DCMedical News: Thursday, June 21, 2018
DCMedical News
Washington, D.C.
Thursday, June 21, 2018
DCMedical News is published every day either the House or the Senate is in session.
THE BIG STORY TODAY IN HEALTH CARE
Association Health Plans and the New Definition of ‘Employer’: The AHP final rule (here) continues to stimulate controversy, proponents arguing that it will make health insurance more affordable, perhaps dramatically so, opponents arguing that it will increase cost for those with pre-existent conditions, or make such coverage unavailable. Two Attorneys General (here, NY, Mass.) indicate they will litigate, seventeen Attorneys General having previously submitted comments (here) opposing the rule.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Supply of Nurse Practitioners and Physician Assistants to Grow, Doctors Not So Much: A study in the New England Journal of Medicine (here) concludes that “Roughly two thirds (67.3%) of practitioners added between 2016 and 2030 will therefore be NPs or PAs, and the combined number of NPs and PAs per 100 physicians will nearly double again to 53.9 by 2030. These shifts will probably be even more pronounced in primary care, where physician supply has been growing more slowly than in other fields and NPs tend to be more concentrated.”
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.
PAYING FOR SEQUENTIAL STAYS IN A UNIFIED PROSPECTIVE PAYMENT SYSTEM FOR POST-ACUTE CARE
Fourth of ten chapters in the MedPAC report.
“Medicare uses separate prospective payment systems (PPSs) to pay for stays in each of the four post-acute care (PAC) settings—skilled nursing facilities (SNFs), home health agencies (HHAs), inpatient
rehabilitation facilities (IRFs), and long-term care hospitals (LTCHs). As a result, Medicare’s FFS payments can differ substantially for similar patients treated in different settings. As mandated by the Congress, in June 2016, the Commission developed a prototype design and estimated the impacts of a unified PAC PPS. The Commission concluded that it is feasible to design a PAC PPS that spans the four settings and uniformly bases payments on patient characteristics.”
“To further advance the unified PAC PPS, the Commission now examines two payment issues that would
increase the accuracy of payments for cases that involve a course of PAC—that is, sequential stays, which we define as PAC stays within seven days of each other. The first issue has to do with the way the cost of a stay can vary, depending on where it falls in a sequence of PAC stays. The second issue involves how to identify, for payment purposes, distinct phases of care for a PAC provider that treats a patient “in place” as care needs evolve. Under a unified PAC PPS, there needs to be a way to trigger payments for different phases of care so that such providers are not financially disadvantaged.”
“We find that costs of a sequence of home health care stays decline over the course of an episode more than payments would under our prototype PAC PPS, suggesting that payments for sequential home health stays need to be adjusted downward (as they are in the current HHA PPS). In contrast, PAC PPS payments for institutional stays would be generally well aligned with the cost of stays throughout a sequence of care.”
“To make accurate payments to providers offering a range of services under the PAC PPS, Medicare could make a single payment for all post-acute care provided during an episode of PAC. The Commission will continue to explore episode-based payments for PAC. Shifting to an episode-based payment would reduce incentives to initiate additional PAC stays while holding to the most important tenets of a PAC PPS: correcting the biases of the current PPSs and increasing the equity of payments across all types of stays so that providers have less incentive to selectively admit certain beneficiaries over others. In the meantime, CMS should proceed with implementing a stay-based unified PAC PPS.”
Medicare Data Update, Interactive Display: “CMS has released updated CMS Program Statistics with 2016 data. The CMS Program Statistics presents detailed summary statistics on Medicare populations, utilization, and expenditures, as well as counts for Medicare-certified institutional and non-institutional providers. Tables for calendar years 2013-2015 have also been updated to reflect changes to the source data for enrollment and utilization information. The CMS Program Statistics data are available at: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/CMSProgramStatistics/index.html.”
Conservative Groups Release New Block Grant Plan: The Health Policy Consensus Group proposes (here, WSJ coverage here) block grants to states to underwrite health insurance for low-income residents.
EVENTS & MEETINGS
June 21
8:30 a.m. – 2:00 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 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 seventeenth and final 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 proposed rule as published in the Federal Register is here, technical corrections here.
Submission of comments, deadline this coming Monday, June 25: ADDRESSES: In commenting, please refer to file code CMS–1694–P. You may submit electronic comments on this regulation to http://www.regulations.gov. Follow the ‘‘Submit a comment’’ instructions. For mail instructions, see pg. 20164.
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: 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