DCMedical News: Thursday, June 7, 2018
DCMedical News
Washington, D.C.
Thursday, June 7, 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. All courtesy subscriptions will end with the edition of July 31.
THE BIG STORY TODAY IN HEALTH CARE
Spending: Administration proposal (H.R. 3, here) for rescissions scheduled for House vote this week. The $7 billion rescission to the Children’s Health Insurance Program involves funds which, according to CBO, could not have been spent and would not eliminate health insurance for any eligible children.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Veterans’ Choice: The President signed the new bill (Veterans Mission Act of 2018), which extends for one year the Veterans Choice Program, but then objected to funding (here). CVS lost no time announcing (here) that its MinuteClinics would benefit Veterans, notwithstanding evidence that walk-in and urgent care clinics add to health spending, rather than substitute for emergency room and doctor office visits (sample study here).
HOSPITALS AND OTHER HEALTH CARE FACILITIES
Socioeconomic factors in the delivery of health services: New study in Tennessee by Sycamore Institute (here).
New treatments more expensive than old for the same conditions: Health Affairs study (here) finds that 11.5% of 30 health conditions studied accounted for 42% of real growth rate in per capita spending 2000-2014.
MEDICARE, MEDICAID, COMMERCIAL HEALTH INSURANCE
Ways and Means: The House Ways and Means Committee held a hearing Wednesday on “Lowering Costs and Expanding Access to Health Care through Consumer-Directed Health Plans.” Whether consumer-directed, or merely consumer-paid, the plans were applauded in Subcommittee Chairman Roskam’s prepared statement here, contending that Health Savings Accounts (HSAs) were empowering “individuals and families to make decisions for themselves.” Panelists included NYU Prof. Sherry Glied (testimony here), an HSA consultant (here), an AHIP representative (here), and an HSA broker (here).
Prof. Glied noted that—citing NCHS numbers—nearly half of those insured through employer-sponsored health insurance plans are in high-deductible plans ($1300 for an individual, or more; $2600 for a family, or more). An early student of HSAs, Prof. Glied testified that “My review of these plans and of the research literature since their introduction, however, suggests that this model has not lived up to these early expectations. CDHPs have not, and are not likely to, lead to more than marginal increases in the number of people who have insurance coverage. The financial benefits of tax incentives for CDHPs have largely accrued to higher income households that already held health insurance and that already had the wherewithal to pay their out‐of‐pocket health care expenses. Finally, CDHPs have not been an effective strategy to rationalize the consumption of health care and to reduce inefficient spending. Expanding the scope and reach of CDHP is unlikely to make any significant dent in the cost, access, and affordability problems that currently face our healthcare system.”
Milliman (see DCMN June 5, report here, Becker’s summary here) reported that, of the total $28,166 cost for health expenses for a family of four in 2018, the employer will be paying $15,788, but the family will be paying the other 44% ($7,674 for employee payroll deduction, $4,704 out-of-pocket).
Things We Know for Certain: May not be. Krumholz and colleagues call attention (in JAMA, here) to an “Emerging Data Chasm” in studies dependent on the utilization of International Classification of Diseases (ICD) coding, specifically to the transition (officially in the U.S. October, 2015) from ICD-9 to ICD-10. The ICD-9 nomenclature for nearly four decades had unique codes for about 14,000 diagnoses and about 4,000 procedures. Now ICD-10 expanded that number to nearly 70,000 diagnoses and 72,000 procedures. Is there precision in comparing studies done with ICD-9 and ICD-10 codes? Perhaps in the future, but, for the moment, not automatically reliable in any crosswalk or linkage of the two, therefore creating the aforementioned “data chasm.” The authors propose a potential checklist for reporting research with data using ICD methodology, an Underwriters Laboratory or Good Housekeeping “seal” to look for in studies in the future. With so much of our health policy determined not at the level of the individual patient and doctor, but at the level of those who read journal articles and advise legislators, the “data chasm” may be a(nother) trap for the unwary.
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.
Access Hospitals, FY 2019, proposed rule. Publication date: May 7, 2018. Comment due date: June 25, 2018.
This is the eighth 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.
“Medicare Uncompensated Care Payments
CMS distributes a prospectively determined amount to Medicare disproportionate share hospitals based on their relative share of uncompensated care nationally. As required under law, this amount is equal to an estimate of 75 percent of what otherwise would have been paid as Medicare disproportionate share hospital payments, adjusted for the change in the rate of uninsured individuals and other factors. In this rule, CMS is proposing to distribute roughly $8.25 billion in uncompensated care payments in FY 2019, an increase of approximately $1.5 billion from the FY 2018 amount due to both an increase in the CMS Office of the Actuary’s estimate of payments that would otherwise be made for Medicare DSH and an updated estimate of the change in the percentage of uninsured individuals since 2014 based on the latest available data.
For FY 2019, CMS proposes to continue incorporating uncompensated care cost data from Worksheet S-10 of the Medicare cost report into the methodology for distributing these funds. Specifically, for FY 2019, CMS proposes to use Worksheet S-10 data from FY 2014 and FY 2015 cost reports in combination with insured low income days data from FY 2013 cost reports to determine the distribution of uncompensated care payments.”
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: 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