DCMedical News: Monday, July 23, 2018
DCMedical News
Washington, D.C.
Monday, July 23, 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
The Big Story is Health Care Prices: for drugs (see DCMN 7-17, 7-18-2018); whether prices are “transparent,” and if “transparency” makes any difference to consumers (see House E & C Oversight Subcommittee below); the price of health insurance (see insurance below); and the aggregate impact of health care prices on GDP (see Medicare, “Data” story).
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Transparency in Pricing, What Impact? The Oversight Subcommittee of the House Energy and Commerce Committee heard from Michael Chernew (prepared testimony here) and Jaime King (prepared testimony here), both of whom cast doubt on any major impact transparency in health prices might have on health consumers. You can listen to their interaction with Subcommittee leaders here: https://www.youtube.com/watch?v=s0oGaY-sjRc&feature=youtu.be&t=51m47s.
House Actions Today on Manpower-Related Bills: On HR 959 (here), the Title VIII Nursing Workforce Reauthorization Act of 2018; HR 1676 (here), the Palliative Care and Hospice Education and Training Act; HR 3728 (here), the “EMPOWER [Educating Medical Professionals and Optimizing Workforce Efficiency and Readiness] Act” of 2018; and HR 5385 (here) the Children’s Hospital GME Support Reauthorization Act of 2018.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Data: MedPAC has released its 2018 data book (here) on health care spending and the Medicare program. “The publication provides data on Medicare spending, demographics of the Medicare population, beneficiaries’ access to care, and quality of care in the program, among other information.” Among the highlights:
“Medicare is the largest single purchaser of health care in the United States. (The share of spending accounted for by private health insurance (35 percent in 2016) is greater than Medicare’s share (22 percent in 2016). However, private health insurance is not a single purchaser of health care; rather, it includes many private plans, including traditional managed care, self-insured health plans, and indemnity plans.) Of the $2.8 trillion spent on personal health care in 2016, Medicare accounted for 22 percent, or $625 billion (as noted above, this amount includes spending on direct patient care and excludes certain administrative and business costs). Thirty-five percent of spending was financed through private health insurance payers, and 12 percent was consumer out-of-pocket spending.”
“The distribution of Medicare spending among services has changed over time. In 2016 . . . Managed care was the largest spending category (28 percent), followed by inpatient hospital services (21 percent), prescription drugs provided under Part D (14 percent), and services reimbursed under the physician fee schedule (11 percent). Spending for inpatient hospital services was a smaller share of total Medicare spending in 2016 than it was in 2007, falling from 29 percent to 21 percent. Spending on beneficiaries enrolled in managed care plans grew from 19 percent to 28 percent over the same period. Medicare managed care enrollment increased 112 percent over the same period.”
Also, “Medicare spending for FFS [fee-for-service] beneficiaries has increased significantly since 2007 across all sectors, even though spending growth has slowed recently. The slowdown is partly attributable to a decline in the growth of FFS enrollment since the number of Medicare Advantage [‘managed care’] enrollees has increased. Spending growth for inpatient hospital services, the sector with the highest level of spending, averaged 1.6 percent per year from 2007 to 2014. Spending then declined by 0.8 percent between 2014 and 2015 . . . This decline is partly attributable to a shift in service volume from the inpatient setting to the outpatient setting and to the decline in the growth of FFS enrollment . . . Spending then increased by 1.2 percent between 2015 and 2016 . . . Despite the slowdown, spending on inpatient hospital services increased, in aggregate, 12.4 percent from 2007 to 2016 . . . Spending growth for outpatient hospital services remained high throughout the period, averaging 8.8 percent per year from 2007 to 2016. Aggregate spending on outpatient hospital services increased 113.7 percent from 2007 to 2016.”
“Health care spending as a share of GDP remained relatively constant between 2009 and 2013. Since then, health care spending as a share of GDP has begun to rise again. As a share of GDP, total health care spending more than doubled from 1975 to 2015, increasing from 7.9 percent to 17.7 percent. Private health insurance spending, Medicare spending, and Medicaid all more than tripled over that same time period, increasing from 1.8 percent to 5.9 percent, from 1.0 percent to 3.6 percent, and from 0.8 percent to 3.0 percent, respectively, as a share of GDP.”
Risk Adjustment, Updated: Katie Keith reports in Health Affairs (here) that “On July 12, 2018, CMS released new technical guidance [here]—primarily for insurers—on implications of the ongoing litigation over the risk adjustment formula in New Mexico [Moda]. This guidance was released after CMS announced a suspension of the risk adjustment program.”
Medical Loss Ratio Calculation: Total medical expenditures divided by premium income? Not so fast. CMS has published new annual reporting instructions (here) and a new calculator/formula tool (here).
GAO on Association Health Plans, DoL Compliance: the Department of Labor complied with procedural rules regarding cost-benefit analysis, unfunded mandates, and regulatory flexibility in the issuance of a proposed rule concerning the definition of an “employer” for purposes of participating in Association Health Plans (AHPs). GAO’s letter to Congressional Committee leaders is here. The final AHP rule was published in the Federal Register June 21, 2018, here, with an effective date of August 20, 2018. Says GAO,
“The regulation facilitates the adoption and administration of AHPs and expands access to affordable health coverage, especially for employees of small employers and certain self-employed individuals. . . [including] owners of an incorporated or unincorporated trade or business, including partners in a partnership, without any common law employees, to . . . be treated as employees with respect to a trade, business, or partnership for purposes of being covered by the AHP.”
Closely watched: state regulation of AHPs. Says GAO,
“Because ERISA classifies AHPs as MEWAs [Multiple Employer Welfare Arrangements], they generally are subject to state insurance regulation. Specifically, if an AHP is not fully insured, then under ERISA section 514(b)(6)(A)(ii) any state insurance law that regulates insurance may apply to the AHP to the extent that such state law is not inconsistent with ERISA. If, on the other hand, an AHP is fully insured, ERISA section 514(b)(6)(A)(i) provides that only those state insurance laws that regulate the maintenance of specified contribution and reserve levels may apply to the AHP.”
EVENTS & MEETINGS
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.
10:00 a.m.-11:30 a.m., Bipartisan Policy Center, “The Future of Healthcare: Where Does the Bipartisan Path Lead?” National Press Club, 529 14th St NW, 13th Floor, Washington, DC, 20045, Burke, Capretta, Daschle, Jennings, Roy
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: 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