DCMedical News: Tuesday, June 26, 2018
DCMedical News
Washington, D.C.
Tuesday, June 26, 2018
DCMedical News is published every day either the House or the Senate is in session.
THE BIG STORY TODAY IN HEALTH CARE
Immigration and Health Care: Kaiser has a fact sheet (here) on “Implications of Separation of Families at the Border,” estimating shelter costs at $17 million for 30 days for the additional 2,342 children separated under “zero tolerance.” Other recent immigration-related studies in the health field include reports on fear of seeking health care (here and here), the impact of loss of immigrant health workers on care of the elderly (here and here), the importance of the international medical graduate in American medicine (here, and an especially thorough report from the AMA, here).
Budget, Appropriations and Health Policy: The Budget Committee and the Appropriations Subcommittees in the House are actively pursuing health policy goals through their respective authorities. Focus today is on the Budget Committee, which has included a “Policy statement on Medicaid work requirements” in its FY2019 bill (bill text here). From the bill, “The Congressional Budget Office projects the average monthly enrollment in Medicaid for fiscal year 2018 to be 76 million people. Of this 76 million people, 27 million – more than one third of the enrollees - are non-elderly, non-disabled adults. Medicaid continues to grow at an unsustainable rate, and will cost approximately one trillion dollars per year within the decade, between Federal and State spending,” concluding that “It is the policy of this concurrent resolution that Congress should enact legislation that encourages able-bodied, non-elderly, non-pregnant adults without dependents to work, actively seek work, participate in a job-training program, or do community service, in order to receive Medicaid; Medicaid work requirements legislation could include 30 hours per week of work, of which 20 of those hours should be spent in the core activities of: public or private sector employment, work experience, on-the-job training, job-search or job readiness assistance program participation, community service, or vocational training and education.”
MEDICARE, MEDICAID, COMMERCIAL HEALTH INSURANCE
Medicaid, Work, HSAs: The Commonwealth Fund reports that research it sponsored (here) in §1115 waiver programs on health savings accounts and work requirements “may not produce the results that state policymakers are aiming for. The authors estimate that confusion about health savings accounts in Indiana places as many as two-thirds of the enrollees at risk of losing some of their benefits or being locked out of the program altogether. In Kansas, work requirements may have modest effects on job-searching behavior but may not change the likelihood of employment for the majority of residents who might enroll were the state to expand Medicaid.”
Medicare Primer(s): Kaiser Family Foundation has updated its Medicare primer (here), following on the 2018 report of the Trustees of the Medicare Trust Fund (here). From the Kaiser publication we learn that: “The Medicare Hospital Insurance (Part A) trust fund is projected to be depleted in 2026, three years earlier than the 2017 projection. In 2017, Medicare benefit payments totaled $702 billion, up from $425 billion in 2007. As a share of total Medicare benefit spending, payments to Medicare Advantage plans for Part A and Part B benefits [increased] between 2007 and 2017, from 18 percent ($78 billion) to 30 percent ($210 billion), as enrollment in Medicare Advantage plans increased over these years.” Also, an important issue for hospitals and other Medicare providers, “Average annual growth in Medicare per capita spending was 1.5 percent between 2010 and 2017, down from 7.3 percent between 2000 and 2010, due in part to the Affordable Care Act’s reductions in payments to providers and plans.”
Medicare Inpatient Prospective Payment System: Proposed rule for FY2019 here, for which the comment period ended Monday. Comments submitted include those from AHA (here) and also from AHA on the inpatient psychiatric proposed rate rule (here), from MedPAC (here), from health finance authority William Cleverly (here) on publication of hospital prices.
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. Continuing this week DCMN will feature excerpts from the report, a consolidation of Medicare-driven health policy issues.
APPLYING THE COMMISSION’S PRINCIPLES FOR MEASURING QUALITY TO POPULATION BASED MEASURES AND HOSPITAL QUALITY INCENTIVES, seventh chapter in the ten-chapter report.
“The Commission has recommended that Medicare link payment to the quality of care to reward accountable entities and providers for offering high-quality care to beneficiaries. In this report, the Commission formalizes a set of principles for measuring quality in the Medicare program. Overall, quality measurement should be patient oriented, encourage coordination, and promote delivery system change. Medicare quality incentive programs should use a small set of population-based measures (e.g., outcomes, patient experience, value) to assess quality of care in Medicare Advantage (MA) plans, ACOs, and FFS in defined market areas, as well as for beneficiaries cared for by specified hospitals, groups of clinicians, and other providers.”
“Medicare quality incentive programs should score population-based measure results against absolute performance thresholds and use peer grouping to account for social risk factors. We apply the Commission’s principles to two population-based outcome measures that may be used to evaluate quality of care for different populations. Potentially preventable admissions (PPAs) constitute an important quality measure, and we find enough variation of performance in this measure to make it useful in assessing quality. We also tested a home and community days (HCDs) measure to assess how well health care markets keep people alive and out of health care institutions, but found limited variation in performance and have concluded that this measure’s utility may be limited. We also explore replacing the four existing payment incentive programs Medicare uses to assess hospital performance with a single quality payment program. The Commission is concerned that the current, overlapping hospital quality payment and reporting programs (the Hospital Inpatient Quality Reporting Program, Hospital Readmissions Reduction Program, Hospital-Acquired Condition Reduction Program, and Hospital Value-based Purchasing) create unneeded complexity in the Medicare program. The Congress could create a single hospital value incentive program (HVIP) that is patient oriented, encourages coordination across providers and time, and promotes change in the delivery system. The HVIP would account for social risk factors by adjusting payment through peer grouping. Over the next year, the Commission plans to continue work on the HVIP.”
EVENTS & MEETINGS
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,panel distinguishing price from cost.
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). Federal Register notice (5-3-2018), here.
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.
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: 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