DCMedical News: Friday, June 22, 2018
DCMedical News
Washington, D.C.
Friday, June 22, 2018
DCMedical News is published every day either the House or the Senate is in session.
THE BIG STORY TODAY IN HEALTH CARE
Reorganization, the Return of Welfare: A wide-ranging government reorganization plan (here) was released Thursday by OMB. The Department of Health and Human Services (HHS) would become the Department of Health and Public Welfare, absorbing some USDA food assistance programs, but losing food safety (now largely with the Food and Drug Administration) to the Department of Agriculture. The FDA would become the “Federal Drug Administration.” The Department of Education and the Workforce would result from the merger of the current Departments of Education and Labor, which “would be charged with meeting the needs of American students and workers, from education and skill development to workplace protection to retirement security.” The Department now known as HHS was formerly the Department of Health, Education and Welfare—Education becoming a separate cabinet department in 1979--and prior to 1953 HEW was the Federal Security Agency. Until 1940 the FDA was part of the Agriculture Department, its major remit food safety.
Association Health Plans, continued: An excellent summary of the AHP implementation issues appears in a Health Affairs blog by Katie Keith (here). Among her points: “Under the final rule, health insurers cannot serve as the sponsor for an AHP. This also applies to an entity that is owned or controlled by a health insurer or a subsidiary or affiliate of a health insurer. Despite comments that urged otherwise, the Department maintained this provision from the proposed rule and expanded it to include subsidiaries or affiliates of insurers,” although the insurer may offer and sell administrative services to an AHP. Also, this observation from Ms. Keith concerning the effective dates of the new rule: “This gives states only a matter of months before the first part of the rule goes into effect [October 1, 2018]—at a time when most state legislative sessions have already closed for 2018. Even the last wave of applicability—in April 2019—occurs before most state legislatures will have ended for 2019. This quick turnaround could limit state policymakers who want to increase their oversight of or apply additional state-level consumer protections to AHPs.” A Los Angeles Times analysis of the comments submitted in response to the proposed AHP rule (here) found 95% opposed.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Sprint, Don’t Walk: HHS will announce in this coming Monday’s Federal Register a “Regulatory Sprint” away from physician self-referral prohibitions. The pre-filing (here) notes that “To help accelerate the transformation to a value-based system that includes care coordination, HHS has launched a Regulatory Sprint to Coordinated Care, led by the Deputy Secretary. This Regulatory Sprint is focused on identifying regulatory requirements or prohibitions that may act as barriers to coordinated care . . . and seeks to identify ways in which its regulations may impose undue burdens on the healthcare industry and serve as obstacles to coordinated care and its efforts to deliver better value and care for patients. Through internal discussion and input from external stakeholders, CMS has identified some aspects of the physician self-referral law as a potential barrier to coordinated care.” Physician groups welcomed the initiative, a “Request for Information.” There will be a 60-day comment period.
COGME Wrestles With Physician Workforce Issues: The Council on Graduate Medical Education (list of members here) met Wednesday and Thursday amid growing concern for the physician workforce (right number, right types, right distribution, burn-out), chronicled (among others) by the General Accountability Office in 2017 (here) and again in 2018 (here).
Said GAO in 2017, “The federal government has reported physician shortages in rural areas; it also projects a deficit of over 20,000 primary care physicians by 2025. Residents in graduate medical education (GME) affect the supply of physicians. Federal GME spending is over $15 billion/year. We found that, from 2005-15, residents were concentrated in the Northeast and in urban areas. And, while many trained in primary care, primary care residents often subspecialize in other fields. Federal efforts to increase GME in rural areas and primary care were limited. In 2015, we recommended HHS develop a plan for its health care workforce programs—it has yet to do so.”
In 2018, GAO found “Multiple federal programs fund graduate medical education for physicians-in-training, known as residents. However, the government doesn't know if these dollars are helping to build the physician workforce that the nation needs. The data collected don't provide all the information needed to fully understand how much it costs to train physicians, how much the government spends, what the government gets for its money.” The “money” was $16.5 billion in 2015. COGME’s latest national plan is here, the agenda for the meeting here, the “strategic planning worksheet” for member deliberations here.
HHS Wrestles with Payment for the Seriously Ill: BNA reports (here) that alternative payment models (PTAC proposals from hospice and palliative care physician groups) for care of the seriously ill (25% of Medicare payments, 3% of beneficiaries) may find favor in HHS.
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.
Encouraging Medicare Beneficiaries to use Higher Quality Post-Acute Care Providers, fifth chapter in the report.
“About 40 percent of Medicare acute inpatient hospital discharges result in the use of PAC [Post Acute Care provider]. The selection of a provider within a PAC category can be crucial because the quality of care varies widely among providers.
Medicare discharge planning regulations make hospitals responsible for educating beneficiaries about their PAC provider choices, but hospitals cannot recommend specific PAC providers. The Commission’s analysis of referral patterns of Medicare beneficiaries who were discharged to SNFs and HHAs indicate that many beneficiaries had another nearby provider that offered better quality care (though not all of the higher quality providers may have had available capacity). Ninety-four percent of beneficiaries who used HHA or SNF services had at least one provider within a 15-mile radius that was of higher quality than the provider that served them. Allowing hospital discharge planners to recommend specific PAC providers based on the quality of care they provide could help beneficiaries select better quality PAC providers. Medicare could expand the authority of discharge planners to recommend higher quality PAC providers in a number of different ways, ranging from prescriptive approaches that provide specific metrics that hospitals must use, to more flexible approaches that allow hospitals to decide on the metrics they use to identify high-quality PAC providers.
Ultimately, beneficiaries should retain freedom of choice, but have better information to make that choice.” [Italics added.]
Medicare-Medicaid Coordination Office: Newly released FY 2017 Report to Congress here.
PHARMA
Medicare Part D Plans: Kaiser Family Foundation reports on Administration’s five-part plan for Medicare Part D, here.
EVENTS & MEETINGS
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.
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: 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