DCMedical News: Wednesday, July 25, 2018
DCMedical News
Washington, D.C.
Wednesday, July 25, 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 Tax That Won’t Die, or Live: The House voted 283-132 for H.R. 184 (the “Protect Medical Innovation Act of 2017”) to repeal the 2.3% excise tax on medical device manufacturers, levied under PPACA. John McDonough in “Inside National Health Reform” recounts the medical device industry participation in discussions of funding PPACA. (Hospital, doctor, pharma and insurance representatives all “signed on” for certain budgeted “savings,” so that expanded benefits under PPACA could be afforded.) “Senate Finance staff . . . started the bidding at $60 billion in [medical device] industry contributions, and the industry reciprocated with a counter offer of zero” (pg. 262). CQ reports “The tax took effect between 2013 and 2015, but was then suspended and is currently not set to take effect again until 2020.” The Library of Congress reports that, for H.R. 184, “As of 07/24/2018 a CBO Cost Estimate for this measure has not been received.”
CMS and Risk Adjustment: Late Tuesday CMS posted a final rule (here) that reissues, with additional explanation, the risk adjustment methodology that CMS previously established for transfers related to the 2017 benefit year. “This important step fills a void created by a federal district court’s vacating of the previously issued methodology, and enables the agency to resume the CMS-operated risk adjustment program in the individual and small group markets.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
E/M Coding: Many physician groups are reacting (see DCMN of 7-13-2018) to the proposed revisions for Evaluation and Management (E/M) codes, the basis for most ambulatory care payments for physician services. What was CMS thinking? A video of CMS Administrator Seema Verma and a panel of CMS officials discussing the E/M changes can be found here: https://www.youtube.com/watch?v=W2QBTQNxfSY&feature=youtu.be. Robert Pear checks in here.
HOSPITALS AND OTHER HEALTH CARE FACILITIES
MEDCAC and TAVR: The Medicare Evidence Development and Coverage Advisory Committee meets today (see “Events” below) to take up the question of whether volume requirements are still necessary for Medicare coverage of Transcatheter Aortic Valve Replacement (TAVR), meeting material here. The meetings (and preparations for this review) were initiated by a letter from the medical director of the cardiac cath lab at Providence St. John’s Hospital in Santa Monica (here). He wrote: “When TAVR was initially approved, very strict criteria for reimbursement and procedure performance by the cardiac team were enumerated in Medicare NCD [National Coverage Determination] 20.32. From the date of initial approval, TAVR has now become a safe, commonplace procedure, with indications expanding from high-risk now to intermediate risk patients. However, the current limitations listed in NCD 20.32 limit the ability of lower volume medical centers and hospitals from providing this key service to Medicare beneficiaries, even if they are high-quality hospitals.”
Substance Abuse Treatment Facilities: The House Energy & Commerce Oversight Subcommittee is examining deceptive advertising and patient brokering referrals for substance abuse treatment. The House-passed opioid bill (H.R. 6, here) had more than 50 separate provisions, but none aimed at deceptive advertising and referral. Meanwhile, The Medical Letter reported (here) that the FDA has approved lofexidine as the first nonopioid to be approved in the U.S. for management of opioid withdrawal symptoms, although Clonidine has been used off-label. Lofexidine has been available in the UK since 1992.
MEDICARE, MEDICAID, COMMERCIAL HEALTH INSURANCE
Growth in Private Health Insurance Spending Accelerates: A new report from Altarum (here) finds that “Spending and price growth among the privately insured population accelerated in 2017 and early 2018 relative to Medicare and Medicaid, despite very low growth in private insurance enrollment. This is a notable reversal in the post-recession period, as prior to 2017 private spending growth was near or below Medicare and Medicaid rates. We also find that: Since the start of the economic recovery in 2009, total Medicaid spending has grown by 72.6%--more than Medicare (50.7%) and private payer spending (49.4%)--largely due to increases in enrollment, although Medicaid spending has slowed significantly, averaging only 2.3% since January 2017. On a per-enrollee basis, private payer spending has grown 45.9% since 2009, three times the rate of Medicare and Medicaid per-enrollee spending.”
“Fixing the Debt”: The Committee for a Responsible Federal Budget invites you to “fix” the national deficit and debt, by making multiple hypothetical on-line choices of program savings or expense (at http://www.crfb.org/debtfixer/). Each choice is then reflected in higher or lower deficits and debt. The greatest amount you can “save” through any single policy measure (including ending war expenditures in Iraq and Afghanistan) is the $1,830 billion from repeal of Obamacare coverage. You could also “save” $870 billion with Medicaid block grants indexed to inflation (not “medical inflation”). Allowing veterans to visit any doctors they wish? That will cost you $560 billion.
PHARMA
PBM Spread Studied in First-of-its-Kind Ohio Report: STAT+ reports (here) that “A new report [executive summary here] shows two pharmacy benefit managers reaped more than $223 million by working on behalf of Ohio Medicaid plans during a recent 12-month period. And the findings are likely to intensify scrutiny of the roles these companies play in shaping pharmaceutical costs nationwide.”
“From April 2017 through March 2018, CVS Caremark (CVS) and OptumRx billed $2.55 billion to a handful of managed care plans that administer Medicaid plans for Ohio residents. At the same time, the pharmacy benefit managers spent $2.3 billion for prescription medicines and services performed by pharmacies. This amounted to an 8.8 percent gain, or spread, of $223 million . . .Ohio state officials commissioned the report, which is apparently the first of its kind, in response to growing concerns over prescription drug costs and a lack of transparency surrounding pricing. More specifically, the state noted the Ohio Pharmacists Association had alleged pharmacy benefit managers were overbilling Medicaid managed care plans, underpaying pharmacies, and pocketing the difference.”
Drug Manufacturers Dominate State Medicaid Prescription Drug Debates: MedPage Today reports that “An investigation by The Center for Public Integrity [here] found that many pharma companies are using pay and perks to lure doctors to prescribe their medicine and employing high-pressure lobbying tactics to make sure state Medicaid systems include their drugs in formularies. In fact, the investigation found that two-thirds of all doctors who are on list-making committees receive some form of payment from pharma.”
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 theBipartisan 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: 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