DCMedical News: Thursday, July 12, 2018
DCMedical News
Washington, D.C.
Thursday, July 12, 2018
DCMedical News is published every day either the House or the Senate is in session.
THE BIG STORY TODAY IN HEALTH CARE
340B: The discount/safety net drug program continues to attract interest and controversy. GAO testified (here) before the House Energy & Commerce Subcommittee on Oversight. The Committee had previously requested a GAO report (here) on the subject of oversight, especially of contract pharmacies. Other testimony came from the chief executive of Parkland Hospital (here), the pharmacist-in-chief for UCSD (here) and the chief executive of Texas Oncology (here).
Additional background on the Committee’s work can be found in the March 2015 hearing of the Subcommittee on Health, https://twitter.com/search?f=tweets&q=%23SubHealth&src=typd, the Subcommittee on Oversight’s July 2017 hearing, at https://twitter.com/search?f=tweets&vertical=default&q=%23SubOversight&src=typd, and the Subcommittee on Oversight’s hearing, at https://twitter.com/search?f=tweets&vertical=default&q=%23SubOversight&src=typd.
Also of use is the Committee’s January 2018 report, here and a report by a consultant for 340B Health here. A related but unrelated issue was raised by Dr. Debra Patt, an oncologist and EVP of Texas Oncology, namely “When cancer care is shifted from private practices to the hospital outpatient department, the cost of care doubles.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
More Physician Burnout: An essay in The Atlantic (here) on physician burnout highlights the link of burnout with the issues of patient safety and medical error. Last fall a study in the Journal of Primary Care (here) found that “Primary care physicians spend nearly 2 hours on electronic health record (EHR) tasks per hour of direct patient care . . . contributing to burnout.” Most of the administrative and policy remedies proposed-to-date involve improvements in EHR functioning, rather than reduced reliance on information technology. Another elixir: independence. Physicians who work in small, independent primary care practices report 13.5% burnout, versus the reported national average of 54.4%, according to a study in the Journal of the American Board of Family Medicine (here).
CMS Nixes Payment of Medicaid Funds to Unions: Under a 2014 Obama administration rule, unions representing home care and other workers paid by Medicaid have been able to have fourteen states pay dues directly, rather than having those dues paid by the individual workers. Announcement of a roll back by CMS (here) would undo a regulation approved in 2014 under the Obama administration that authorized states to divert Medicaid funds to third parties, a move done to put the union dues diversions on firmer legal footing.
MEDICARE, MEDICAID, COMMERCIAL HEALTH INSURANCE
Commissions on Medicare Products: A report in Seeking Alpha focused on eHealth (ticker EHTH), a Medicare broker. The report says “In 2015 the government approved changes, pegged to start in 2016, in the way it sets the commission rate that insurers are allowed to pay for Medicare Advantage C and Prescription Drug Plan D renewals. Since then . . . insurers are allowed to pay you in relation to the total value of the transaction. No matter when you make the sale - 2018, for example - if the rates are higher in 2019 or 2020, eHealth can get paid more in those renewal years. . . The bottom line is, the government keeps increasing what it pays insurers to administer Part C and Part D, and thus what the insurers are allowed to pay brokers like EHTH keeps rising.”
Risk Adjustment Explained: Nicholas Bagley unpacks the risk adjustment controversy (see DCMN 7-10-2018) in The Incidental Economist (here). The introduction: “The Affordable Care Act’s risk adjustment program tells insurers with relatively healthy enrollees to fork over some of their premiums to health plans with relatively unhealthy enrollees. Risk adjustment isn’t remotely controversial. It’s also used in Medicare Advantage and Medicare Part D, and it aims to discourage insurers from competing over how best to attract healthy people to their plans.” More here.
Medicare Advantage and Social Determinants of Risk Adjustment: A new study in Health Affairs (here) says Medicare Advantage rankings penalize plans serving disadvantaged populations.
EVENTS & MEETINGS
July 12
10:00 a.m. House Energy & Commerce Committee will mark up (here) four health-related bills including H.R. 5385, here, the Children's Hospital GME Support Reauthorization Act, which would reauthorize the Children's GME program for five years; H.R. 959, here, the Title VIII Nursing Workforce Reauthorization Act, which would reauthorize nursing workforce development programs; H.R. 1676, here, the Palliative Care and Hospice Education and Training Act, which would direct HHS to award grants for training of health professionals in palliative care; and H.R. 3728, here, the Education Medical Professionals and Optimizing Workforce Efficiency Readiness Act, which would reauthorize various programs that support loan repayment and training in primary care, dentistry, rural or under-served areas and community-based settings. 2123 Rayburn HOB.
5:00 p.m., Cato Institute, patient safety “To Err is Human” film, events@cato.org, 1000 Massachusetts Avenue NW, Hayek Auditorium, Carolyn Clancy, Michael Cannon and others.
July 13
9:00 a.m.-Noon, “Strategies for stabilizing the individual market,” USC-Brookings, 1775 Massachusetts Avenue, N.W., Paul Ginsburg, academics.
July 13
9:00 a.m-Noon, Brookings, PPACA repair by the states, study of four states, discussion, (202) 797-6105, events@brookings.edu.
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. Continued on the 18th, 8:30 a.m. – 3:00 p.m.
10:00 a.m., House Ways and Means Oversight Subcommittee hearing “Combating Fraud in Medicare,”
1100 Longworth HOB.
10:15 a.m., House Energy & Commerce Subcommittee on Oversight and Investigation will explore state efforts to improve transparency in health care pricing. National Conference of State Legislatures report here. 2322 Rayburn HOB.
2:00 p.m., House Ways and Means Subcommittee on Health, Hearing “Modernizing Stark Law to Ensure the Successful Transition from Volume to Value in the Medicare Program.”
July 20
12:00 p.m. – 1:30 p.m., “State Responses to the Evolving Individual Health Insurance Market,” Commonwealth and Alliance for health Policy, Dirksen SD-106, lunch!
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 of meeting here, National Coverage Determination request for comment (6-28-2018) 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: 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