DCMedical News: Wednesday, June 20, 2018
DCMedical News
Washington, D.C.
Wednesday, June 20, 2018
THE BIG STORY TODAY IN HEALTH CARE
Association Health Plans: The Department of Labor issued the final rule (here) on Association Health Plans. The President’s executive order can be found here, the proposed rule from January 5 here, commentary from January here, from June here, the response of the American Nurses Association here, of the American Medical Association here, and a report on plans of the National Restaurant Association and UnitedHealth here. A CBO report indicating the potential impact on PPACA is 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.
USING PAYMENT TO ENSURE APPROPRIATE ACCESS TO AND USE OF HOSPITAL EMERGENCY DEPARTMENT SERVICES, second of ten chapters in the MedPAC Report, continued: “By contrast, the numbers of stand-alone, off-campus EDs (OCEDs) in several urban markets has grown rapidly. Based on a review of the literature and interviews with ambulance operators, we observe that patients who seek care at OCEDs appear to have less complex care needs than patients served at on-campus EDs. While OCEDs have lower standby costs and treat less severe patients, the Medicare payment rates they receive (Type A ED payment rates) are equal to those of on-campus hospital EDs. The Commission recommends that for urban OCEDs that are within six miles of an on-campus hospital ED, Medicare should pay Type A payment rates reduced by 30 percent to better align payments with costs. The recommendation would curb the incentives to develop new OCEDs near existing sources of ED services, reduce cost sharing for Medicare beneficiaries served at OCEDs close to on-campus EDs, and lower Medicare spending.”
REBALANCING MEDICARE’S PHYSICIAN FEE SCHEDULE TOWARD AMBULATORY EVALUATION AND MANAGEMENT SERVICES, third of ten chapters in the MedPAC report: Ambulatory evaluation and management (E&M) visits allow clinicians to manage patients’ chronic conditions, develop care plans, coordinate care across providers and settings, and discuss patients’ preferences. E&M services are critical for both primary care and specialty care. The Commission has long been concerned that, over time, E&M services have become undervalued in the Medicare physician fee schedule (the “fee schedule”) relative to other services, such as procedures. This could limit beneficiary access to E&M services. Payment rates in the fee schedule are based on assessments of how much time and intensity (e.g. mental effort and technical skill) services require relative to one another. If estimates of time and intensity are not kept up to date, especially for services that experience efficiency improvements, payment rates become inaccurate. Because of advances in technology, efficiency improves more easily for procedures, imaging, and tests than for ambulatory E&M services, which are defined in large part on clinicians’ time, and so do not lend themselves to efficiency gains. Because the fee schedule is budget neutral, the payment rates for ambulatory E&M services have become too low relative to payment rates for other services. We describe a budget-neutral approach to rebalance the fee schedule that would increase payment rates for ambulatory E&M services provided by all clinicians, while reducing rates for other, relatively overpriced services.”
EVENTS & MEETINGS
June 20
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, meeting notice here, agenda 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 17
9:00 a.m. – 5:00 p.m., National Committee on Vital and Health Statistics (NCVHS), Standards (patient medical record information, electronic exchange of such information, health terminology and vocabulary).
Federal Register notice here.
July 18
8:30 a.m. – 3:00 p.m., NCVHS Meeting, Continued
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 sixteenth art 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 proposed rule as published in the Federal Register is here.
CMS is proposing revisions in the Conditions of Participation (CoP), the basic minimum national standards for hospital operations, present since the 1965 passage of Medicare. The focus is on electronic patient information. The proposals, found on pgs. 20550-20553 of the Federal Register proposed rule, are broad, with examples such as (1) requiring hospitals to electronically transfer medically necessary information upon patient discharge/transfer, (2) requiring hospitals to electronically send discharge information to a community provider when possible, and (3) requiring hospitals to make information electronically available to patients or a specific application if requested.
A summary of payment provisions in the FY2019 proposed rule, with associated Federal Register pages:
Inpatient Hospital Operating Update, p. 20381-20382
Disproportionate Share Hospital (DSH) Payments and Uncompensated Care Payments, p. 20386-20401
Indirect Medical Education and Direct Graduate Medical Education Payments, p. 20438-20440
Inpatient Admission Requirements, p. 20447-20448
Multi Campus Hospitals Rural Reclassification Rules, p. 20358-20360
Outlier Payments, p. 20580-20584
CAR-T, p. 20284-20295
Physician Certification, p. 20550
Public Listing of Standard Charges, p. 20548-20549
Post-Acute Care Transfer, p. 20377-20381
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: 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