DCMedical News: Friday, June 8, 2018
DCMedical News
Washington, D.C.
Friday, June 8, 2018
DCMedical News is published every day either the House or the Senate is in session. Add our domain (dcmedicalnews.org) to your white list. Welcome to our new “courtesy trial” recipients. (Courtesy subscriptions may end without notice, and all will end July 31. Subscription information below.)
THE BIG STORY TODAY IN HEALTH CARE
Sabotage of PPACA? Not so said HHS Secretary Azar before the House Education and Workforce Committee (NYTimes report here), noting, for example, that “silver loading” will continue to be allowed in 2019, a means of subsidizing premium expense in the absence of cost-sharing reduction appropriations.
Last night, however, the Department of Justice filed a memorandum (here) indicating that it would not defend the constitutionality of PPACA, on grounds that the individual mandate is no longer linked to a tax. “The United States agrees with the Plaintiffs that Section 5000A(a) must now be struck down as unconstitutional in light of the amendments that were made to it in the Tax Cuts and Jobs Act (TCJA).” The suit against PPACA, filed by Texas and 19 other states in February, will now be defended by 17 (Democratic) state Attorneys General.
Opioid legislative collision: More than sixty bills approved by House Committees (below), modest efforts in Senate.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Doctors at Work: National Center for Health Statistics reports (here) on physician office visit 2015 results, as follows: “In 2015, most Americans had a usual place to receive health care (85% of adults and 96% of children). The majority of children and adults listed a doctor’s office as the usual place they received care. In 2015, there were an estimated 990.8 million office-based physician visits in the United States.” Among the 313 office-based physician visits per 100 persons the visit rate for women exceeded that for men, the rate for infants and older adults exceeded those for persons aged 1-64 years, a larger percentage of visits by children were for preventive care or a new problem, a larger percentage by adults included a laboratory test, imaging or procedure.
A companion NCHS study of mental health visits found (report here) that “Mental health-related visit rates by physician specialty were 693 per 10,000 adults for psychiatrists, 397 per 10,000 adults for primary care physicians, and 162 per 10,000 adults for other specialties.
Opioid Prescriptions? Problem not with Physicians, says the AMA: In a report (here) the group reports that between 2013 and 2017 the number of opioid prescriptions dropped more than 22%, 550,000 doctors took classes in pain management and substance abuse in 2017 and naloxone prescriptions increased from 3,500 to 8,000 weekly by 2017.
Comprehensive Primary Care: Another APM Dud: A RAND-Mathematica group reports in Health Affairs (here) that another alternative payment model fell short. The 2012 Comprehensive Primary Care initiative in more than 500 locations “[D]id not reduce Medicare spending enough to cover care management fees or appreciably improve physician or beneficiary experience or practice performance on a limited set of Medicare claims-based quality measures.”
HOSPITALS AND OTHER HEALTH CARE FACILITIES
Got Innovation? HHS wants to hear from you, in a notice (here) in Thursday’s Federal Register concerning “Facilitation of Public-Private Dialogue to Increase Innovation and Investment in the Healthcare Sector.”
MEDICARE, MEDICAID, COMMERCIAL HEALTH INSURANCE
Medicaid and Work Requirements: MACPAC checks in with a comprehensive overview of the new work requirements (here) and a focus on Arkansas (here).
Medicare Advantage program flexibility: Commonwealth Fund (here) reports on new flexibility, increased revenue, for MA plans to use in supplemental benefits.
House Ways and Means Committee: Promotes HSA hearing as cost containment success (see DCMN 6-7), no mention of contrary views by the only academic among the witnesses.
PHARMA
Opioid Legislation Pending: CBO reports (here) on H.R. 5776, the “Medicare and Opioid Safe Treatment Act of 2018,” a series of seven bills reported by the House Ways and Means Committee. The bill provides funds for FQHC training in opioid use disorder; expands the availability of medication-assisted treatment (MAT) for Medicare beneficiaries, for programs certified by the Substance Abuse and Mental Health Services Administration (SAMHSA); creates a new “bundled payment” for MAT through these certified programs, with “considerable discretion for defining bundles and establishing payment rates”; requires review and possible modification of the OPPS (Hospital Outpatient Prospective Payment System) for pain management treatment, especially if the Secretary “determined that there was a financial incentive to use opioids in place of nonopioid medications”; authorizes the Center for Medicare and Medicaid Innovation (CMMI) to test beneficiary awareness of psychological services, and to “help those beneficiaries curtail use of hospital-based mental health or behavioral health services”; and directs a study of supplemental benefits to pay for substance abuse treatment or prevention in MA plans.
CBO Working to Keep up with 59 more House bills, reports on these Thursday: H.R. 5327, Comprehensive Opioid Recovery Centers Act of 2018; H.R. 5261, Treatment, Education, and Community Help to Combat Addiction Act of 2018; H.R. 5272, Reinforcing Evidence-Based Standards Under Law in Treating Substance Abuse Act of 2018; H.R. 5202, the Ensuring Patient Access to Substance Use Disorder Treatments Act of 2018; H.R. 5176, Preventing Overdoses While in Emergency Rooms Act of 2018; H.R. 5197, Alternatives to Opioids (ALTO) in the Emergency Department Act; H.R. 5102, Substance Use Disorder Workforce Loan Repayment Act of 2018; H.R. 5009, Jessie’s Law; H.R. 5041, Safe Disposal of Unused Medication Act; H.R. 4841, Standardizing Electronic Prior Authorization for Safe Prescribing Act of 2018; H.R. 5002, Advancing Cutting Edge Research Act; H.R. 4684, Ensuring Access to Quality Sober Living Act; H.R. 449, Synthetic Drug Awareness Act of 2018; H.R. 4284, Indexing Narcotics, Fentanyl, and Opioids Act of 2017. CBO report links here.
Community Catalyst has a new Report on Prescription Drug Prices: here.
EVENTS & MEETINGS
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 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.
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: 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