DCMedical News: Friday, May 25, 2018
DCMedical News
Washington, D.C.
Friday, May 25, 2018
DCMedical News is published every day either the House or the Senate is in session. Congress begins a recess today and resumes work in Washington June 4. Subscription information 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
Spending: The Senate Appropriations Committee (report here) has developed its own “302b” allocation of the $1.24 trillion discretionary spending allowed under the budget caps agreed to in February for FY 2019. (The House version, here, was reported yesterday.)
Budget: The Congressional Budget Office weighed in with a new analysis of the Administration budget (here). Summary: “According to CBO’s analysis, the Administration’s proposals would have the following effects: Federal debt held by the public would equal 86 percent of gross domestic product (GDP) in 2028 under the President’s budget, compared with 96 percent that year in the agency’s baseline and about 78 percent this year. The federal deficit would be $2.9 trillion smaller under the President’s budget than in CBO’s baseline during the 2019–2028 period, CBO estimates. By contrast, the Administration estimates that the deficit would be $5.2 trillion smaller than the baseline amount during that period. The two largest changes over the 2019–2028 period would be a $2.1 trillion reduction in nondefense discretionary spending (excluding that designated for overseas contingency operations, or OCO) and a $1.3 trillion reduction in mandatory spending for health care.”
Speaking of federal spending on health care: CBO presented a report (here) on this subject at the Alliance for Health Policy “Summit on Health Care Costs in America.” Eye-popping numbers: federal net spending on health goes from $1 trillion in 2018 to $2 trillion in 2028, average annual growth rate of 6.3%. Still, annual spending slows, from the 8% per year rate 1980-2005 to the 5-6% in recent years. Counted as “major health programs” by CBO in these summaries: Medicare, Medicaid, CHIP and marketplace subsidies, but not the tax subsidy for employer-sponsored health insurance. These major health programs enroll 155 million people now, projected to enroll 176 million in 2028. Marketplace subsidies per enrollee, now $6,300, are expected to grow to $12,450 in 2028. Outlays for Social Security, 4.9% of GDP now, will grow to 6% of GDP by 2028; outlays for the major health programs, now 5.2% of GDP, will grow to 6.8% by 2028.
MEDICARE, MEDICAID, COMMERCIAL HEALTH INSURANCE
Center for Budget and Policy Priorities: Has two new publications, one (here) on the cost of autarchy (bureaucracy, unanticipated expense, friction) in compelling Medicaid beneficiaries to work, the other (here) on the falling cost of uncompensated care under PPACA.
CBO on Medicare: In addition to the summary document (see “The Big Story”), CBO re-posted its detailed analysis of future Medicare expenditures, here: this revised table now distinguishes provisions for which CBO estimated that there would be no effect on direct spending from provisions for which there was not enough information to estimate a budgetary effect.
EVENTS & MEETING
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 fifth part of a multi-part series on the Hospital Inpatient Prospective Payment System (IPPS) FY 2019 proposed rule. The 480-page Federal Register document is here.
Hospital Value-Based Purchasing (VBP) Program
“The Hospital VBP Program adjusts payments to IPPS hospitals for inpatient services based on their performance on an announced set of measures. In the FY 2019 IPPS/LTCH PPS proposed rule, CMS is proposing to implement updates to the Hospital VBP Program, including the removal of ten measures, all of which are also included in the Hospital IQR and/or HAC Reduction Program measure sets, and revised weighting of the Hospital VBP Program domains.”
“In this proposed rule, CMS proposes the following: 1. De-duplicate 10 measures: a. Remove all seven healthcare associated infection and patient safety measures from the Safety domain, as they are already in the HAC Reduction Program; and b. Remove three condition-specific payment measures from the Efficiency and Cost Reduction domain, as they are already in the Hospital IQR Program, while retaining the Medicare Spending per Beneficiary-Hospital measure; and 2. In conjunction with the proposed removal of the measures from the program, revise the program’s domain weighting beginning with the FY 2021 program year by increasing the weight of the Clinical Care domain in calculating hospitals’ total performance scores.” (See summary of the “Measure Name” and the “Removal Rationale” on pg. 7 of the web summary, here.)
Hospital-Acquired Conditions (HAC) Reduction Program
“The HAC Reduction Program establishes an incentive for hospitals to reduce hospital-acquired conditions by requiring the Secretary to reduce applicable IPPS payment by 1 percent to all subsection (d) hospitals that rank in the worst-performing 25 percent of all eligible hospitals. In the FY 2019 IPPS/LTCH PPS proposed rule, CMS is proposing administrative updates to receive and assess accuracy for five Healthcare Associated Infection measures currently included in the program. CMS is also proposing to update measure weighting to simplify our methodology and address concerns raised by small hospitals.”
Measures under the HAC Reduction Program would remain the same.
Hospital Readmissions Reduction Program (HRRP)
“The HRRP provides an incentive for hospitals to provide high quality patient care by reducing applicable IPPS hospital payments by up to 3 percent for excess hospital readmissions in six clinical areas. The 21st Century Cures Act requires that CMS begin assessing eligible hospital readmission performance relative to hospitals with a similar proportion of dual-eligible Medicare-Medicaid patients. CMS will assign eligible hospitals into five equal sized peer groups based on their proportion of dual eligible patients. For the FY 2019 IPPS/LTCH PPS proposed rule, CMS is proposing several updates to clarify definitions needed to implement statutory requirements of the 21st Century Cures Act.”
Measures under the HRRP would remain the same.
Continued when we resume publication, June 4.
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.
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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