DCMedical News: Wednesday, Sept. 5, 2018
DCMedical News
Washington, D.C.
Wednesday, Sept. 5, 2018
DCMedical News is published every day either the House or the Senate is in regularly scheduled session.
THE BIG STORY TODAY IN HEALTH CARE:
InsideHealthPolicy reports on the Texas “Obamacare” hearing (motion for a preliminary junction) today, as follows: “In Texas v. Azar, 20 GOP-led states seek to end enforcement of the entire Obamacare law, and the Trump administration argues the law’s preexisting conditions provision is no longer valid now that there is no penalty for not buying insurance. But the Democratic attorneys general defending the law will tell the judge that the mandate is still constitutional, even if the penalty for not having insurance has been zeroed out, because the government could increase the tax later. The Democratic AGs will argue that granting the GOP states a preliminary injunction would throw the health care system into chaos.”
The Department of Justice and Attorney General Sessions checked in (letter to House Speaker Ryan here) to partially agree with the plaintiffs, as follows: “After careful consideration, and with the approval of the President of the United States, I have determined that, in Texas v. United States [Azar], No. 4: l 8-cv-00167-O (N.D. Tex.), the Department will not defend the constitutionality of 26 U.S.C. 5000A(a), and will argue that certain provisions of the Affordable Care Act (ACA) are inseverable from that provision.”
The House and Senate are back in regular session with eleven legislative days before the end of the FY2018 fiscal year. The largest FY 2019 spending bills await House-Senate conference committee meetings. The Labor-HHS appropriations bill is “paired” with the pentagon spending bill in the Senate, not yet debated in the House. The Senate measure is $2 billion larger than the House bill. The House bill prohibits federal funding for Planned Parenthood. The Senate bill calls for regulations to require price information in advertisements for prescription drugs.
MedPAC comes to town with meetings this Thursday and Friday. The Energy & Commerce Committee has petitioned MedPAC (letter here) to review mergers and hospital consolidations, with apparent special focus on vertical integration. (A key concern of the Committee is larger hospitals and health systems purchasing physician practices, designating those practices as additional sites eligible for 340B drug discounts, ramping up hospital profits from sale of the discounted drugs without evidence of additional devotion of those profits to charitable care or community benefit.)
Featured tomorrow in Thursday’s DCMN: MedPAC tackles “context” for Medicare payment policy; a unified payment system for post-acute care; mandated reports on long-term care hospitals and clinician payment; and (on Friday) redesigning Medicare’s hospital quality and value programs. Can’t make the MedPAC meeting? DCMN is there for you, reports to follow.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
CMS Proposal to “Reform” Office Visit Payments: Song and Goodson (here) explore the specifics of the CMS physician payment proposal for calendar 2019 (see DCMN September 4, proposed rule here, comment period ends September 10), focusing on unintended consequences. They note that “…in reality, administrative burden may not be easily mitigated,” except of course by elimination of documentation required for “pay for performance” programs which will “continue to be consequential for providers participating in risk-adjusted alternative payment models.”
HOSPITALS AND OTHER HEALTH CARE FACILITIES
Acute Care Shift: a Harvard group reported in JAMA Network (here) that “Between 2008 and 2015, there were substantial shifts at which venue Americans received acute care for low-acuity conditions”—more from urgent care, lots more, and less from hospital emergency departments.
On the cost of care for low-acuity conditions: “From 2008 to 2015, inflation-adjusted prices per visit for treatment of low-acuity conditions were stable for urgent care centers ($165 per visit in 2008; $162 per visit in 2015), retail clinics ($74 per visit in 2008; $75 per visit in 2015), and telemedicine ($40 per visit in 2008; $39 per visit in 2015). In contrast, the price per ED visit for treatment of low-acuity conditions increased by 79%, from $914 per visit in 2008 to $1637 per visit in 2015 . . . Out-of-pocket costs for ED visits for treatment of low-acuity conditions increased by 125%, from a mean of $187 per visit in 2008 to $422 per visit in 2015, whereas out-of-pocket costs for urgent care centers ($59 to $66), retail clinics ($34 to $37), and telemedicine ($16 to $14) were nearly unchanged. Average overall spending per member for low-acuity conditions increased by 14% from 2008 to 2015 (from $70 to $80 per member per year).”
MEDICARE, MEDICAID, COMMERCIAL HEALTH INSURANCE
Medicare Red Tape Relief: House Ways and Means Committee leaders write to CMS (here, here and here) on “red tape relief,” also the subject of a recent Committee report, here. The report notes: “Recently a study in the Annals of Internal Medicine found that physicians spend nearly two additional hours of paperwork for every hour they were seeing patients. These numbers cannot possibly reflect the purpose of the reporting regulations passed by Congress.”
Medicaid and the Mid-term elections: Governing Magazine (here) has a feature on this subject.
EVENTS & MEETINGS
September 5
10:00 a.m., the Health Subcommittee of the House Energy and Commerce Committee, chaired by Rep. Michael C. Burgess, M.D. (R-TX), room 2123 of the Rayburn House Office Building. The hearing is entitled, “Opportunities to Improve Health Care,” including prohibition of gag clauses, enhancement of fraud prevention, care coordination under Medicaid for children with complex conditions, extension of “Money Follows the Person” legislation for five years, details here.
2:00 p.m., House Ways and Means Committee mark-up of health legislation (details here). Included: finalization of PACE regulations, called for by year’s end. Also important: the “Local Coverage Determination Clarification Act of 2017” which would codify the process through which MACs (Medicare Administrative Contractors) make their own local coverage determinations on technologies, procedures and services.
September 10
9:00 a.m., continuing September 11, Advisory Committee on Training in Primary Care Medicine and Dentistry (ACTPCMD). Information about ACTPCMD and the agenda for this meeting can be found on the ACTPCMD website at: https://www.hrsa.gov/advisory-committees/primarycaredentist/index.html. Details here.
September 26
9:00 a.m. to 4:00 p.m., continuing September 27, meeting of the National Advisory Council on Nurse Education and Practice. Details 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
September publication dates: 6, 7, 12, 13, 14, 17, 18, 20, 21, 24, 25, 26, 27, 28.
October publications dates: 1, 2, 3, 4, 5, 9, 10, 11, 12, 15, 16, 17, 18, 19, 22, 23, 24, 25, 26
November publication dates: 13, 14, 15, 16, 26, 27, 28, 29, 30
December publication dates: 3, 4, 5, 6, 7, 10, 11, 12, 13, 14
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com