DCMedical News: Friday, July 20, 2018
DCMedical News
Washington, D.C.
Friday, July 20, 2018
DCMedical News is published every day either the House or the Senate is in session.
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THE BIG STORY TODAY IN HEALTH CARE
Story of the States, Reversion to Pre-PPACA, WSJ Headline “Health-Law Rollbacks Lead to National Patchwork”:
The Wall Street Journal Thursday featured a profile (here) of the states and their actions concerning health insurance: “As the Trump administration moves to roll back parts of the Affordable Care Act, some states have taken steps to preserve parts of the health law or strengthen their ACA markets.” Highlights, shown graphically with the article:
States (listed by two letter abbreviations for the state name, east to west and north to south) which regulate short-term coverage, that is, states which limit or regulate short-term health plans that do not have the “essential health benefits” of PPACA: NH, CT, VT, MA, NJ, MD, NY, MI, IN, MN, ND, SD, NV, AZ, OR, CA and HI.
States which “promote a competitive marketplace,” that is, states which have established rules for the health insurance market which resemble PPACA rules, e.g. requiring plans to be sold through exchanges: VT, MA, MD, NY, DC, NV, WA.
States which have a health insurance mandate, requiring their residents to pay a penalty if they have no health insurance, or otherwise requiring some minimum form of coverage: VT, MA, NJ, OR.
States which have a reinsurance program through §1332 waivers to stabilize the individual health insurance market, control premium cost, or both: MN, AK, OR.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Technology Review Changing in Health Care: FierceHealth reports that the Trump administration is shutting down the National Guideline Clearinghouse (NGC) run by the Agency for Healthcare Research and Quality (AHRQ), nominally for reasons of budget. (See segment below concerning the history of AHRQ and the perils of guidelines.)
Proponents of the guideline business—the NGC had 200,000 on-line visitors per month—support it as “evidence based” medicine, a phrase first seen in the American medical literature in 1992. Opponents deride guidelines as “cookbook medicine.” AHRQ was originally targeted by the Administration to be closed entirely (see STAT from March, 2017, here). The ECRI Institute (www.ecri.org) says it will launch a replacement (here). ECRI, in Plymouth Meeting, PA, is a private safety and standards organization, founded by an anesthesiologist concerned with the absence of organized mechanisms for testing the adequacy of medical equipment and technology. Formerly the Emergency Care Research Institute, ECRI is now a major business involved with equipment acquisition, patient safety, PSO records analysis and sequestration; its major competitor is IHI (www.ihi.org), the “Institute for Healthcare Improvement.”
TAVR On The Docket: The next major review of standards for high technology in American hospitals may be with the Transaortic Valve Replacement (TAVR) program. On July 25, 2018 (see Events, below) CMS’ Medicare Evidence Development and Coverage Advisory Committee (MEDCAC) will meet to make recommendations regarding procedural volume requirements for hospitals and heart team members to begin and maintain TAVR programs. According to the meeting announcement, here (which also includes the agenda, list of actions previously taken, questions posed to the panel in May for their responses, speaker list, presentations and background materials), “MEDCAC will specifically focus on appraisal of the state of evidence for surgical aortic valve replacement (SAVR), TAVR, percutaneous coronary intervention (PCI) and other relevant structural heart disease procedural volume requirements.” This meeting will essentially review the May 2012 national coverage determination for TAVR (https://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=355) that established specific requirements for coverage, including procedural volume requirements hospitals must meet to begin and maintain TAVR programs. CAR-T is also on the MEDCAC docket, here.
VAD: Another process, also related to “high technology” in cardiovascular devices, has resulted in a list of ventricular assist devices (here) that meet the CMS facility standards. There are 173 such VAD sites among the nation’s 4,950 acute general care hospitals.
CDSM: The commercial import of CMS approvals will be evident in the coming adoption of Clinical Decision Support Mechanisms. Approved CDSMs are found here.
The fate of technology review, safety standards and the evidence for evidence-based medicine will influence contests over “waste” in medical expenditures. STAT’s report (here) on AHRQ summarizes the last similar, major battle.
“The agency found itself in the middle of a fierce battle when it looked at treatments for lower-back pain in the 1990s. It issued guidelines that said, in most cases, less invasive interventions would eventually cause the pain to go away without the need for costly operations.
While adopted by large segments of the medical community, the findings generated howls of protests from the North American Spine Society, whose members received a large share of the money spent on back surgery. They complained to Republican budget leaders, who then concluded that the agency's work was inefficient and duplicative, and proposed to eliminate its funding. In that battle, AHRQ lost a quarter of its funding and ended up changing its focus and name (it was formerly the Agency for Health Care Policy and Research).
Simpson, the Academy Health CEO who worked at the agency during the transition, said its leadership resolved to move away from publishing specific guidelines.
Earlier this year, the agency was in the spotlight again, as stories surfaced about how Price [Dr. Thomas, an orthopedic surgeon, later briefly HHS Secretary] tussled with the AHRQ while serving as a Republican congressman from Georgia. An aide to Price had sent several emails pressing the agency to remove a study from its website that questioned the safety and efficacy of BiDil, a treatment for African-Americans suffering from heart failure. The chief executive of Arbor Pharmaceuticals, the company that markets the drug, had given Price the maximum campaign contribution of $2,700. AHRQ ultimately kept the study on its site, but included a note indicating it was greater than five years old.”
EVENTS & MEETINGS
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.
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: 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