DCMedical News: Thursday, January 16, 2020
DCMedical News-DCMN
Washington, D.C.
Thursday, January 16, 2020
DCMedical News is published every day both the House and the Senate are in session.
THE BIG STORY IN HEALTH CARE
Money and Health
At the JPMorgan health fair in San Francisco: Community Health was up 15% on its 2020 outlook presented at the confab (here), although at $2.66 the stock is less than one tenth as valuable as it was January 15, 2010 ($31.55) prior to a private equity-inspired acquisition misadventure.
Elsewhere, UnitedHealth’s CEO discussed (here) results behind the company’s $19.7 billion profit for 2019. “Full year revenues exceeded $242 billion, growing $16 billion over 2018 with notable gains in our Medicare, care delivery and pharmacy care services businesses . . . We finished the year encouraged by continued performance improvement in Medicaid . . . Within our Medicare Advantage offerings including dual eligible growth, we expect to serve nearly 700,000 more people in 2020.” UnitedHealth’s Optum division CEO, “encouraged and humbled,” reported that “In 2019, Optum revenues reached $113 billion growing 12% year-over-year. Total operating earnings grew 14% to $9.4 billion. OptumHealth revenues reached $30.3 billion in 2019, up 26% led by OptumCare, our care delivery business.” Report on 8-k filing, here.
So How Poor is Poor?
Tuesday’s Federal Register included this year’s annual update of the guidelines (here) for the federal poverty level for programs using such guidelines. Family of four? $26,200, higher in Hawaii and Alaska.
There are two legislative working days (the 27th and 28th, Congressional calendar here) left in January.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
PCI vs. CABG: Brief Review
A brief review in NEJM Journal Watch Cardiology (here) notes that “Revascularization for symptomatic significant left main (LM) coronary artery disease (CAD) has been the standard of care for more than 30 years. More recent advances in drug-eluting stents have begun to level the playing field between percutaneous coronary intervention (PCI) and coronary-artery bypass grafting (CABG), with the less invasive approach preferred when data demonstrate similar outcomes. However, randomized trial comparisons between PCI and CABG for LM disease have not demonstrated a conclusive winner.”
70,000 Deaths Per Year, More or Less
Is addiction a terminal disease? A thought on addicted patients and clinical decisions, here, in the NEJM.
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
A Huge Deal
The Source on Healthcare Price and Competition reports (here) on a “A Huge Deal: Settlement Terms of Sutter Health Antitrust Case Will Promote Transparency and Competition in California Provider Markets.” The Source reports, “The high-profile antitrust case against Sutter Health settled on the eve of trial in October 2019, when the Northern California hospital giant reached a preliminary settlement agreement with the California Attorney General’s office and class action plaintiffs after five years of litigation. The terms of the settlement [here] were released late December, which include both monetary compensation for the private plaintiffs and injunctions against Sutter’s conduct that will restore competition and promote transparency in the provider market.” Hearing on the Motion February 25.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
More Money: OIG Reports that “Billions in Estimated Medicare Advantage Payments from Chart Reviews Raise Concerns”
The HHS Office of the Inspector General is worried that Medicare Advantage plans are treating the chart, not the patient, taking “advantage” of lax CMS controls. The report (here) says “MAOs [Medicare Advantage Organizations] may use chart reviews to increase risk-adjusted payments inappropriately. Unsupported risk-adjusted payments are a major driver of improper payments in the MA program, which provided coverage to 21 million beneficiaries in 2018 at a cost of $210 billion. CMS risk-adjusts payments by using beneficiaries’ diagnoses to pay higher capitated payments to MAOs for sicker beneficiaries―which may create financial incentives for MAOs to make beneficiaries appear as sick as possible. MAOs report these diagnoses via CMS’s MA encounter data system and RAPS [Risk Adjustment Processing System] based on services and chart reviews (i.e., MAO’s reviews of a beneficiary’s medical record to identify diagnoses that a provider did not submit or submitted in error). To be eligible for risk adjustment, a diagnosis must be documented in a medical record as a result of a face-to-face visit. Although CMS requires MAOs to identify chart reviews in the encounter data, CMS does not require MAOs to link these chart reviews to a specific service associated with the diagnoses. This may provide MAOs opportunities to circumvent CMS’s face-to-face requirement and inflate risk-adjusted payments inappropriately.”
READINGS AND REFERENCES
U.S. House of Representatives:
Members at https://www.house.gov/representatives
Committees and Members at https://www.house.gov/committees
U. S. Senate:
Committees and Members at https://www.senate.gov/committees
CQ 2020 Calendar of Regularly Scheduled Sessions, here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
January 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.