DCMedical News: Wednesday, May 23, 2018
DCMedical News
Washington, D.C.
Tuesday, May 22, 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
Health Insurance Coverage, National Survey: CDC released the National Health Interview Survey (here) for 2017, covering estimates for the U.S. and 18 selected states. Summary: In 2017, 29.3 million (9.1%) persons of all ages were uninsured at the time of interview—not significantly different from 2016, but 19.3 million fewer persons than were uninsured in 2010. In 2017, among adults aged 18–64, 12.8% were uninsured at the time of interview, 19.3% had public coverage, and 69.3% had private health insurance coverage. In Texas, 26.4% of all ages were uninsured in 2017, in Massachusetts 5.4%.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Planned Parenthood and New Abortion Limitations: A proposed rule (here, 129 pages) was published in the Federal Register Tuesday that would prohibit federal family planning funds from going to organizations that provide abortions or abortion referrals, such as Planned Parenthood. Currently providers cannot use federal funds for abortions. However, currently under the federal family planning program organizations may use private funds for abortion services while using their federal grant money for other family planning activities. Under this proposed new rule, federal grants could not be used by groups that provide abortion or referrals.
HOSPITALS AND HEALTH CARE FACILITIES
Looming Pension Crisis: Health Leaders Media cites a Pew study (here) on public hospital and other public employment pensions, estimating a national shortfall of $645 billion in unfunded pension liability. Complicating factors: Tax reform bill, new Governmental Accounting Standards Board rules for public facilities, aging baby boomers, predictable shortfall from 401(k) funding. In general, the industry with the highest percentage of defined benefit pension plans: hospitals, largely the result of union representation, especially of nurses.
PHARMA
The Senate version of “Right to Try” legislation passes in the House, is sent to the President. Opioid bills are scheduled for full House debate in early June.
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.
2:30 p.m., Senate Aging Committee, opioid misuse among older Americas, 562 Dirksen SOB.
May 24
8:30 – Noon, “Health Care Costs in America,” Alliance for Health Policy, Kaiser/Jordan Conference Center, 1330 G Street NW, Washington, DC.
9:00, Senate Finance, Rural Healthcare in America, Challenges and Opportunities, 215 Dirksen SOB.
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 22
7:00 p.m. Single Payer Strategy Conference, Minneapolis, Keynote DNC Deputy Chairman
Rep. Keith Ellison
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.
MEDICARE, MEDICAID, COMMERCIAL HEALTH INSURANCE
Individual Markets: Kaiser Family Foundation (KFF) study (here) shows 2017 to be profitable for commercial insurers in the individual market, but the future for that market challenged by political instability. KFF used insurance company data report to the National Association of Insurance Commissioners (NAIC), with these major findings: Medical Loss Ratios declined in 2016, averaging 82% in the individual market; gross margins for individual market per member per month were up ($43.67 in 2011, dipping to -$9.21 in 2015, improved to $78.52 in 2017); premiums per enrollee grew 22% between 2016 and 2017, but claims per person grew only 5%; average individual monthly market hospital inpatient days per 1,000 enrollees stable from 2015, but up (20.6 to 26.3) from 2011, since the market for insurance was available for those with preexisting conditions.
New Waiver Type for §1115: Minnesota submits a Section 1115 waiver demonstration request for Substance Use Disorder “System Reform,” application here, focus on intensive residential settings.
Special Report: Medicare Inpatient Prospective Payment System, Hospitals, Long Term Care Hospitals and Critical Access Hospitals, FY 2019, proposed rule. Publication date: May 7, 2018. Comment due date: June 25, 2018.
This is the third part of a multi-part series on the Hospital Inpatient Prospective Payment System (IPPS) FY 2019 proposed rule. Reference to page numbers in this series will be to the 480-page Federal Register document, here.
Meaningful Use (MU) gone, Promoting Interoperability arrives: The 2011 MU (child of the 2009 American Recovery and Reinvestment Act), much derided, is now discarded. MU called for physicians (“eligible professionals”) to collect information on patients which was rarely of use to either the doctor or the patient, for example the weight of ophthalmology patients. Nationwide, scales appeared in the hallways of doctors’ offices, as patient weight was a “low hanging” MU metric. Now, “We are proposing to overhaul the Medicare and Medicaid EHR Incentive Programs to focus on interoperability, improve flexibility, relieve burden and place emphasis on measures that require the electronic exchange of health information between providers and patients. To better reflect this new focus, we are re-naming the Meaningful Use program ‘Promoting Interoperability.’” Among new PI measures will be “Verify Opioid Treatment Agreement, related to e-prescribing of opioids (Schedule II controlled substances) that align with the overall agency initiative on the treatment of opioid and substance use disorders. We also propose to remove certain measures which do not emphasize interoperability and the electronic exchange of health information.”
Surprise Bills: “Under current law, hospitals are required to establish and make public a list of their standard charges. In an effort to encourage price transparency by improving public accessibility of charge information, CMS is updating its guidelines to specifically require hospitals to make public a list of their standard charges via the Internet.” Also, “CMS is concerned that challenges continue to exist for patients due to insufficient price transparency, including patients being surprised by out-of-network bills for physicians, such as anesthesiologists and radiologists, who provide services at in-network hospitals, and patients being surprised by facility fees and physician fees for emergency room visits. We are seeking information from the public regarding barriers preventing providers from informing patients of their out of pocket costs; what changes are needed to support greater transparency around patient obligations for their out of pocket costs; what can be done to better inform patients of these obligations; and what role providers should play in this initiative. CMS is also considering making information regarding hospital non-compliance with the requirements public and also intends to consider additional enforcement mechanisms in future rulemaking.
Continued tomorrow.
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: 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