DCMedical News: Wednesday, June 13, 2018
DCMedical News
Washington, D.C.
Wednesday, June 13, 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. (All courtesy subscriptions will end on or before July 31. Subscription information below.)
THE BIG STORY TODAY IN HEALTH CARE
Bills Addressed at Opioid Abuse Continue to be Deliberated in the House and Senate: Many of the bills will have a direct impact on doctors and hospitals participating in the Medicare and Medicaid programs. See CBO reports on the House Energy & Commerce Committee bills here (25 passed yesterday, list here), House Ways and Means Committee bills here.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Remote Monitoring: HealthcareDive reports on a letter (here) from 49 medical organizations urging CMS to provide additional codes and higher payment for remote patient monitoring. This follows the unbundling of telemedicine from remote monitoring (CPT 99091) in the 2018 physician fee schedule final rule (here). The unbundling allows doctors to bill for patient generated health data collected and interpreted remotely from the home or work or other locations. The group of 49 organizations seeks payment rates equal to those which would be paid to on-site professionals. The letter, however, cites no studies demonstrating that such monitoring actually helps patients, avoids more expensive services, or both.
Payment Fix: InsideHealthPolicy reports that doctors praise the Physician-Focused Payment Technical Advisory Committee (PTAC) work, but that the work seems to “disappear” inside the HHS Secretary’s office. Those waiting for this Thursday and Friday’s PTAC meeting (annual meeting schedule here) will find that it has been canceled, on grounds that no proposals were ready for Committee consideration. Here are the proposals pending after the last meeting, March 26-27. Here is the transcript of that last meeting. Here and here are the proposals presented at that last meeting. PTAC, born of MACRA, met first in February 2016; more information on the group at this site, https://aspe.hhs.gov/meetings-physician-focused-payment-model-technical-advisory-committee.
MEDICARE, MEDICAID, COMMERCIAL HEALTH INSURANCE
Medicaid and the Courts: George Washington’s Sara Rosenbaum has a learned and lucid discussion of “Medicaid and the Role of the Courts” (Commonwealth Fund, here). A coming round is Stewart v. Azar, challenging the role of HHS in approving state §1115 Medicaid waiver demonstrations requiring Medicaid beneficiaries to work as a condition of eligibility, a seeming narrowing of the statutory definition of eligibility.
For the significance of such cases, beyond Medicaid, Rosenbaum writes: “Today Medicaid is essentially ground zero in an ongoing and profound philosophical debate within the judiciary about the proper place of courts in cases involving state-administered public benefit programs . . . Medicaid is silent on the question of judicial review of state agency actions. This silence may be traceable to the judicial philosophical principles that held sway at the time of Medicaid’s enactment, when the courts’ ability to intervene to block unlawful state practices was a bedrock assumption. These principles no longer hold as much sway. Today the Supreme Court looks for unequivocal rights and clear evidence in the text of laws themselves indicating congressional intent to allow federal courts to intervene to protect private interests in state-administered public welfare programs.” (Emphasis added.)
Medicare: CMS announces (here) there will be no “Star” rating updates for July, but additional measures/requirements are being added, and of course “CMS is no longer reporting the Pain Management composite 4 on Hospital Compare or in the downloadable databases.” (CMS through patient HCAHPS surveys, The Joint Commission, doctors, hospitals and drug companies have all been faulted in discussions of where the current prescription opioid epidemic began.)
EVENTS & MEETINGS
June 14
1:00 – 2:15 p.m., Alliance for Health Policy, “Prescription Drug Costs: Can Increased Competition Restrain Prices?” Industry reps., info@allhealthpolicy.org.
June 20
AHIP Institute & Expo, San Diego, California.
8:30 a.m.-5:00 p.m., COGME: Council on Graduate Medical Education, 5600 Fishers Lane, Rockville, Md., conf. call 800-619-2521 code 9271697, KCarter@hrsa.gov, Federal Register notice here.
June 21
8:30 a.m.-2:00 p.m., COGME continues.
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 eleventh part of a multi-part series, beginning with the edition of May 21; previous editions of DCMN may be accessed by clicking on “View this email in your browser.” This IPPS proposed rule is arguably the single most important federal rule-making for hospitals each year. The 480-page proposed rule as published in the Federal Register is here. Rural Hospitals have these limited provisions in the FY 2019 IPPS Proposed Rule:
Rural Community Hospital Demonstration
“The Rural Community Hospital Demonstration was originally authorized for a 5-year period by section 410A of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), and extended for another 5-year period by sections 3123 and 10313 of the Affordable Care Act. Section 15003 of the Cures Act extended the demonstration for another 5-year period.”
“The demonstration is required to be budget neutral. Each year since 2004, CMS has included a segment specific to the demonstration program in the IPPS/LTCH PPS proposed and final rules. On an annual basis, this segment has detailed the status of the demonstration, as well as the methodology for ensuring budget neutrality. Each of the past 13 years, CMS has adjusted the IPPS rates by an amount sufficient to account for the added costs of the demonstration program, thus applying budget neutrality across the payment system as a whole rather than merely across the participants in the demonstration program.”
“In the FY 2019 IPPS/LTCH PPS proposed rule, we provide a summary of the previous legislative provisions and their implementation, as well as our final policies for implementation of the extension period authorized by the Cures Act.
We also describe the budget neutrality methodology finalized in accordance with these policies, and identify the amount of the proposed adjustment to the IPPS rates for FY 2019.”
Frontier Community Health Integration Project (FCHIP) Demonstration
“Section 123 of the Medicare Improvements for Patients and Providers Act of 2008 (Pub. L. 110–275), as amended by section 3126 of the Affordable Care Act, authorizes a demonstration project to allow eligible entities to develop and test new models for the delivery of health care services in eligible counties in order to improve access to and better integrate the delivery of acute care, extended care and other health care services to Medicare beneficiaries. The demonstration is titled “Demonstration Project on Community Health Integration Models in Certain Rural Counties,” and is commonly known as the Frontier Community Health Integration Project (FCHIP) demonstration.”
“Ten Critical Access Hospitals are participating in the FCHIP Demonstration, which aims to test new models of health care delivery in the most sparsely populated rural counties with the goal of improving health outcomes and reducing Medicare expenditures. This Demonstration is for three years and it began on August 1, 2016. In the FY 2019 IPPS/LTCH PPS proposed rule, we reiterate our previously announced policy to address the budget neutrality requirement for the demonstration in the event the demonstration is found not to have been budget neutral.”
[Rural hospital special in Modern Healthcare this week, here, focus on declining inpatient utilization.]
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: 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.
August publication dates: prn, Senate may be in session.
September publication dates: 4, 5, 6, 7, 12, 13, 14, 17, 18, 20, 21, 24, 25, 26, 27, 28.
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com