DCMedical News: Friday, Sept. 21, 2018
DCMedical News
Washington, D.C.
Friday, Sept. 21, 2018
DCMedical News is published every day either the House or the Senate is in session. Subscription information is below.
THE BIG STORY TODAY IN HEALTH CARE:
The Dow Jones Industrial Average and the Standard & Poor’s 500 both rose to intraday records Thursday. Judge Kavanaugh’s hearing is set for Monday. The House returns the 25th with the end of the fiscal year five legislative days away. And tariffs? Merck announced that Keytruda will cost half as much in China as it does in the U.S. (see STAT+ Pharmalittle, here).
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
AMA Voices 136 Pages of Concerns on the Proposed 2019 Physician Fee Schedule: The letter, here, is in addition to the 14-pager AMA sent (here) with 169 other physician organizations in opposite to the collapsing of E/M (evaluation and management) office visit payment codes in the same 2019 proposal. In this latest missive, the AMA outlines seven goals for consideration by CMS (the Centers for Medicare and Medicaid Services) in its review of the QPP (quality-payment program), as follows: Make virtual groups more viable; Simplify MIPS scoring; Avoid raising the performance threshold, changing category weights and removing quality measures when there is no MIPS data to analyze (bonus decisions are being based on hypothetical assumptions from legacy programs such as the Physician Quality Reporting System); Reduce the required number of measures a physician must report under the Quality category; Retain flexibility in the “Cost” category for the next four years while the eight new episode-based cost measures are evaluated and more are developed and piloted (the AMA writes that, in its desire to "capture more physicians in the cost category," CMS is undermining the reliability of and confidence in the measures”); Simplify requirements in the Promoting Interoperability (PI) category; and Move ahead on [still more] alternative payment models (APMs).
Oh, and the AMA doesn’t like “Step Therapy,” either (letter in opposition here).
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
“Efficiency, Transparency and Burden Reduction”: CMS publishes a proposed rule Thursday (Federal Register, here), comments due by November 19.
DRUGS AND DEVICES
CMS Not Keeping Up With FDA on Medical Device$: Office of Management and Budget (OMB) Associate Director for Health Programs Joe Grogan told a meeting of the Alliance for Health Policy yesterday that “breakthrough devices” approved by the FDA should be paid for by CMS. InsideHealthPolicy reported that Grogan said CMS’ treatment of devices was hard to understand, including “how we cover them, how we pay for them, why it takes so long at CMS, the whole process.” He added that CMS and Administrator Seema Verma “have some cool ideas, and hopefully we’ll start to see some things happen over the next six months.” However, the overwhelming percentage of new FDA device approvals use the 510(k) model which, by definition, means such devices are not “breakthroughs,” but are dependent for their approval on the prior approval of nearly identical or very similar devices.
More Devices: FierceHealthcare reports that “Despite a growing body of evidence that shows wellness programs and wearables have a pretty minimal impact, insurers aren’t backing off their commitment to them.” FitBit unveiled a “coaching platform,” and Humana will cover it (story here).
EVENTS & MEETINGS
Sept. 25
3:30 p.m., Senate HELP Committee, “Health Care in Rural America: Examining Experiences and Costs.”
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, witnesses Dr. Lee Gross (Docs 4 Patient Care Foundation, Epiphany Health Direct Primary Care; Cheryl DeMars (The Alliance, Madison, WI); Dow Constantine (Executive of King County, Seattle); Dr. Jonathan Perlin, CMO, HCA, Nashville).
Oct. 25
1:00 to 5:00, “Top Minds,” Chernew, Dafny and more, “Disrupting the Health Care Landscape: New Roles for Familiar Players,” NEJM Catalyst webinar, https://join.catalyst.nejm.org/events, also sign up for “New Marketplace Survey: Payers and Providers Remain Far Apart,” which reports (here) that “health care stakeholders are not working together to achieve value-based care, but instead are waiting on government regulators to change the payment model – including, possibly, single-payer health care.”
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: 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