DCMedical News: Thursday, June 28, 2018
DCMedical News
Washington, D.C.
Thursday, June 28, 2018
DCMedical News is published every day either the House or the Senate is in session.
THE BIG STORY TODAY IN HEALTH CARE
The Supremes, Minus One: Justice Kennedy announced he is retiring, but not before joining the majority as the Court dealt a blow to public-sector unions (including those representing doctors and nurses in public hospitals) in the Janus decision (here).
Health Appropriations and the HHS Budget:
The Senate Appropriations Subcommittee on Labor-HHS is assembling its FY 2019 spending bill, including an added $2.3 billion for Health and Human Services agencies (Committee summary here). The Senate increase is roughly twice that in the companion House measure (House Committee Report here). The full Senate Appropriations Committee is scheduled to act on the bill today.
Medicare and Spending: The Congressional Budget Office Tuesday issued its annual long-term budget outlook report (here). Big factors: Medicare spending, rising interest costs and Social Security. Aging will account for one-third of the Medicare cost increase during the next 30 years, two-thirds is due to rising health care costs.
DOCTORS, NURSES AND OTHER HEALTH CARE PROFESSIONALS
NP/PA Growth in Physician Practices: About 54 percent of adults who saw their usual source of health care provider in 2015 visited a practice that had two or more nurse practitioners or physician’s assistants. A quarter visited practices which had neither (Medical Expenditure Panel Survey from AHRQ, here).
Fee-for-Service: Rotenstein and Jena in Health Affairs (here, “It’s Time to Rethink the Anatomy of Physician Behavior”) contend “We should acknowledge more readily that financial incentives are only a fractional determinant of overall practice patterns. Influencing physician behavior through modifying payment alone is unlikely to have a large impact.”
HOSPITALS AND OTHER HEALTH CARE FACILITIES
Hospital at Home (HaH): A report in JAMA Internal Medicine from Mount Sinai (NY, here) seems to indicate that patients in an HaH experiment with 30-day post-acute transitional care did better than those without the post-acute care, and also better than those referred to certified home health agencies. The measures of outcome, however, were administrative, and not without controversy (here), including the fact that the program was not actually paid on a bundled basis, leaving out, for example, physician fees for emergency and primary care. HaH is a PTAC recommendation from September 2017.
Dying in-Hospital: A study of site of death in JAMA (here) found that the proportion of deaths among Medicare patients occurring in a hospital declined from 32.6% in 2000 to 19.8% in 2015, while the proportion dying at home or in a community setting increased from 31% to 40%.
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.
MANAGED CARE PLANS FOR DUAL-ELIGIBLE BENEFICIARIES, ninth chapter of ten in the report.
“Dual-eligible beneficiaries (individuals who receive both Medicare and Medicaid) often have complex health needs but are at risk of receiving fragmented or low-quality care because of the challenges in obtaining services from two distinct programs. Many argue that the two programs could be better integrated by developing managed care plans that provide both Medicare and Medicaid services. Integrated plans could improve quality and reduce federal and state spending because they would have stronger incentives to coordinate care. However, these plans have been difficult to develop, and only 8 percent of full-benefit dual eligible beneficiaries are now enrolled in a plan with a high level of Medicare and Medicaid integration. We examine the use of integrated plans and consider three potential policies that would encourage the development of highly integrated plans.”
“Three potential policies to encourage the development of integrated plans are: limiting how often dual eligible beneficiaries can change their coverage, limiting enrollment in D–SNPs [dual eligible special needs plan] to dual eligibles who receive full Medicaid benefits, and expanding the use of passive (automatic) enrollment.”
PHARMA
Incentives for Higher Drug Prices: Senate Finance minority staff publish (here) a guide to drug prices (“A Tangled Web”), including these observations: Medicare Part D plans, insurers, wholesale distributors and pharmacy benefit managers all make higher profits off rebates or premiums when drugs are first given a high price. Also, seven of the 25 largest U.S. companies make most of their money off of prescription drugs, but none manufacture the pharmaceuticals themselves.
Medicaid and Drug Payments: CMS published (here) approval of an Oklahoma Medicaid drug pricing plan which is the first to allow a state to negotiate value-based purchasing arrangements with drug manufacturers that could produce extra rebates for the state if clinical outcomes are not achieved. Also approved by CMS: a requirement (here) that Medicaid programs pay for new drugs approved by the FDA under “accelerated approval.” Turned down by CMS: a Massachusetts request (here) for a closed drug formulary for that state’s Medicaid program (turndown here).
EVENTS & MEETINGS
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 13
9:00 a.m.-Noon, “Strategies for stabilizing the individual market,” USC-Brookings, 1775 Massachusetts Avenue, N.W., Paul Ginsburg, academics.
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: 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