DCMedical News: Thursday, November 21, 2019
DCMedical News-DCMN
Washington, D.C.
Thursday, November 21, 2019
DCMedical News is published every day both the House and the Senate are in session. The House and Senate adjourn their regularly scheduled sessions today. The next day on which both the House and the Senate are in session is December 3, when DCMN will resume publication. Subscription information below.
THE BIG STORY IN HEALTH CARE
Congress adjourns.
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
PCI and CABG Often Unnecessary? Don’t Expect Change
The report from the American Heart Association’s Scientific Sessions that Percutaneous Coronary Intervention and Coronary Artery Bypass Graft are often unwarranted (New York Times, here) may not, however, lead to change in the prescribing or performing habits of interventional cardiologists and cardiac surgeons (Axios report, here). Austin Frakt explains (here) why habit and commercial interest still lead to the offering of numerous treatments that don’t help.
More Controversy Over Ascension-Google Patient Information Sharing
Modern Healthcare reports (here) more dissention on the Ascension-Google plan to share patient information. The project appears to have a shifting public rationale. A key part of the original Wall Street Journal story (here) was that Ascension and Google would be analyzing patient data to recommend changes in patient care, different treatment plans, diagnostic tests, etc. Ascension has subsequently said that the Google partnership doesn’t include any plan to suggest care changes. Another controversy is that Ascension is not paying for Google’s work developing the electronic health record search tools, raising the question of what Google obtains in return. Both Google’s reputation and Ascension’s (see DCMN of 11/13/19) have led to caution, probes and further inquiries from the HHS Office of Civil Rights, and probable congressional inquiries, as well.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Nothing Certain but Death and Pay-Fors
Kaiser Health News pulls together evidence (here) of the disappearance of taxes contained in the Patient Protection and Affordable Care Act (“It’s paid for!”), the result of Congressional use of those taxes as “pay-fors” in unrelated legislation, and, more generally, the indisposition of public officials to fulfill the promises of their predecessors.
Federal Control to Increase Over Medicaid Supplemental Payments
A bulletin from the National Association of Medicaid Directors (NAMD) calls attention to increased federal control over Medicaid “supplemental payments” (DSH, upper limits) by the States. The increased federal control would follow from the proposed new rules governing such payments (Notice of Proposed Rule Making, NPRM, here) in the November 18 Federal Register, comments due January 17, 2020. NAMD writes that the “NPRM tackles a wide variety of Medicaid financing structures that CMS views as posing risks to the fiscal integrity of the program, including supplemental payment arrangements, provider taxes and donations, and sources of state share of Medicaid funding.”
The proposed rule would define Medicaid base and supplemental payments, require any supplemental payment (such as DSH, supplemental payments to safety net hospitals known as Disproportionate Share Hospitals) to automatically sunset after three years, require states to report each hospital’s share of supplemental payments and prevent states from using intergovernmental transfers not taken from state or local tax sources as non-federal matching funds.
READINGS AND REFERENCES
Big Winners in HITECH
Summary of Data from the “Office of the National Coordinator,” from Modern Healthcare 11-18-2019, “EHR vendors most in-use throughout Medicare incentive program” (here).
Venus, Mars
A study at UCSF (here) shows that women physicians spent more time on electronic health records after hours on clinic days as well as non-clinic days, spent more time handling messages from the system’s “In Basket,” spent more time performing clinical review, had longer notes, had a greater use of the copy/paste function, had more patient contacts returned within 24 hours, and fewer visits closed on the same day. The authors believe the additional hours, stress and patient involvement may accelerate physician burnout.
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
December 3, 4, 5, 6, 9, 10, 11, 12
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.