DCMedical News: Tuesday, June 19, 2018
DCMedical News
Washington, D.C.
Tuesday, June 19, 2018
DCMedical News is published every day either the House or the Senate is in session.
THE BIG STORY TODAY IN HEALTH CARE
PPACA in the Courts, continued: In the Texas case (constitutionality of PPACA in the absence of a tax penalty for failure to have compliant health insurance, complaint here) a group of law professors filed an amicus brief supporting PPACA (here) and America’s Health Insurance Plans (AHIP) joined in (here).
MEDICARE, MEDICAID, COMMERCIAL HEALTH INSURANCE
MedPAC Makes June Report to Congress, continued: The report may set off or reinvigorate contests between competing financial interests in the health field. The report is here, a summary here, the press release here. Today and this week DCMN will feature excerpts from the report, a consolidation of Medicare-driven health policy issues.
The Effects of the Hospital Readmissions Reduction Program, first of ten chapters in the MedPAC Report: “Medicare’s Hospital Readmissions Reduction Program (HRRP) enacted in 2010 . . . contributed to a significant decline in readmission rates without causing a material increase in observation stays or ED visits, or an adverse effect on mortality rates . . . While ED visits increased following the introduction of the HRRP, this increase is likely related to reasons other than the HRRP. Changes in ED use following a hospital discharge were comparable for conditions covered by the HRRP and for all other conditions. Also, the growth in ED visits was similar for beneficiaries recently discharged from a hospital and those not recently discharged, and the share of all ED visits that were post discharge visits was the same before and after the introduction of the HRRP. Thus, it appears that the growth in ED visits is a phenomenon unrelated to the HRRP. Some researchers have asserted that efforts to reduce readmissions have resulted in higher mortality for heart failure patients. We examined heart failure mortality rates during the hospital stay and 30-days post discharge from 2010 to 2016 (before and after the implementation of the HRRP). We found no evidence to suggest that the readmission policy had a worsening effect on mortality rates. To the extent that there is any effect, we find the HRRP may have slightly improved (reduced) mortality rates.”
Using Payment to Ensure Appropriate Access to and Use of Hospital Emergency Department Services, second of ten chapters in the MedPAC Report: “Maintaining access to emergency department (ED) services can be challenging in remote rural areas, where a single hospital may be the sole source of ED care. If that hospital closes, access to emergency care can be lost. In contrast, efficiency can be a challenge in urban areas, where EDs can be in oversupply. To reduce the risk of ED services being undersupplied in rural areas and oversupplied in urban areas, we recommend two changes to Medicare payment for ED services. . . The Commission recommends an alternative, voluntary payment model that would allow Medicare to pay for emergency services at outpatient-only hospitals in isolated rural areas. Under this model, isolated rural inpatient hospitals could choose to convert to outpatient-only hospitals and continue to receive standard prospective payment rates for ED visits. In addition, an annual block subsidy payment would be made to help cover the facility’s fixed costs . . . Importantly, shifting to an outpatient-only hospital would dramatically reduce cost sharing for many beneficiaries. Outpatient only hospitals could decide to switch back to their prior status if community circumstances changed.”
PHARMA
Price Policy: HHS Secretary Azar appeared at the Washington Post program to discuss the administration’s drug price control plans (America’s Patients First,” here, graphic summary of details here, CQMagazine discussion here).
The Common Rule Update: Updating the fundamental document protecting human subjects in research (here) will have to wait another year. A prior version of the Common Rule update was published the day before inauguration of the President in 2017. “This rule delays the general compliance date for the 2018 Requirements for an additional 6-month period, until January 21, 2019. As a result of this delay, regulated entities will be required, with an exception, to continue to comply with the requirements of the pre-2018 version of the Federal Policy for the Protection of Human Subjects (the ‘pre-2018 Requirements’) until January 21, 2019. The one exception to this general rule is that institutions will be permitted (but not required) to implement, for certain research, three burden-reducing provisions of the 2018 Requirements during the delay period (July 19, 2018, through January 20, 2019). Those three provisions are: the revised definition of ‘research,’ which deems certain activities not to be research covered by the Common Rule; the elimination of the requirement for annual continuing review with respect to certain categories of research; and the elimination of the requirement that institutional review boards (IRBs) review grant applications or other funding proposals related to the research.”
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.
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.
Aug. 22
7:30 a.m. – 4:30 p.m., Medicare Evidence Development and Coverage Advisory Committee (MEDCAC), CAR-T cell therapies, collection of patient reported outcomes in cancer clinical studies.
Maria Ellis, MEDCAC, (410) 786-0309, maria.ellis@cms.hhs.gov. Federal Register notice (6-15-2018) here.
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 fifteenth 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.
FY 2019 Inpatient Quality Summary: At risk for FY 2019 are sums hospitals may lose, first a 25% reduction of the market basket update for not reporting inpatient quality measures, and a 2.175% reduction for non-reporting of e-measures (promoting interoperability). Hospitals may earn (or lose) 2% of the base DRG amount for value based purchasing reporting and performance, may lose 3% of the base DRG for excess readmissions (no credit for improvement) and may lose 1% of total payments for being in the one quarter of hospitals deemed as having the worst performance in hospital acquired conditions (no credit for improvement). No new measures are proposed for the hospital readmissions reduction program, the value based payment program or the hospital acquired condition reduction program.
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.
Trial subscriptions may end without notice, and all will end July 31.
June publication dates: 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