DCMedical News: Wednesday, June 6, 2018
DCMedical News
Washington, D.C.
Wednesday, June 6, 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
Repeal and Replace: Senator (and doctor) Bill Cassidy has published (here) “Ideas to make health care affordable again.” Affordability continues as the big story, with announcements of significant premium increases in the individual exchange market, averaging 24% in the State of New York, for example, and the Medicare Trustees reporting (here) diminished solvency in the Medicare trust fund. Cassidy’s paper, while presented in some reports as a “repeal and replace” document, is actually a discussion of most or all of the current challenges in managing the cost of health care, including patient roles, health insurance premiums, monopoly behavior, drug costs, waste and the importance of primary care.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Bigs vs. Independents: Big medical groups (having invested in the process) urged CMS to stop allowing independent physicians to opt-out of MIPS, reported (here) by Modern Healthcare.
Veterans Choice, the VA Private Care Program, Falls Short: The AP reports, “A key program being expanded by the Trump administration to give veterans greater access to private doctors has failed to provide care within 30 days as promised due to faulty data and poor record-keeping that could take years to remedy” according to a Government Accountability Office study (here). “Veterans often had to wait between 51 and 64 days for appointments with private doctors under the Veterans Choice program.” The report “blamed in part bureaucratic inefficiency and understaffing at the Department of Veterans Affairs, which often took weeks to make a referral to a private doctor. In more than 1 out of 10 cases it reviewed, the GAO also found that the VA had entered incorrect starting dates used to measure the amount of time veterans must wait for medical care; investigators said it was unclear whether the data entries were a mistake or an inappropriate attempt to mask delays in providing care.” (Former VA chief and war hero General Shinseki resigned over similar “workarounds” by staff in the Phoenix VA, later found to be the norm in a majority of 230 VA facilities.)
Doctors and Nurses in the Cockpit: A piece in JAMA Internal Medicine (here) describes a scene which may be familiar to many in American medicine, “The ‘cockpit’ where physicians and other health professionals work now consists of a cacophony of warning alerts, pop-up messages, mandatory tick boxes, a Sisyphean inbox, and maddening documentation. Paradoxically, many interventions intended to improve quality, safety, or value, when taken in totality, may in fact contribute to health system dysfunction by virtue of the cumulative impact on workload and consequent burnout.”
HOSPITALS AND OTHER HEALTH CARE FACILITIES
Rural Health: Rural health and challenges to rural hospitals have renewed focus, Administration policy here, commentary from Governing magazine here. A Senate Finance Committee hearing on May 24th heard from the North Carolina Rural Health Research Program (here); Geisinger’s chief innovation officer (here); the Center for Rural Health Policy Analysis of the University of Iowa (here); the CEO of a health care system in Alamosa, Colorado (here); and the CEO of UnityPoint Accountable Care in West Des Moines, Iowa (here). An overview of the hearing is here, a statement by Senator Hatch here, Ranking Senator Wyden here, a Modern Healthcare story on global budgeting for rural hospitals here; and, of course, focus on the role of Medicaid (here and here). Rural EDs were the focus of MedPAC here and of Senators here. North Carolina legislators promote teaching programs in rural hospitals here.
Skilled Nursing and Assisted Living Facilities: HHS Secretary Azar (remarks here) addressed the American Health Care Association and the National Center for Assisted Living. He noted the 50% increase (from 2000 to 2016, 46 million to 69 million) in the number of Americans over age 60, on the way to 77 million in 2020 and 102 million in 2040. He noted that “This represents an opportunity for those who serve our elderly.” Another thought, “It’s much better to be running a nursing home these days in America than to be running a college or university.” An overview: “…a system that pays for value will aim to move patients into the lowest-cost appropriate setting.”
PHARMA
Tumor-infiltrating Lymphocytes Highlight Breast Cancer News from ASCO: A report published in Nature Medicine (here), summarized in the Los Angeles Times (here) and Bloomberg (here) has been the big news from the American Society of Clinical Oncology. A single infusion of a patient’s immune cells just before Christmas of 2014 “eliminated all evidence of advanced-stage breast cancer in a 49-year-old woman who had run out of treatment options.”
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 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.
June 22
7:00 p.m., Single Payer Strategy Conference, Minneapolis, Keynote DNC Deputy Chairman Rep. Keith Ellison.
June 24
Academy Health, Annual Research Meeting, Seattle, Washington.
June 29
Noon – 1:30 p.m., Alliance for Health Policy, Congressional Briefing on Health Care Costs in America.
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 seventh 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.
Summary of payments and penalties: Beginning 10-1-2018 acute care hospitals will receive a 1.75% operating payment rate increase. This is based on CMS’ calculation of a 2.8% market basket update, a .5% increase required by statute, and reductions of .8% for “productivity” and .75% for subsidy of PPACA benefits.
“CMS projects that the rate increase, together with other proposed changes to IPPS payment policies, will increase IPPS operating payments by approximately 2.1 percent, and that proposed changes in uncompensated care payments, capital payments, and the changes to the low-volume hospital payments will increase IPPS payments by an additional 1.3 percent for a total increase in IPPS payments of 3.4 percent. Other additional payment adjustments will include continued penalties for excess readmissions which reflect an adjustment to a hospital’s performance relative to other hospitals with a similar proportion of patients who are dually eligible for Medicare and full-benefit Medicaid, a continued 1 percent penalty for hospitals in the worst performing quartile under the Hospital Acquired Condition Reduction Program, and continued upward and downward adjustments under the Hospital Value-Based Purchasing Program. In sum, CMS projects that total Medicare spending on inpatient hospital services, including capital, will increase by about $4 billion in FY 2019.”
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: 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