DCMedical News: Tuesday, June 5, 2018
DCMedical News
Washington, D.C.
Tuesday, June 5, 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, opioids, budgets, continued.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Direct Provider Contracting: A new association dubbed America’s Physician Groups has proposed a Direct Provider Contracting model to CMS. The model is a “network” of Clinically Integrated Organizations given capitation funds and responsibility for all professional and hospital payments. But initial reaction was not positive: Dr. Jane Orient of the Association of American Physicians and Surgeons said capitation “Rewards cherry picking, denial of care and massive diversion of resources to box-clickers, data miners and bureaucrats who pretend to be measuring quality.”
Opioid Workforce Treatment Act: InsideHealthPolicy reports (here) on a proposal (not yet included in either the House or Senate opioid packages of bills) to create 1,000 Medicare GME-funded residency slots in addiction medicine and pain management.
MEDICARE, MEDICAID, COMMERCIAL HEALTH INSURANCE
Commercial health insurance: The uninsured rate rose (see Gallup report, here) in seventeen states in 2017, the first rise for any state since full PPACA implementation in 2014. Uninsured rates increased at least 3% in Hawaii, Iowa, New Mexico and West Virginia. The “national uninsured” rate was 12.2% in 2017-Q4, up from 10.9% in 2016-Q4. Meanwhile, Milliman reports (here) that the cost in 2018 for a family of four with employer sponsored PPO-plan health insurance is $28,166.
Medicaid Buy-In: Governing magazine has a feature (here) on Medicaid-for-all, states considering allowing anyone to “buy in” to Medicaid coverage, regardless of income.
PHARMA
OIG did a study of Part D drug prices. Results? The study (here) found that “Total reimbursement for all brand name drugs in Part D increased 77 percent from 2011 to 2015, despite a 17 percent decrease in the number of prescriptions for these drugs . . . Part D unit costs for brand name drugs rose nearly 6 times faster than inflation from 2011 to 2015. The percentage of beneficiaries responsible for out of pocket costs of at least $2,000 per year for brand name drugs nearly doubled across the 5-year span.”
BioTech’s Big Annual Convention and ASCO (the clinical oncologists) will be in the news today.
EVENTS & MEETING
June 6
11:00 a.m., House Ways and Means Health Subcommittee, Hearing on “Lowering Costs and Expanding Access to Health Care through Consumer-Directed Health Plans.”
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 14
1:00 – 2:15 p.m., Alliance for Health Policy, Prescription Drug Costs: Can Increased Competition Restrain Prices?
June 20
AHIP Institute & Expo, San Diego, California.
Special Report: Medicare Inpatient Prospective Payment System, Hospitals, Long Term Care Hospitals and Critical Access Hospitals, FY 2019, proposed rule. Publication date: May 7, 2018. Comment due date: June 25, 2018.
This is the sixth part of a multi-part series on the Hospital Inpatient Prospective Payment System (IPPS) FY 2019 proposed rule. The 480-page Federal Register document is here.
PPS-Exempt Cancer Hospital Quality Reporting (PCHQR) Program
CMS is proposing to collect a new measure, and remove six previously-adopted measures. Specifically, the proposed rule proposes to: 1. Adopt one new claims-based hospital 30-day unplanned readmission outcome measure beginning with the FY 2021 program year, and 2. Remove 6 measures, each of which addresses healthcare associated infections, oncology, or prostate cancer.
Long Term Care Hospital Quality Reporting Program (LTCH QRP)
Under the LTCH QRP, the applicable annual update to the LTCH PPS standard Federal rate for discharges is reduced by two percentage points if the LTCH does not submit to CMS data in accordance with the requirements of the LTCH QRP.
CMS is proposing to remove the following measures: National Healthcare Safety Network (NHSN) Facility-wide Inpatient Hospital-onset Methicillin-resistant Staphylococcus aureus (MRSA) Bacteremia Outcome Measure (NQF #1716) (beginning with the FY 2020 LTCH QRP); National Healthcare Safety Network (NHSN) Ventilator Associated Event (VAE) Outcome Measure (beginning with the FY 2020 LTCH QRP); Percent of Residents or Patients Who Were Assessed and Appropriately Given the Seasonal Influenza Vaccine (Short Stay) (NQF #0680) (beginning with the FY 2021 LTCH QRP)
Burden Reduction
In addition to proposals that would reduce the number of measures acute care hospitals are required to report across the 5 quality and value-based purchasing programs CMS is proposing to reduce burden by easing documentation requirements. Specifically, CMS is proposing to: (1) Remove the requirement that Part A certification statements detail where in the medical record the required information can be found; (2) Reduce the number of denied claims for clerical errors in documenting physician admission orders by removing the requirement that a written inpatient admission order be present in the medical record as a specific condition of Medicare Part A payment; (3) Provide more flexibility for new urban teaching hospitals to enter into Medicare Graduate Medical Education affiliation agreements, which allow hospitals to share full time equivalent cap slots to accommodate the cross training of residents.
Also, (4) Allow hospitals to use average hourly wage data from the current year’s IPPS final rule to demonstrate they are the only hospital in their Metropolitan Statistical Area for the purpose of meeting an exemption from certain wage index geographic reclassification requirements beginning in FY 2021; (5) Revise regulations to allow certain hospitals which are excluded from the IPPS (for example, LTCHs) to operate IPPS-excluded units; (6) Revise regulations to allow that an IPPS-excluded satellite of an IPPS excluded unit of an IPPS-excluded hospital would not have to comply with the separateness and control requirements so long as the satellite of the unit is not co-located with an IPPS hospital
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.
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June publication dates: 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