DCMedical News: Friday, June 15, 2018
DCMedical News
Washington, D.C.
Friday, June 15, 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
Continued Fallout from DoJ Memorandum on PPACA: The Wall Street Journal has called attention (here) to the implications of the Department of Justice’s position on PPACA for group health insurance. That DoJ position was announced in a Memorandum (here) submitted by the Department to a court considering the Constitutionality of PPACA. The Department chose to join 19 states in the suit, Texas et. Al. v. United States of America and California, contending that failure to have health insurance (the individual mandate) now has no tax penalty, that the Constitutionality of PPACA was found to be dependent on having a tax penalty, that the remainder of PPACA is also now un-Constitutional. The Journal noted that the case might also affect group health plans provided through employers to more than 170 million people. “Anyone who just thinks this is just impacting the 12 to 15 million individuals with individual coverage is wrong,” said Timothy Jost. Further complicating matters, Nicholas Begley draws attention in The Incidental Economist (here) to drafting (and possibly conceptual) error in the DoJ Memorandum.
Political Health: Both The New York Times (“The Health Care Stalkers,” here) and The Wall Street Journal (“The Autumn of ObamaCare,” here) gave lead editorials to current attempts to salvage or submerge PPACA.
C-SRs Need Not be Paid by the Government to Insurers (“Moda” case): News report here, split decision here.
Budget: Appropriations Committee releases FY2019 proposal for Labor, Health and Human Services and Education, here.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Births in the U.S.A.: A report (here) from the National Center for Health Statistics says “Infants born before 37 weeks of gestation, commonly referred to as preterm, are at greater risk of early death than those born later in pregnancy and can suffer numerous health and developmental problems, especially at earlier gestational ages. The incidence of preterm birth in the United States rose from the early 1980s through 2006 but declined from 2007 through 2014. Recent data for 2014–2016, however, indicate that the preterm rate is on the rise again.”
HOSPITALS AND OTHER HEALTH CARE FACILITIES
Angina for Hospital Executives: A promotional piece (ASC Physician Focus) from the Ambulatory Surgery Center Association has this feature: “Safely Moving Cardiology Procedures to ASCs,” explaining that “Over the last 10–15 years, advances in technology have presented an opportunity for cardiologists to move select procedures to ASCs.”
Coding for Hospital Discharges October 1, 2018ff.: CMS has released ICD-10-CM codes with updates for FY2019, to be used for discharges occurring from October 1, 2018 through September 30, 2019 and for patient encounters during the same time period. Link to codes found here: https://www.cms.gov/Medicare/Coding/ICD10/2019-ICD-10-CM.html
MEDICARE, MEDICAID, COMMERCIAL HEALTH INSURANCE
Anthem and Emergency Department Use: An article in RAC Monitor (here) claims that Anthem has backed off its new policy of denying emergency room reimbursement for patients who turn out not to have had emergencies. Missouri, one state affected, passed Senate bill 982 which defines an emergency medical condition as one that is sudden and would lead a prudent layperson to believe that immediate medical care is required. Perhaps as a “trade-off,” the bill also requires binding arbitration for out-of-network emergency care.
PHARMA
Antibiotic Development and Reimbursement: FDA Commissioner Dr. Scott Gottlieb has addressed (here) the difficulty of attracting pharmaceutical investment into antibiotic research. Antibiotics, when successful, are short-term therapy, compared to drugs for chronic disease. Said Gottlieb, “The increase in serious antimicrobial drug resistant infections is a critical public health concern and a growing threat to patients. According to our colleagues at the Centers for Disease Control and Prevention, each year in the U.S. at least 2 million people become infected with bacteria that are resistant to antibiotics and 23,000 people die each year as a direct result of these infections.” The FDA provided new “guidance” (here) to industry.
EVENTS & MEETINGS
June 19
9:30 a.m., Bipartisan Policy Center, “Counting the Costs: Introduction to CBO’s Updated Health Insurance
Model,” info at http://bipartisanpolicy.org/events/, CBO officials.
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 27
10:00 a.m., Senate Health, Education, Labor and Pensions (HELP) Committee, hearing on
"How to Reduce Health Care Costs: Understanding the Cost of Health Care in America," Ashish Jha,
other academics, Niall Brennan of HCCI.
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 thirteenth part of a multi-part series on the Hospital Inpatient Prospective Payment System (IPPS) FY 2019 proposed rule. Our series began 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 Federal Register document is here.
Numerous changes are proposed which are represented as simplification of current CMS policy. For example, inpatient admission orders are currently required to be present in the medical record, in order for a hospital to receive payment under Medicare Part A. As a result, with many opportunities for technical discrepancies or shortcomings, such as a missing signature, or the timing of a signature, payments are held up or even denied, notwithstanding medical necessity.
The proposal in this rule is to revise 2 CFR 412.3(a) to remove language requiring the physician’s order to be in the medical record. In addition, “medical reviews” would focus on “medical” issues, such as medical necessity and reasonableness. In the text, CMS says the intent of the current rule was not to deny payment for services which were, otherwise, necessary.
42 CFR 424.11: A similar rationale and representation involves physician certification for claims. Currently when supporting information for a claim is required, it need not be repeated, but its location—where the information can be found—must be stated. Now claims are denied when the location is not indicated, even when the location is apparent to a reviewer or auditor. In the proposed rule CMS would eliminate the requirement that the physician indicate where supporting information for a claim can be found, relying, instead, on a searchable EMR.
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: 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