DCMedical News: Monday, July 16, 2018
DCMedical News
Washington, D.C.
Monday, July 16, 2018
DCMedical News is published every day either the House or the Senate is in session.
THE BIG STORY TODAY IN HEALTH CARE
DoJ Will Not Challenge CVS Health-Aetna Merger: the Department of Justice announced that the $69 billion acquisition of Aetna by CVS will not be challenged. CVS shares rose 3 percent, Aetna's shares increased 2 percent, while shares of Cigna and Express Scripts also rose; the health insurer Cigna is in the process of acquiring the pharmacy benefit manager.
Benefit Design Not a Cost Solution: Bloomberg reports (here) that “Sky-High Deductibles Broke the U.S. Health Insurance System--Employers are questioning a system they say costs patients too much.” They report, “39 percent of large employers offer only high-deductible plans, up from 7 percent in 2009, according to a survey by the National Business Group on Health. Half of all workers now have health insurance with a deductible of at least $1,000 for an individual, up from 22 percent in 2009, according to data from the Kaiser Family Foundation. About 41 percent say they can’t pay a $400 emergency expense without borrowing or selling something, according to the Federal Reserve.” Wagner Dean Sherry Glied reports in Health Affairs (here) that premium support (shifting the risk of future health care cost increases of Medicare to beneficiaries) fails the test of risk bearing. A systematic review of Value-Based Insurance Design (also in Health Affairs, here), finds “an increase in medication adherence when cost-sharing was reduced,” but “little evidence of improvements in outcomes or clinical quality, and no effect on overall health spending.” Reductions in readmissions appear to be an illusion, when including “observation status” in the count, according to a report in NEJM here.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Health Manpower: The full Energy & Commerce Committee has marked up four bills pertaining to health manpower. Chairman Walden’s statement is here. The bills were referred from the Health Subcommittee, including the Nursing Workforce Reauthorization Act, Public Health Service Workforce Authorization, the Children’s Hospital Graduate Medical Education Reauthorization and the Palliative Care and Hospice Education and Training Act. (See DCMN 7-12-18, see here for bill 959, here for 3728, here for 5385 and here for 1676).
MEDICARE, MEDICAID, COMMERCIAL HEALTH INSURANCE
End Stage Renal Disease, DME: On July 11, 2018, the Centers for Medicare & Medicaid Services (CMS) issued a rule (here, 368 pages; news release here) that proposes to update payment policies and rates under the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for renal dialysis services furnished to beneficiaries on or after January 1, 2019. This rule also proposes updates to the acute kidney injury (AKI) dialysis payment rate for renal dialysis services furnished by ESRD facilities to individuals with AKI and proposes changes to the ESRD Quality Incentive Program (QIP). The proposed rule will be published in the Federal Register July 19, with comments due by September 10.
Dialysis centers are the “health industry’s growth story” according to a Modern Healthcare profile (here). “Dialysis has become a major growth field as diabetes and other kidney diseases have exploded. Now the seventh-leading cause of death in the nation, diabetes affects 30.3 million Americans, or more than 9 percent of the population, according to the Centers for Disease Control & Prevention . . . More than 1.5 million new cases of diabetes are being diagnosed each year in the U.S., the CDC reports.”
Specifically, the proposal is projected to result in a 1.8% increase in total payments for hospital-based ESRD facilities, while for freestanding facilities the projected increase in total payments is 1.7%, according to CMS' fact sheet (here) on the rule. The labor-related share of reimbursed costs would increase from 50.7% (using the 2012-based market basket) to 52.3% (using the 2016-based market basket). This reflects a relative increase in labor costs and a relative decrease in all other costs, especially drugs. The proposed rule will also revise the drug designation process to include new renal dialysis drugs and biologicals as of January 1, 2019 to be eligible for the Transitional Drug Add-on Payment Adjustment (TDAPA), but not after that period expires.
The bundled PPS for renal dialysis services furnished to Medicare beneficiaries for the treatment of ESRD began January 1, 2011. The bundled payment under the ESRD PPS includes all renal dialysis services furnished for outpatient maintenance dialysis, including drugs and biologicals (with the exception of oral-only ESRD drugs until 2025) and other renal dialysis items and services that were formerly separately payable under the previous payment methodologies. The bundled payment rate is case-mix adjusted for a number of factors relating to patient characteristics. There are also facility-level adjustments for ESRD facilities that have a low patient volume, for facilities in rural areas, and for the wage index. For high-cost patients, an ESRD facility may be eligible for outlier payments. Under the ESRD PPS for CY 2019, Medicare expects to pay approximately $10.6 billion to approximately 7,000 ESRD facilities for the costs associated with furnishing chronic maintenance dialysis services.
Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS): The proposed rule also changes the bidding and pricing methodologies under the DMEPOS competitive bidding program (CBP). CMS notes that it has yet to begin the process for recompeting DMEPOS CBP contracts, that the current DMEPOS CBP contract periods of performance will end on December 31, 2018, and that beginning January 1, 2019, beneficiaries may receive DMEPOS items from any willing supplier (until new contracts are awarded under the DMEPOS CBP). CMS is also soliciting comments in a request for information (RFI) on the gap-filling process for establishing fees for new DMEPOS items. This means that medical equipment suppliers won’t have to bid for Medicare business next year, probably not until 2021.
EVENTS & MEETINGS
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, 2322 Rayburn HOB.
10:15 a.m., House Energy & Commerce Subcommittee on Health, hearing on health care costs.
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,” 1100 Longworth HOB.
July 18
8:30 a.m.-2:45 p.m., AHRQ National Advisory Council, worth watching, Federal Register notice here.
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: 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