DCMedical News: Thursday, July 26, 2018
DCMedical News
Washington, D.C.
Thursday, July 26, 2018
DCMedical News is published every day either the House or the Senate is in session.
Trial and courtesy subscriptions will end July 31. Subscribe now, avoid interruption of service.
THE BIG STORY TODAY IN HEALTH CARE
The House of Representatives passed a group of bills intended to encourage the use of health savings accounts (HSAs) on exchanges, and to provide other exchange options, as well.
HR 5963 (here) would delay the annual federal fee on health insurance companies until after 2020.
HR 6199 (here) passed 277-142, consolidates a number of HSA proposals (summary here).
HR 6301 (here) removes part of the “high deductible” from high deductible health plans.
HR 6305 (here) eliminates some disqualifications for eligibility, and expands the purposes for which funds may be used.
HR 6306 (here) would allow increased contributions to HSAs, and also allow both spouses to “catch-up.”
HR 6309 (here) would allow Medicare beneficiaries to contribute to HSAs.
HR 6311 (bill text here, CBO cost estimate here, section by section summary here) passed 242-176, proposes to increase access to lower premium plans and expand HSA use. Lower premium plans would include change in the criteria for qualified health plans, and would allow the purchase of copper (“catastrophic” coverage) plans on the exchanges.
HR 6312 (here) allows HSA account funds to be used for fitness, gyms.
HR 6313 (here) would allow the carryforward of health care flexible spending account balances.
HR 6314 (here) allows bronze and copper plans to be used together with HSA accounts.
HR 6317 (here) allows direct primary care to be used together with HSA accounts.
The Joint Committee on Taxation had estimated all of this would cost more than $90 billion over 10 years, but no offsets have been identified. Other pending bills include delay or elimination of the “Cadillac” tax (now on health insurance premiums greater than $11,000 for an individual or $30,000 for a family of four) and relief from the employer mandate.
The House will recess for August. The Senate is supposed to be in session in August, but there are no announced plans for legislation.
CMS Proposes 2019 Rule for Hospital Outpatient Services, Ambulatory Surgery Centers: CMS proposed changes that move closer to “site neutral” payments (aligning or equating hospital outpatient department to physician-office rates), and adding procedures which may be paid by Medicare and performed in Ambulatory Surgery Centers (ASCs). The proposed rule (here, 761 pgs., Fact Sheet here) will be published in the July 31 Federal Register, with comments due by September 24.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Doctors Blogging on Sermo React to the Evaluation and Management (E/M) Coding Changes Proposed in the 2019 Medicare Fee Schedule: The massive change in physician office visit coding and payment proposed in the 2019 physician fee schedule (see DCMN of 7-13-2018) is evoking negative practitioner comment, for example, on the “physician-only” Sermo website. Samples: “If you use a mid-level [NP, PA], it is very unlikely they will allow you to bill anything but the lowest level”; “I have mostly older patients with lots of comorbidities so most of my visits are 99214. Yet another race to the bottom, to be won by poorly trained midlevels”; “It means I can finally get rid of my stethoscope”; “Our interventional pulmonologist is leaving because of the RVU system of payment here. He is seeing complicated patients with cancer, LAD, etc. while another guy who is nearing retirement is only seeing sleep patients and simple stuff. The second guy is making way more than him because he's seeing about 50% more patients”; “It doesn't matter what we think, or even what we can prove. The government's intent is to reduce payment to physicians. Facts do not matter.” And many more.
ICYMI: CMS re-sent the recorded panel discussion (all CMS employees) of what they intended with the E/M changes: “We have held listening sessions all over the country and heard from thousands of providers and one thing they consistently brought up was how documentation was needlessly burdensome, wasn’t improving patient care, and was actually having a negative impact on patient care. We listened and in response we proposed streamlining the documentation requirements for E&M visits, as well as moving to single payment rates. At https://youtu.be/W2QBTQNxfSY
HOSPITALS AND OTHER HEALTH CARE FACILITIES
Expanding Procedures in Ambulatory Surgery Centers: H.R. 6138 (here) would change how HHS determines whether Medicare will cover a surgical procedure when the procedure is performed in an ASC. If HHS excludes a procedure, this bill would require the Secretary to identify the evidence on which that determination is based. Also under the bill additional procedures now performed in a physician’s office may be performed in an ASC, at higher cost to Medicare. Moving surgery from a hospital outpatient department to an ASC would decrease Medicare spending. CBO estimates no net effect.
HCA: The Hospital Corporation of America reported that its Q2 profit grew 25% to $820 million on revenue of $11.5 billion.
Antibiotics in Urgent Care Centers: A PEW study (here) shows “Patients seen at urgent care centers for common conditions such as asthma, the flu, and the common cold are more likely to receive antibiotics unnecessarily, compared with patients treated for the same illnesses at other types of health care facilities.”
MEDICARE, MEDICAID, COMMERCIAL HEALTH INSURANCE
Medicare and Health Spending, Continued: (See also DCMN of 7-23-2018.) From the June 2018 Data Book of MedPac (here), “Health Care Spending and the Medicare Program.”
Medicare Growth: “For 2017 to 2025, the Trustees and CBO project that growth in per beneficiary spending will
be higher than the recent lows but lower than the historical highs, with an average annual growth rate of 4 percent . . . Over the last few years, the enrollment growth rate rose from about 1 percent to 2 percent per year historically to 3 percent and is projected to continue growing at a similar rate throughout the next decade. So, despite the slowdown in spending per beneficiary (relative to historical standards), growth in total spending over the next decade is projected by the Trustees to average 7 percent and by CBO to average 6 percent annually.” (Pg. 9)
Medicare and GDP: From 1% of GDP in 1975, Medicare is projected to reach nearly 6% of GDP in 2075. “[S]pending will rise from 3.6 percent of GDP in 2015 to 5.4 percent of GDP by 2035, largely because of rapid growth in the number of beneficiaries, and then to 5.9 percent of GDP in 2075, with growth in spending per beneficiary becoming the greater factor in the later years of the forecast. The rapid growth in the number of beneficiaries began in 2011 and will continue through 2030 as members of the baby-boom generation reach age 65 and become eligible to receive benefits.” (Pg. 10)
Bottom Line: Medicare spending more than doubled since 2005, increasing from $337 billion to $695 billion by 2016.
PHARMA
5% Addiction Risk From Opioids for Sprained Ankle: A study in the Annals of Emergency Medicine (here) found unexpectedly high prevalence and wide variability in the emergency room prescription of opioid medication for sprained ankles. “A total of 25.1% received an opioid prescription . . . State-level prescribing rates ranged from 2.8% in North Dakota to 40.0% in Arkansas . . the adjusted rate of prolonged opioid use was 4.9% [with higher dosage and duration] . . compared with 1.1% . . . among those who received at total MME of 75 and 0.5% . . among those who did not fill an opioid prescription.”
GSK: GlaxoSmithKline said it was cutting manufacturing, concentrating on high growth, investing $300 million in 23andMe.
EVENTS & MEETINGS
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. Subscribe now, avoid interruption of service.
July publication dates: 27, 30, 31.
August publication dates: prn, Senate may be in session, but no legislative activity is planned.
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