicare. We also are proposing to establish new requirements and revise existing requirements for eligible professionals (EPs), eligible hospitals, and CAHs participating in the Medicare and Medicaid Promoting Interoperability Programs. We are proposing to update policies for the Hospital Value-Based Purchasing (VBP) Program, the Hospital Readmissions Reduction Program, and the Hospital-Acquired Condition (HAC) Reduction Program.”
Continued tomorrow.
PHARMA
Opioid Bills: The House Energy and Commerce Committee advances 57 of them, the latest here. The House Ways and Means Committee has its own, smaller, set of bills advancing, here.
One certain beneficiary of current drug pricing proposals: InsideHealthPolicy announces a new publication, InsideDrugPricing. Interested? Contact healthpolicy@iwpnews.com or 703-416-8505.
EVENTS & MEETING
May 23
1:00 p.m., Hearing, Subcommittee on Health (House Energy & Commerce Committee) Reauthorization of the Children’s Hospital Graduate Medical Education Program, 2322 RHOB, bill here.
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.
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: 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