DCMedical News: Thursday, May 24, 2018
DCMedical News
Washington, D.C.
Thursday, May 24, 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
Veterans Choice and Medical Care: The Senate took final action on a bill (S2372, bill text here as passed) which extends the VA Choice Program, allowing veterans to seek medical care from private physicians and hospitals, for one year, part of a reorganization of seven different community care programs in the VA. The bill ends a provision in the 2014 legislation which required that veterans face a wait of more than 30 days before they could see a private doctor and have the VA pay for that private doctor’s services, or live more than 40 miles from a VA facility. Under this bill, expected to be signed by the President, veterans can now seek private care if they need medical services not offered by the VA in their area, or if their doctor decides it’s in their best interest. Also called for: prompt payment, more money for VA physician recruitment.
Spending: CQ reports (exhibit here) that Appropriations Subcommittees in the House have added $37 billion to the Administration’s requests for FY 2019, more than half of that amount for defense, none of it for Department of HHS. Later Wednesday the House Committee issued its brief report, here. The effort divides up $1.24 trillion in discretionary spending allowed under budget caps agreed to in February. Defense and nondefense programs both have (in the aggregate) approximately 3 percent increases above fiscal 2018.
HOSPITALS AND HEALTH CARE FACILITIES
Labor Saving Devices: A report in Healthcare Informatics indicates that more than 70% of hospitals use their electronic medical records “solutions” for revenue cycle management (getting paid for what they do, pushing back against wrenches and syrup in the gears). Three-quarters say that insurer denials are the largest revenue cycle management challenge.
MEDICARE, MEDICAID, COMMERCIAL HEALTH INSURANCE
CBO issued a new report on federal subsidies for health insurance: The Congressional Budget Office reported (here) that “In an average month in 2018, about 244 million of those people [noninstitutionalized under age 65] will have health insurance, and about 29 million will not. By 2028, about 243 million are projected to have health insurance and 35 million to lack it. Net federal subsidies for insured people in 2018 will total $685 billion. That amount is projected to reach $1.2 trillion in 2028. Medicaid and the Children’s Health Insurance Program account for about 40 percent of that total, as do subsidies in the form of tax benefits for work-related insurance. Medicare accounts for about 10 percent, as do subsidies for coverage obtained through the marketplaces established by the Affordable Care Act or through the Basic Health Program.”
With regard to individual health insurance plans, “Premiums for benchmark plans, which are the basis for determining subsidies in that market, are projected to increase by about 15 percent from 2018 to 2019 and by about 7 percent per year between 2019 and 2028. Since CBO’s most recent report comparable to this one was published in September 2017, the projection of the number of people with subsidized coverage through the marketplaces in 2027 has fallen by 3 million, and the projection of the number of uninsured people in that year has risen by 5 million. Projected net federal subsidies for health insurance from 2018 to 2027 have fallen by 5 percent.”
More on federal subsidies: The Committee for a Responsible Federal Budget also checks in with a report (here) on subsidized health insurance.
Whoops: InsideHealthPolicy reports that a Blue Cross and Blue Shield of America official said Wednesday that “Average premium increases nationwide will be in the low teens, and range from the low single digits up to 70-80 percent . . . He said the main factors causing these likely premium increases are the repeal of the ACA’s federal individual mandate and Congress’ failure to enact market stabilization legislation earlier this year.”
EVENTS & MEETING
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, CONTINUED
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 fourth 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.
Hospital Inpatient Quality Reporting (IQR) Program: “The Hospital IQR Program collects and publishes data on quality measures for the inpatient hospital setting. In the FY 2019 IPPS/LTCH PPS proposed rule, CMS is proposing to remove certain measures from the Hospital IQR Program, while retaining the same measures in one of the value-based purchasing programs (Hospital Value-Based Purchasing, Hospital Readmissions Reduction, and Hospital Acquired-Condition Reduction Programs).”
“The proposals to remove these measures are consistent with CMS’ commitment to using a smaller set of more meaningful measures. CMS is focusing on measures that provide opportunities to reduce both paperwork and reporting burden on providers and patient-centered outcome measures, rather than process measures.”
Here are three rationales for change in the measures:
“1. Adopt one additional factor to consider when evaluating measures for removal from the Hospital IQR Program measure set: ‘The cost associated with a measure outweighs the benefit of its continued use in the program.’
2. Remove 18 previously adopted measures that are “topped out”, no longer relevant, or where the burden of data collection outweighs the measure’s ability to contribute to improved quality of care.
3. De-duplicate 21 measures to simplify and streamline measures across programs. These measures will remain in one of the other 4 hospital quality programs.”
Results: See “Measure Name” and “Removal Rationale” beginning on pg. 3 of the CMS.gov web site summary, here.
Continued tomorrow, with Hospital-Based VBP Program proposed changes.
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: 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