DCMedical News: Monday, June 4, 2018
DCMedical News
Washington, D.C.
Monday, June 4, 2018
DCMedical News is published every day either the House or the Senate is in session. 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
Prices: The President advises that drug companies will drop prices (Administration plan here). Hospitals continue to acquire physician practices, raising prices for both. Price transparency (in a study of orthopedic procedures) appears illusory. See stories below.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Avalere reports (here): During twelve months of 2015 to 2016, hospitals acquired 5,000 physician practices, employing 14,000 additional physicians. The report notes a 100% rise since 2012 in hospital-owned physician practices and a 63% jump in hospital-employed doctors.
HOSPITALS AND HEALTH CARE FACILITIES
Price Transparency: Researchers writing in JAMA Internal Medicine report (here) lack of success in measuring price transparency. They note: “Over the past decade there has been increasing demand for price transparency in US health care. A 2014 Government Accountability Office report called on the Centers for Medicare and Medicaid Services to take concrete steps to collect and disseminate pricing information. Most US states have legislation requiring hospitals to report price information. A 2012 study identified more than 60 state health care price transparency websites. Several private businesses sell price transparency products.” How are we doing four years later? There was no evidence of improvement in the ability of hospitals to report prices, and in fact movement in the opposite direction, as follows: “The percentage of hospitals able to provide a bundled price declined from 15.8% in 2012 to 6.7% in 2016 and the percentage able to provide a complete price declined from 47.5% to 20.8%. The percentage unable to provide any price increased from 14.2% to 44.2%.”
MEDICARE, MEDICAID, COMMERCIAL HEALTH INSURANCE
Big changes in Medicaid law: For the first time in its 53-year history, Medicaid has “work” requirements. Significant legal question: can HHS “waive” the statutory architecture (which does not include a work requirement), or not? Another legal conundrum: can Medicaid beneficiaries seek redress if their state boots one of their providers from the Medicaid program? The conservative Fifth Circuit said “Yes,” in a case involving Planned Parenthood as a provider, but 90 Republican members of Congress say “No,” (their petition to the Supreme Court, seeking review, is here).
Big changes in Medicaid enrollment: HHS’ Center for Medicaid and CHIP services reported 73,910,380 individuals enrolled in Medicaid and CHIP in the 51 states reporting March 2018 data. 67,428,137 individuals were enrolled in Medicaid and 6,482,243 individuals were enrolled in CHIP. Nearly 16.3 million additional individuals were enrolled in Medicaid and CHIP in March 2018 as compared to the period prior to the start of the first Marketplace open enrollment period (July - Sept. 2013), in the 49 states that reported relevant data for both periods, representing nearly a 29 percent increase over the baseline period. About half of the total enrollees are children.
New Jersey Joins Massachusetts with an “Individual Mandate” to Purchase Health Insurance: As signed by the Governor, the bill (here) “[E]ntitled the ‘New Jersey Health Insurance Market Preservation Act,’ restores the recently repealed shared responsibility tax provided under the Affordable Care Act (ACA), which requires most individuals, other than those who qualify for certain exemptions, to obtain health insurance or pay a penalty. The bill is intended to ensure that health insurance markets in New Jersey remain robust and affordable by ensuring that individuals who can afford to purchase insurance participate in the market. Specifically, the bill requires that every resident taxpayer of the State obtain health insurance coverage that qualifies as minimum essential coverage under the bill. If the taxpayer does not obtain coverage, the bill imposes a State shared responsibility tax equal to a taxpayer’s federal penalty under the ACA prior to the repeal of that provision.”
Here is where AHIP (and Milliman) thinks your health insurance premium dollar goes. Here is where the members are.
PHARMA
The Senate HELP Committee will vote June 20 on a bill by Sen. Susan Collins to ban "gag clauses" that prevent pharmacists or others from advising patients concerning potential savings on prescription drugs. Proponents believe that pharmacies can help customers save money if they pay the out-of-pocket price for a drug instead of purchasing the drug through their health insurance.
READING
CQ Magazine has a cover story (here) on opioid legislation, summarizing current legislative efforts in light of the larger and longer-term scope of addiction challenges.
The NYT publishes a story (here) on possible side-effects of moving infusion and injection drugs from Part B to Part D. Oncologists have sued (complaint here, 50-page letter here) over the 2% sequestration and may sue again over any movement of infusion and injection drugs from Part B (payment to the doctor based on drug cost plus markup) to Part D (payment to the doctor based on negotiated rates, not including drug cost).
EVENTS & MEETINGS
June 7
1:15 p.m., Health2 Resources and Global Health Care, Elizabeth Currier, Lisa Davis, Steven Farmer, Geoffrey Frost, all CMMI, Lessons from BPCI, contact: (206) 452-5612, https://www.bundledpaymentsummit.com/registration.
June 8
8:00 a.m., Health2 Resources and Global Health Care, Gregory Woods, acting deputy director of CMMI,
contact: (206) 452-5612, https://www.bundledpaymentsummit.com/registration.
9:00 a.m., Cato Institute, “Overcharged: Why Americans Pay Too Much for Health Care,” Hayek Auditorium, 1000 Mass. Avenue, Washington, D.C., authors, law professors, former officials, watch online at www.cato.org/live.
June 12
HHS Secretary Azar testifies before Senate HELP Committee, the first public hearing on the Administration’s proposals to limit drug prices.
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.
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.
June publication dates: 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