DCMedical News: Monday, December 9, 2019
DCMedical News-DCMN
Washington, D.C.
Monday, December 9, 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
Surprise on Surprise Medical Bills
Bloomberg reports that leaders of House and Senate health committees reached agreement (press release here) Sunday on a package of health proposals, including a new measure to address “surprise” (out-of-network, uncovered, see Brookings report below) medical bills. The bill would include dispute resolution through arbitration.
The package would also extend (for five years) funding for §330 (of the Public Health Service Act) community health centers and undertake some limited initiatives to promote transparency in drug pricing. Left out of the bi-partisan announcement was Senate HELP Committee Chairman Lamar Alexander’s long-time bi-partisan partner, ranking Committee member Sen. Patty Murray.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Doctors Are Paid Enough, Says Congressional Advisory Panel, and So Are Their Ambulatory Surgery Centers
At its meeting December 5, MedPAC heard presentations (here and here) the thrust of which was that physicians and ambulatory surgery centers participating in the Medicare program would see no rate increases in 2021.
Staff reported that in 2018 Medicare Fee-For-Service (which does not include payments by the Medicare Advantage programs) paid a little more than $70 billion under 7,000 billing codes to about one million clinicians, approximately two-thirds of them physicians, the remainder advanced practice nurses and PAs. There was rapid growth among APRNs and PAs providing services, and a slight decline in the number of primary care physicians.
In surveys and focus groups, Medicare beneficiaries reported no problems obtaining a doctor’s appointment or finding a new physician. Their “reported access continues to be similar to or better than privately insured individuals ages 50-64.” From 2013 to 2018 “encounters per beneficiary with primary care physicians decreased by an average of 2.9% per year while encounters with APRNs/PAs increased rapidly.”
Commercial health insurance preferred provider rates were 135% of Medicare rates in 2018, up from 122% in 2011, with the greatest increases and highest rates for physician specialist services.
The median annual compensation for primary care physicians was half that for radiologists and also half that for non-surgical procedural specialists. This “probably reflects underpricing of ambulatory E&M [evaluation and management] visits.”
Recommendations from the panel will be made formally in January at the MedPAC meeting January 16-17, 2020, with transmission to Congress in March.
The Commission evidenced interest in stronger control over (or at least more paperwork from) ASCs, for example recommending that the surgery centers be required to submit (as hospitals have since 1965) annual cost reports, a recommendation MedPAC has made every year for the past decade.
Some 5,700 surgery centers were paid $5 billion by Medicare Fee-For-Service (again, not including payments from Medicare Advantage plans). The average annual change in the number of ASCs from 2013 to 2017 was 1.5%, increasing to 2.6% in 2017-2018; the volume per Fee-For-Service beneficiary increased 1.5% per year from 2013 to 2017, and 2.2% from 2017-2018, based on claims analysis. The staff estimated that Medicare accounts for about 20% of total ASC revenue.
Usual, Customary and Unreasonable?
Brookings and USC Schaeffer publish (here) a study of provider (here meaning physician) charges, compared to Medicare payment rates for such services during the years 2012-2017. The mean primary care charge was 2.2x Medicare payment rates; for diagnostic radiology 4x; for emergency medicine 5.4x; and for anesthesiology 6.7x.
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
MedPAC May Recommend Hospitals Get 2.8% Bump from Medicare in 2021, 2.6% in 2022
Medicare Payment Advisory Commission members reviewed a draft recommendation (here) for base payments to acute care hospitals to increase by 2% in 2021, in addition to a .8% incentive bonus increase, and a possible 2.6% raise the following year.
The staff presentation noted that Medicare Fee For Service paid 4,700 hospitals a little more than $200 billion in 2018, a 3.6% increase from 2017, for about 9.5 million inpatient stays and 171 million outpatient services. Inpatient stays declined 1.6%, but total funds expended increased because of higher prices and higher “intensity” of services.
MedPAC staff noted that hospital margins from all third parties were at a near-record high of 6.8%, but that Medicare losses by hospitals averaged 9.3% in 2018 (a 10.6% loss among non-profits, a .9% loss among for-profit hospitals).
In the presentation concerning physician fees (above), staff noted geographic variation in the rate of “ambulatory care-sensitive hospital use,” with rates of “ambulatory care-sensitive hospitalizations and ED visits” twice as high in some hospital service areas as in others.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
READINGS AND REFERENCES
Medicine as a Humanitarian Profession, Health Care as a Competitive Business
Mayo’s John Noseworthy’s Shattuck Lecture, here.
The Difficulties of Health Reform
Commonwealth, Harvard researchers and the New York Times report on a poll of 2,000 adults in the summer of 2019, here.
Are all Americans being treated equally in health care? Only 16% say yes, and 93% say equal treatment is somewhat or very important. Eighty percent have a very or somewhat favorable view of Medicare, but only 53% would be willing to pay more in taxes so that all might have health insurance.
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.
House 2020 Calendar of Regularly Scheduled Sessions, here; Senate schedule subject to Impeachment Debate
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
December 10, 11, 12
January 7, 8, 9, 10, 13, 14, 15, 16, 27, 28
February 4, 5, 6, 7, 10, 11, 12, 13, 25, 26, 27, 28
March 2, 3, 4, 5, 9, 10, 11, 12, 23, 24, 25, 26, 27, 30, 31
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.