DCMedical News: Wednesday, June 27, 2018
DCMedical News
Washington, D.C.
Wednesday, June 27, 2018
DCMedical News is published every day either the House or the Senate is in session.
THE BIG STORY TODAY IN HEALTH CARE
Medicaid Program Integrity: Under pressure from the Senate Homeland Security Committee (staff report here), the Senate Budget Committee (letter here), the CBO (here) and (earlier this year) the GAO (here and here), CMS announced a new program (here) to monitor expenditures under Medicaid. Modern Healthcare reports here that the primary focus is enforcement of new Medicaid and Medicaid managed care rules published in 2016 (here). One focus of GAO’s criticism was the waiver/demonstration programs; in ten states “demonstrations” account for more than 75% of total Medicaid expenditures. Another GAO focus was improper payments in Medicaid. CBO made a presentation (here) at AcademyHealth on the growth of Medicaid managed care. (See “Events” below for Homeland Security hearing today.)
Under Medicare managed care, Plans compete to enroll beneficiaries on the basis of benefits and cost. Under Medicaid managed care Plans cater to states looking to cut costs, leading to skimpy provider networks and denial of care. The late Princeton economist Uwe Reinhardt was remembered at this year’s AcademyHealth for once asking the New Jersey state legislature whether a physician’s care of a poor child was worth only one quarter of that same physician’s care for a wealthy (commercially insured) one. Connecticut, frequently a thought leader in social insurance, gave up Medicaid managed care, reverting to fee-for-service Medicaid on grounds that the “managed Medicaid” ultimately saved no money. Under the final 2016 federal rule, network adequacy assessment was left to the states. The recently released “Medicaid score card” for the states can be found here: https://www.medicaid.gov/state-overviews/scorecard/index.html.
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. The Budget Committee has included in its budget resolution for FY 2019 (here) a “Policy Statement on Medicare,” which states:
“SEC. 507. POLICY STATEMENT ON MEDICARE. 13 (a) FINDINGS.—The House finds the following: More than 58 million Americans depend on Medicare for their health security. The Medicare Trustees Report has repeatedly recommended that Congress address Medicare’s long-term financial challenges. Each year without reform, the financial condition of Medicare becomes more precarious and the threat to those in or near retirement more pronounced. The current challenges that Congress will need to address include—(A) the Hospital Insurance Trust Fund will be exhausted in 2026 and unable to pay the full scheduled benefits; (B) Medicare enrollment is expected to increase more than 50 percent in the next two decades, as 10,000 baby boomers reach retirement age each day; (C) due to extended life spans, enrollees remain in Medicare three times longer than at the outset of the program five decades ago; (D) notwithstanding the program’s trust fund arrangement, current workers’ payroll tax contributions pay for current Medicare beneficiaries instead of being set aside for their own future use; (E) the number of workers supporting each beneficiary continues to fall; in 1965, the ratio was 4.5 workers per beneficiary, and by 2030, the ratio will be only 2.4 workers per beneficiary; (F) the average Medicare beneficiary receives about three dollars in Medicare benefits for every dollar paid into the program; (G) Medicare is growing faster than the economy, with an average projected growth rate of 7 percent per year over the next 10 years; and (H) by 2028, Medicare spending will reach more than $1.5 trillion, more than double the 2017 spending level of $702 billion.”
As a consequence, according to the Budget Committee, “This concurrent resolution assumes transition to an improved Medicare program that ensures—(1) Medicare is preserved for current and future beneficiaries; (2) future Medicare beneficiaries may select from competing guaranteed health coverage options for a managed care plan that best suits their needs; (3) traditional fee-for-service Medicare remains a plan option; (4) Medicare provides additional assistance for lower-income beneficiaries and those with greater health risks; and Medicare spending is put on a sustainable path and becomes solvent over the long term.”
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. Continuing this week DCMN will feature excerpts from the report, a consolidation of Medicare-driven health policy issues.
RECENT PERFORMANCE OF AND LONG-TERM ISSUES CONFRONTING MEDICARE ACCOUNTABLE CARE ORGANIZATIONS, eighth chapter in the ten-chapter report:
“Medicare accountable care organizations (ACOs) were created to reduce growth in Medicare spending and improve the quality of care for beneficiaries by giving providers greater responsibility for costs and quality of care. We review the current Medicare ACO models and their performance. The Commission finds that two-sided ACOs have been more successful at producing savings than one-sided ACOs, and we consider six issues that are important to sustaining two-sided ACOs in Medicare: the role of hospitals as participants in ACOs; the trade-offs of asymmetric models; setting appropriate benchmarks; an alternative for distributing the 5 percent bonus for clinicians in advanced alternative payment models; the role of specialists in ACOs; and the long-term viability of two-sided ACOs in the Medicare program.”
EVENTS & MEETINGS
June 27
10:30 a.m., Senate Homeland Security hearing on Medicaid fraud overpayments, 342 Dirksen Senate Office Building, Comptroller General (GAO), HHS audit services, see lead story above.
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: 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