DCMedical News: Tuesday, Sept. 18, 2018
DCMedical News
Washington, D.C.
Tuesday, Sept. 18, 2018
DCMedical News is published every day either the House or the Senate is in session. Congress is not in session tomorrow, Yom Kippur. Is DCMedical News new in your in-box? Subscription information is below, courtesy trials end without notice.
THE BIG STORY TODAY IN HEALTH CARE:
Judge Kavanaugh: More hearings scheduled. Background in “health-related” cases in DCMN, 7-11-2018 (here).
Opioids: Senate passes its bill, here. House bill passed three months ago, summary here. Major difference: no provision in the Senate bill for Medicaid coverage of intermediate care in facilities with more than 16 beds.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Uh-Oh. New Medicare and Medicaid Programs “to Promote Program Efficiency, Transparency, and Burden Reduction”: Proposed regulations (here, 285 pages, summary here, 5 pages) to be published 9-20-2018 “[W]ould reform Medicare regulations that are identified as unnecessary, obsolete, or excessively burdensome on health care providers and suppliers. This proposed rule would increase the ability of health care professionals to devote resources to improving patient care by eliminating or reducing requirements that impede quality patient care or that divert resources away from furnishing high quality patient care.”
The proposed rule, for which comments are due by 11-20-2018, would compel hospitals to accept transfers from ambulatory surgery centers (ASCs), even without a transfer agreement, a proposal made by the ASC trade group. The proposal would also eliminate CMS quality reporting by individual hospitals for hospitals that are members of a health system, taking a “system” report instead. Individual hospitals, however, are the entities licensed by each state, while health systems are not; in addition, individual hospitals are accredited, rather than health systems.
PPACA: Suit to Block STLDI Plans: Health groups sued (complaint here), contending that the Short Term Limited Duration health plans are contrary to the intent of PPACA to have comprehensive insurance available. From the Wall Street Journal: the suit “takes aim at one of the central planks of the administration’s plan to roll back the Obama-era health law, after Congress failed to repeal it last year . . The Trump administration rule finalized in August [here] loosens restrictions on a type of coverage known as short-term medical insurance—low-cost plans that cover a limited period with less-expansive benefit offerings, which are subject to fewer consumer protection regulations. The plans don’t have to cover people with pre-existing conditions, and insurers can charge higher premiums based on a consumer’s health status.”
PHARMA
Cigna Announces Green Light to Acquire PBM Express Scripts: The Department of Justice has ended the Hart-Scott-Rodino review period for the acquisition of pharmacy benefit management firm Express Scripts by insurer Cigna, according to the companies. The $67 billion acquisition has also been approved by 14 of the 29 states whose approval is required. Stock prices of both firms were up. Company statement here.
States May Regulate PBMs and Prohibit Favoritism: So says a U.S. District Court decision in a case involving the State of North Dakota (decision here), finding that, with one minor exception, North Dakota’s attempts to regulate pharmacy benefit managers were not preempted by ERISA or federal law generally. Among the North Dakota statute’s provisions: “First, it contains provisions prohibiting PBMs from imposing accreditation requirements that are stricter than state and federal law. Second, the legislation requires PBMs to utilize benchmarks set by an unbiased, nationally-recognized entity when evaluating pharmacy performance, and it regulates the fees PBMs may levy on pharmacies due to deficient performance.” Also, “The second disclosure provision obligates PBMs with an ownership interest in a pharmacy to disclose, to plan sponsors, the difference between the amount paid to a pharmacy and the amount charged to the plan sponsor.”
READING and REFERENCE
Bundled Payments: Austin Frakt summarizing studies of bundled payments, in the NYT, here.
Risk Adjustment: Fragile patient status is inadequately accounted for in pay-for-performance experiments, JAMA Internal Medicine, here.
Readmission Penalties: Are disproportionately due to patient status, not provider incompetence, JAMA Internal Medicine, here.
Scribes Reduce Physician Stress in the EHR era: JAMA Internal Medicine, here, noting that “Widespread adoption of electronic health records (EHRs) in medical care has resulted in increased physician documentation workload and decreased interaction with patients. Despite the increasing use of medical scribes for EHR documentation assistance, few methodologically rigorous studies have examined the use of medical scribes in primary care.”
OIG Says Treatment Planning for Children in Foster Care Receiving Psychotropic Medication Is Lacking: The report, here, says that “Up to 80 percent of children enter foster care with significant mental health needs . . . psychotropic medications . . . may be effective treatments. However, these medications can have serious side effects.”
EVENTS & MEETINGS
Sept. 18
10:00 a.m., Senate HELP (Health, Education, Labor and Pensions Committee) hearing on transparency and health care costs. (A transcript of the HELP hearing on costs, 6-27-2018, can be found here, with testimony from Dr. Melinda Buntin of Vanderbilt, Dr. Ashish Jha of Harvard, Dr. Niall Brennan of the Healthcare Cost Institute and Dr. David Hyman of Georgetown. A transcript here and written testimony here from the HELP hearing of 7-17-2018 includes Vanderbilt’s Dr. Jeff Balser, Montefiore’s Dr. Steven Safyer, Dr. David Lansky of the Pacific Business Group and Dr. Brent James of Stanford. Testimony from another HELP hearing on costs on 7-31-2018—focusing on administrative expense—can be found here from Becky Hultberg, here from AHIP’s Matt Eyles, David Cutler here, Robert Book here.)
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. 20
9:00 a.m., Alliance for Health Policy, discussion with Joseph Grogan, Associate Director for Health Programs at the Office of Management and Budget, 1299 Pennsylvania Ave., registration here.
Sept. 26
8:30 a.m. to 4:00 p.m., Medicare & Medicaid Programs, and Other Program Initiatives, and Priorities; Meeting of the Advisory Panel on Outreach and Education. Registration required, information at https://www.regonline.com/apoe2018sept26meeting, notice and background here.
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.
Sept. 27
10:00 a.m., Senate HELP Committee continues hearing on costs, this hearing focusing on innovation.
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: 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