DCMedical News: Tuesday, July 31, 2018
DCMedical News
Washington, D.C.
Tuesday, July 31, 2018
DCMedical News is published every day either the House or the Senate is in session.
Trial and courtesy subscriptions will end today. Subscribe now, avoid interruption of service. DCMN ends its regular publication today, to resume on Tuesday, September 4th. The House is adjourned for August. Any regular (business) session for the Senate will be reported in special editions.
THE BIG STORY TODAY IN HEALTH CARE:
The House is in recess for August. The Senate is scheduled to be in session in August, and continues appropriations work this week.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Provider and Insurer Market Concentration: A Commonwealth Fund summary (here) of recent research holds that “When examining the relative concentration between providers and insurers, providers generally had the upper hand. Provider concentration was in a higher category relative to insurers in 58.4 percent of the MSAs [Metropolitan Statistical Areas], while the opposite was true in only 5.8 percent of the MSAs.”
Electronic Medical Records, Continued: Do they improve results for patients, after given time to “mature?” See a Health Affairs piece here, which reports that “[N]ational investment in hospital EHRs should yield improvements in mortality rates, but achieving them will take time.” Or do they introduce avoidable error? A piece (here) in the Journal of the American Medical Information Association reports that “We reviewed charts of 30 patients with inflammatory bowel disease (IBD) from each of 6 gastroenterology centers. Centers compared IBD medications from the medication list to the clinical narrative . . . We reviewed 379 IBD medications among 180 patients. There was variation by center, from 90% patients with complete agreement between the medication list and clinical narrative to 50% agreement.”
HOSPITALS AND OTHER HEALTH CARE FACILITIES
Federal Register Publishes CY 2019 OPPS Proposed Rule Today: The clock starts today with official publication (here) of the “Proposed Changes to Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Requests for Information on Promoting Interoperability and Electronic Health Care Information, Price Transparency, and Leveraging Authority for the Competitive Acquisition Program for Part B Drugs and Biologicals for a Potential CMS Innovation Center Model.” Comments on the 761 page proposal are due by the end of business September 24, with electronic submission to http://www.regulations.gov, follow the instructions under the “submit a comment” tab.
MEDICARE, MEDICAID, COMMERCIAL HEALTH INSURANCE
Mercatus Paper Says Medicare-for-All a $33 Trillion With a “T” Expense: The report, here, says “The leading current bill to establish single-payer health insurance, the Medicare for All Act (M4A), would, under conservative estimates, increase federal budget commitments by approximately $32.6 trillion during its first 10 years of full implementation (2022–2031), assuming enactment in 2018. This projected increase in federal healthcare commitments would equal approximately 10.7 percent of GDP in 2022, rising to nearly 12.7 percent of GDP in 2031 and further thereafter. Doubling all currently projected federal individual and corporate income tax collections would be insufficient to finance the added federal costs of the plan. It is likely that the actual cost of M4A would be substantially greater than these estimates, which assume significant administrative and drug cost savings under the plan, and also assume that healthcare providers operating under M4A will be reimbursed at rates more than 40 percent lower than those currently paid by private health insurance.”
Other options (here) for public sponsorship of universal coverage were developed for Oregon by RAND at the end of 2017.
Exchange Waivers: §1332 waivers for reinsurance programs were approved by CMS for Maine and Wisconsin, with promises of lower premiums in both states. They join Alaska, Minnesota and Oregon in establishing “reinsurance” programs to offset the cost of the most expensive enrollees. Others who have already applied are Maryland and New Jersey. The individual state efforts follow on a failure in Congress early in 2018 to establish such a program on a national basis.
HSAs and “Cross Subsidies in the WSJ: The Wall Street Journal editorialized in favor of the HSA bills passed by the House (here, see also DCMN 7-30). John Cochrane discussed “cross subsidies” of health expenses (here); he believes this is one answer to the question “Why is paying for health care such a mess in America?”
AHPs: States are checking in on Association Health Plans, suing (here), regulating (here, New York State). The final rule on short-term, limited duration insurance plans (STLDI) is coming soon.
PHARMA, DEVICES
“The Bleeding Edge”: The Netflix documentary on medical devices—focusing especially on the 510(k) approval process—gets attention (here). Says the producer, “"Ninety-eight percent of devices can be approved for sale without any studies in humans, meaning we are Guinea pigs and we don't know it.”
Rebates: The New “Villain” of High Drug Prices(?): In the New York Times, here.
Competitive Acquisition Program Returns in the Proposed Rule for CY 2019 OPPS, here. The background, “As part of active efforts to reduce the cost of prescription drugs, CMS is issuing a Request for Information to solicit public comment on how best to leverage the authority provided under the Competitive Acquisition Program (CAP) to get a better deal for beneficiaries as part of a CMS Innovation Center model. We believe a CAP-based model would allow CMS to introduce competition to Medicare Part B, the part of Medicare that pays for medicines that patients receive in a doctor’s office. Currently, CMS pays the average sales price for these therapies plus an extra add-on payment. A CAP-based model would allow CMS to bring on vendors to negotiate payment amounts for Part B drugs, so that Medicare is no longer merely a price taker for these medicines. We are seeking public comment on how the vendors that CMS brings on could help the agency structure value-based payment arrangements with manufacturers, especially for high cost products, so that seniors and taxpayers will know that medicines are working before they have to pay.”
EVENTS & MEETINGS
July 31
10:00 a.m., Senate HELP Committee hearing, “Reducing Healthcare Costs: Decreasing Administrative Spending,” 430 Dirksen SOB.
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 and courtesy subscriptions will end tomorrow. Subscribe now, avoid interruption of service.
August publication dates: prn, House adjourned, 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