DCMedical News: Thursday, Sept. 13, 2018
DCMedical News
Washington, D.C.
Thursday, Sept. 13, 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:
MACPAC is Back in Town: The Medicaid and CHIP Payment and Access Commission meets today (but, because of hurricane Florence, not tomorrow) as payment and access issues in Medicaid continue to grow contentious. The agenda is here, with discussion scheduled on DSH payments, Medicaid coverage of new and high-cost drugs and “operational considerations for work and community engagement requirements.”
Arkansas, the first state to implement work requirements for its Medicaid program, reported (here) that it has removed more than 4,000 low-income adults from its Medicaid program; 5,000 more have failed to meet the work requirements for two months and will be removed from the program if they fail for a third month. In its report Wednesday CQ notes “September marks the first time in U.S. history that people have lost their health insurance because of Medicaid work requirements.”
Work requirements have been approved by CMS for four states (Indiana and New Hampshire, in addition to Arkansas and Kentucky), with seven more applications (under §1115 waivers) pending or in preparation. In Arkansas a beneficiary, once removed, is not allowed to re-enroll for Medicaid during the following coverage year. The attempt of Kentucky to implement a work requirement program was turned back by a federal district court (decision here). The National Health Law Program has filed a similar suit (complaint here) in an attempt to invalidate the Arkansas program; the same judge (Boasberg) is presiding.
MACPAC Resources: The Commission has provided a variety of tools with which to follow these controversies, including (a) a Medicaid data book, published last December, here; (b) annotated Title XIX (here) and Title XXI (here) of the Social Security Act; and a file in Excel (here) containing a summary by state of Medicaid payment policies for Medicare cost sharing, separated into hospital inpatient, hospital outpatient, nursing facilities and physician services.
Jobs Continue Growth in Hospitals, Health Care: BLS, the Bureau of Labor Statistics, reports (here) that health care employment increased by 33,000 jobs in August, two thirds of the jobs in ambulatory care, 8,000 in hospitals. Monthly healthcare hiring for the past year has averaged 25,000, with annual wage increases 2.5-3.0%. RN growth from 2010 to 2017 was 20%, now totaling 3 million RNs nationally. Last year (here) BLS projected “Employment in the health care and social assistance sector is projected to add nearly 4.0 million jobs by 2026, about one-third of all new jobs. The share of health care and social assistance employment is projected to increase from 12.2 percent in 2016 to 13.8 percent in 2026, becoming the largest major sector in 2026.”
HOSPITALS AND OTHER HEALTH CARE FACILITIES
Long Term Care Hospitals: MedPAC received another “mandated” report at its meeting September 6, this one on the history, payments and regulations affecting (in fact, defining) LTCH facilities. The slides (here) pre-sage a portion of the 2019 report of MedPAC to Congress. “Site neutral” payments for LTCHs are coming in 2020, with all cases paid at a single rate, except those following three days of ICU care in an acute care hospital, or those involving prolonged ventilator use. Mean payment for the 126,000 LTCH cases in 2016 was $41,000, Medicare paying for about two thirds of all LTCH discharges. Medicare has attempted to control (its) expenditures on LTCHs through two moratoria on development, for eight of the last ten years, and by reducing payment for cases with relatively short lengths of stay. Elimination of the 25% rule in the 2019 IPPS means there is a “continued incentive for ACHs [acute care hospitals] to discharge patients to LTCHs for financial, rather than clinical reasons.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Obamacare Changes Pending in the House: HR 3798 (here, see also DCMN of 9-12), may be up for a House vote before hurricane Florence hits Washington, D.C. The bill would retroactively suspend for four years the employer requirement (for employers with more than 50 employees) to offer coverage, increase hours (from 30 to 40) for an employee to be considered “full time” and further delay (from 2021 to 2022) the 40% excise tax on “overly generous” or “Cadillac” health insurance plans.
Medicare Changes: Passed by the House Wednesday (see DCMN of 9-7) HR 6662 (helps MA enrollment), HR 6690 (smart card “integrity” experiment for Medicare), HR 6651 (compels HHS to finalize PACE regulations) and HR 3635 (helps device manufacturers with standardization of Medicare coverage determinations). Ways and Means Chair Brady here on the bills.
MedPAC on Quality Measures Under Medicare: MedPAC reviewed proposed changes in its “quality” programs September 6. Slides from the presentation (here) show the merging of HRRP (readmissions reduction) and VBP (value-based purchasing) and elimination of IQRP (inpatient quality reporting) and HAC (hospital-acquired condition reduction), and the subsequent introduction of HVIP (the Hospital Value Incentive Program). Under the existing programs, hospitals receive a maximum reward of 3% and a maximum penalty of 6%; discussion centered on how large the incentive/disincentive would be under HVIP. Also noted: consistent with recent studies (see DCMN 7-19) hospital acquired infection rates have improved, but hospital practices have changed to include “culturing asymptomatic patients on admission” (PoA) so that subsequently diagnosed infections could be thought to have been PoA, and “ordering antibiotics without culturing a patient [to] avoid having a positive finding” of hospital-acquired infection.
EVENTS & MEETINGS
Sept. 13
9:30 a.m. to 4:15 p.m., (but not continuing September 14) MACPAC, the Medicaid and CHIP Payment and Access Commission, at Reagan/ITC, highlights here.
1:15 p.m. (Rayburn HOB), Energy & Commerce Subcommittee on Health holds a hearing on “Examining Barriers to Expanding Innovative, Value-Based Care in Medicine.”
Sept. 14
9:15 a.m. House Energy and Commerce Committee’s Health Subcommittee holds a hearing (in 2322 Rayburn HOB) on “Better Data and Better Outcomes: Reducing Maternal Mortality in the U.S.,” with focus on H.R. 1318 which would create grants to improve reporting of maternal health outcomes.
Sept. 18
Noon, Families USA, “What’s at Stake for Medicaid in 2018 Elections,” conference call with focus on Nebraska, Utah, Idaho, information at press@families.usa.org
Sept. 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: 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