DCMedical News: Friday, June 29, 2018
DCMedical News
Washington, D.C.
Friday, June 29, 2018
DCMedical News is published every day either the House or the Senate is in session.
THE BIG STORY TODAY IN HEALTH CARE
Gone: Congress is gone for the week, returning July 9.
Health Costs: Coming back. Senate HELP Committee Chairman Alexander promises more hearings. Testimony from the Committee hearing June 27 here. David Cutler noted last fall in JAMA (here) that rising cost is coming back on the “radar” of public officials. His lucid summary of alternative remedies (control prices, share cost, bundle services and payments) illustrates how little might be done with current tools. Global budgeting, the ultimate bundle, gets attention in JAMA this week in a summary (here) of studies of the Maryland experience.
Health Appropriations and the HHS Budget: The Senate Appropriations Committee approved the Labor-HHS-Education bill for FY 2019, a total of $179 billion, by a vote of 30-1, text of bill here.
HOSPITALS AND OTHER HEALTH CARE FACILITIES
Patient Balance After Insurance: PBAI, a new acronym in hospital finance, is growing in use since “patient responsibility” is often instant bad debt. So says a Transunion Healthcare study here.
Hospital Acquired Infections Rising, says Leapfrog; Reporting Burdensome, says CMS: Leapfrog is campaigning to preserve reporting on hospital acquired infections (HAIs) in the hospital inpatient quality report. CMS thinks the reporting is excessive, and has moved in the Inpatient Prospective Payment System for FY 2019 to remove reports. Says Leapfrog (report here), “The percentage of hospitals reporting zero infections for the five HAIs measured has declined dramatically since 2015. This trend puts patients at higher risk for numerous complications and longer recoveries and is cause for concern.”
Hospital Inpatient Use Falling: AHRQ reports (here) that in 2015 the rate of inpatient stays for those 65 years and older had a 25 percent reduction compared with 2000; among patients aged 45-64 years, a 9 percent decrease since 2000; among patients aged 18-44 years, a 16 percent reduction since 2000; and among patients aged 18 years and under, a decrease of 19 percent since 2000.
MEDICARE, MEDICAID, COMMERCIAL HEALTH INSURANCE
Medicaid Improper Payments: GAO (new report here) remains unhappy with CMS oversight of Medicaid payments, especially with managed Medicaid (“Regarding managed care payments, which were nearly half--or $280 billion--of Medicaid spending in fiscal year 2017, GAO has found that the full extent of program risk due to overpayments and unallowable costs is unknown”); with supplemental payments (e.g. DSH, “payments made to providers—such as local government hospitals—that are in addition to regular, claims-based payments made to providers for specific services. These payments totaled more than $48 billion in fiscal year 2016 and in some cases have shifted expenditures from the states to the federal government”); and with “demonstrations” (“which allow states to test new approaches to coverage. Comprising about one-third of total Medicaid expenditures in fiscal year 2015, GAO has found that demonstrations have increased federal costs without providing results that can be used to inform policy decisions”).
Medicaid Enrollment by State: CMS released the April enrollment report for Medicaid and CHIP (here), showing 73.8 million people enrolled, a 28.5% increase in five years (12% in states not expanding Medicaid under PPACA, 37% in the expansion states, a total of 12 million people in California, 6.5 million in New York).
MedPAC Makes June Report to Congress on Medicare, continued: The report may set off or reinvigorate contests between competing financial interests in the health field and, in the case of this final chapter, resistance from users of “low-value” care. The report is here, a summary here, the press release here.
MEDICARE COVERAGE POLICY AND USE OF LOW-VALUE CARE, the final chapter of ten in the report.
“We review the coverage processes used in FFS Medicare and by Medicare Advantage (MA) plans and Part D sponsors and examine the use of low-value care in Medicare. Medicare covers many items and services without an explicit coverage policy. When an explicit coverage policy is required, policies are often based on little evidence and usually do not include a consideration of a service’s value relative to existing treatment options. Many MA plans are permitted to use tools that are not widely used in FFS Medicare (e.g., requiring prior authorization, using variable levels of cost sharing).”
“Some researchers contend that there is substantial use in the Medicare program of low-value care—care that has little or no clinical benefit, or care in which the risk of harm from the service outweighs its potential benefit. Our review of the literature reveals that such care is prevalent across FFS Medicare, Medicaid, and commercial insurance plans. In 2014, annual Medicare spending for certain types of low-value care ranged from $2.4 billion to $6.5 billion. These spending estimates are conservative because they do not reflect the downstream costs of low-value services. We also present three case studies on potentially low-value services in FFS Medicare: starting dialysis earlier in the course of chronic kidney disease, proton beam therapy, and H.P. Acthar Gel (a drug covered under Part D). We identify six tools that Medicare could consider using to address the use of low-value care in the program: prior authorization, clinical decision support and provider education, increasing beneficiary cost sharing for low-value services, delivery system reform and new payment models that hold providers accountable for the cost and quality of care, revisiting coverage determinations on an ongoing basis, and linking FFS coverage decisions and payment policies to information about the comparative clinical effectiveness and cost-effectiveness of health care services.”
PHARMA
Under-Reporting of Opioid Overdose Deaths: A study in Public Health Reports (here) finds “States may be greatly underestimating the effect of opioid-related overdose deaths because of incomplete cause-of-death reporting, indicating that the current opioid overdose epidemic may be worse than it appears.”
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.
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