DCMedical News: Monday, June 25, 2018
DCMedical News
Washington, D.C.
Monday, June 25, 2018
DCMedical News is published every day either the House or the Senate is in session.
THE BIG STORY TODAY IN HEALTH CARE
Budget: The rescission bill is dead, says CQHealth, following a vote (48 in favor, 50 opposed) in the Senate. The proposal (to “take back” $15 billion in funds authorized but not spent, especially $7 billion from CHIP) was already reduced significantly from earlier Administration plans. In Senate deliberations the amount of actual reduced spending in the rescission bill was seen as inconsequential, in light of the $1.3 trillion spending package approved in March. However the bill was seen as mischievous in usurping appropriations authority (Senator Collins).
Texas vs. U.S.: The suit from red states urging that PPACA be declared unconstitutional (here) has continued to attract opponents, (see links to amici briefs in DCMedical News of 6-19-2018). Additional briefs cite a new study from the Urban Institute (here) that projects the number of uninsured to increase by 50 per cent in 2019 if PPACA is undone. America’s Health Insurance Plans (AHIP, amicus brief here), representing commercial health insurers, noted the difficulty which would face insurers who have already priced 2019 premiums. AHIP says insurers have already set their 2019 premiums to account for the disappearance of the individual mandate (tax reduced to zero). The brief from the AMA and four specialty societies is here. The brief from the AHA, FAH, CHA and AAMC is here. The brief from the AARP is here, and from six national voluntary health associations here. The brief from a group of eleven economists (Cutler, Feder, Glied and others) is here. Families USA, Community Catalyst, CPPP and CBPP are here, the APHA here, SEIU here, a small business group here.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Death and Prescription Opioids: Efforts have been made to minimize the physician role and responsibility in opioid overdose deaths. The House passed (396-14) H.R. 6 (here, summary of major provisions here) consisting of 58 bills addressing the opioid addiction crisis. The Energy & Commerce Committee’s web page said 40% of such deaths in 2016 involved prescription drugs.
The House page linked to the “Opioid Overdose” CDC page (https://www.cdc.gov/drugoverdose/data/overdose.html with this citation: “From 1999 to 2016, more than 200,000 people died in the U.S. from overdoses related to prescription opioids. Overdose deaths involving prescription opioids were five times higher in 2016 than 1999.”
The bill has seven provisions with specific impact on Medicaid providers, seven on Medicare providers, and three important public health provisions. Numerous reporting requirements are also part of the 58-bill package. Also of import for Medicaid providers, the House passed (261-155) H.R. 5797 which will reduce the federal prohibition on Medicaid reimbursements for substance abuse treatment provided at institutions for mental disease, freestanding residential treatment facilities with more than 16 beds. The bill would allow Medicaid to pay for the treatment of opioid use disorder (with treatment of cocaine use added in an amendment) in such facilities for stays of up to 30 days. The exclusion would remain for all other substance use disorders and for mental health treatment.
Maternal Morbidity and Mortality: The Health Resources & Services Administration sponsored a “Maternal Mortality Summit.” The focus was “Maternal mortality rates in the United States have tripled over the past 25 years. They're highest among minority moms – in the U.S., as in most developed countries. And women today are more likely to die following childbirth than their mothers were, often of complications from treatable conditions like preeclampsia that go undetected, misdiagnosed or ignored. For every maternal death, there are nearly 100 pregnant women who have suffered from a traumatic event or near-death experience in childbirth,” said George Sigounas, MS, Ph.D., HRSA Administrator. CDC report here.
Urgent Care? Check: AHRQ’s Medical Expenditure Panel Survey reports (here) that an overwhelming majority of practices (95 percent or higher) visited as USC [usual source of care] providers by children, adults, and the elderly routinely set aside time for same-day appointments.
“Hungry Tapeworm on the American Economy” (Buffett) or “Expensive Pile of Junk” (Gawande): Walgreen’s bumped GE off the 30-company Dow Jones Average (f/k/a/ Dow Jones Industrial Average), joining Dow health field members UnitedHealth Group Inc., Pfizer Inc., Merck & Co. and Johnson & Johnson. Health care accounts for a bit less than 20% of U.S. economic output.
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.
ISSUES IN MEDICARE’S MEDICAL DEVICE PAYMENT POLICIES, sixth chapter in the report:
“We examine two distinct topics related to Medicare’s payment policies for durable medical equipment, prosthetic devices, prosthetics, orthotics, and supplies (DMEPOS). First, we discuss the potential for Medicare to expand the use of competitive bidding to set payments for DMEPOS. Second, we examine ways to restrain the program integrity risks posed by physician-owned distributors (PODs) of devices and prosthetics.”
“CMS began to phase in the DMEPOS Competitive Bidding Program (CBP) in 2011 to use market competition to set payment rates and limit fraud and abuse, while ensuring beneficiaries retained access to needed DMEPOS products. The CBP began with some of the highest cost and highest volume DMEPOS products in nine large urban areas and has been expanded into more areas of the country over time. CBP has been successful in driving down the cost of DMEPOS products for the Medicare program and beneficiaries; Medicare’s payment rates for some of the highest expenditure DMEPOS products have fallen by an average of 50 percent. By contrast, Medicare spending for products excluded from CBP have continued to grow. To address overpayments for these products, more could be moved into CBP.”
“PODs derive revenue from selling devices to their physician-owners to use in procedures the physician owners perform on their own patients. PODs can distort the supply chain for medical devices, potentially resulting in an increase in the volume of services performed on beneficiaries, higher costs for hospitals and the Medicare program, and inappropriate care. The Commission suggests several ways policymakers could constrain these risks, including two options to revise the Stark law, which is intended to prohibit physicians from referring Medicare beneficiaries to certain health care facilities in which they have a financial interest. The Commission supports increasing the transparency of POD–physician relationships by requiring all PODs to report under the Open Payments program—a program designed to shed light on financial ties between physicians and certain industries.”
EVENTS & MEETINGS
June 26
9:30 a.m., Senate Finance Committee holds hearing on Administration drug price cost proposals.
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 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). Federal Register notice (5-3-2018), 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: 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