DCMedical News: Wednesday, November 20, 2019
DCMedical News-DCMN
Washington, D.C.
Wednesday, November 20, 2019
DCMedical News is published every day both the House and the Senate are in session. Subscription information below.
THE BIG STORY IN HEALTH CARE
House Passes a Budget Bill, Moves on to December 20
The House passed a “stopgap” government funding bill (summary here, full text 211 pgs. here), including delay in $4 billion in cuts to Medicaid DSH (disproportionate-share hospital) payments, until Dec. 20. Current funding authorization expires Thursday night.
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Not All Hospitals are Making Money
Modern Healthcare reports (here) that CommonSpirit, “formed through the Feb. 1 merger of Catholic Health Initiatives and Dignity Health, posted a $227 million operating loss on $7.2 billion in operating revenue in the quarter, which ended Sept. 30, or a 3.2% negative operating margin. That's compared with a $56 million loss on $7.1 billion in revenue in the prior-year period, a 0.8% negative margin.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Blue Plans Sue for Risk Corridor Funds Under PPACA
Blue Cross plans participating in exchange health insurance programs under the Patient Protection and Affordable Care Act have sued (complaint here) for recovery of “risk corridor” funds. “Anthem brings this Complaint to recover money damages owed by the Government for calendar years 2014, 2015 and 2016, for violations of the mandatory risk corridors payment obligations Defendant owes to Anthem’s qualified health plan issuers (“QHPs”), prescribed in Section 1342 of the Patient Protection and Affordable Care Act and its implementing federal regulations; and for breach of the implied-in-fact contracts between Defendant and Plaintiffs regarding such risk corridors payments.” According to Bloomberg, “The government has admitted it owes Anthem Blue Cross the money.” In the similar Moda complaint the U.S. Court of Appeals for the Federal Circuit held that the government has promised to repay the insurers risk corridor losses, but that Congress later clarified that the program was to be budget neutral. “That is, the Health and Human Services Department could pay insurers that lost money only out of the funds it collected from insurers that made money” (by having less “risky” enrollees). “The HHS wasn’t obligated to pay the insurers in full because it never collected enough money to do so.” The Supreme Court will hear oral arguments on the issue December 10.
Price Transparency Medicare Learning Network (MLN) Call
MLN offers a “hospital price transparency final rule call” on December 3, 1:30 to 3:00 p.m., including “requirements for making public all standard charges for all items and services in a machine-readable format, requirements for displaying shoppable services in a consumer-friendly manner and monitoring and enforcement.” Final rule here, “Fact Sheet” here.
Aging of the U.S. Population and Growth in Medicare Expenditures
Modern Healthcare presents (here) an infographic on the growth of the over 65 population (17% of the nation’s population in 2016, 19% in 2025); percentage change by county 2012-2017 (greatest in western states); and growth in Medicare revenue per hospital cost report 2014-2018 ($30 million plus inpatient growth per year, $13 million plus outpatient growth per year, per hospital).
Balance Billing Protection Elusive? Not in Washington State
“The Balance Billing Protection Act establishes new requirements applicable to health carriers that offer coverage, and hospitals, ambulatory surgical facilities, laboratories and several types of health care providers who provide health care services in Washington state.” See the Insurance Commissioner’s page, https://www.insurance.wa.gov/balance-billing-protection-act-r2019-04?utm_content=&utm_medium=email&utm_name=&utm_source=govdelivery&utm_term=
READINGS AND REFERENCES
PowerPoint for 2020 Presidential Campaign
The Kaiser Family Foundation produces a slide show (here) on where the Democratic Presidential candidates stand on “health reform.” More, KFF also produces a “health policy resources guide” (for journalists and others) interested in covering issues in the campaign, here.
Reddit Posts on Health-Related You-Tube Channels
What are your favorites? What do others favor? Check on r/medicine, here:
https://www.reddit.com/r/medicine/comments/dymv8i/what_are_your_favourite_medicinerelated/
U.S. House of Representatives:
Members at https://www.house.gov/representatives
Committees and Members at https://www.house.gov/committees
U. S. Senate:
Members at https://www.senate.gov/general/contact_information/senators_cfm.
Committees and Members at https://www.senate.gov/committees
House and Senate 2019 Calendar of Regularly Scheduled Sessions, here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
November publication dates: 21
December 3, 4, 5, 6, 9, 10, 11, 12
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.