DCMedical News: Tuesday, Sept. 25, 2018
DCMedical News
Washington, D.C.
Tuesday, Sept. 25, 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 House returns today with four legislative working days remaining before the end of the current fiscal year and will take up the Labor-Health and Human Services appropriations bills as part of a package with Defense appropriations. The Senate Judiciary Committee hearing on Judge Kavanaugh takes place Thursday at 10:00 a.m.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Doctor ACOs Save Money, Hospital ACOs Do Not: A new study in the New England Journal of Medicine (here) says: “After 3 years of the MSSP [the Medicare Shared Savings Program], participation in shared-savings contracts by physician groups was associated with savings for Medicare that grew over the study period, whereas hospital-integrated ACOs did not produce savings (on average) during the same period.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Election Law: CQ Magazine’s cover story (9-24-2018) reports that the “Health Care Law [is] Again Front and Center in Midterms.” The story reports, “Senate Democrats running for re-election in states that Trump won have nearly all brought up pre-existing conditions protections this summer in campaign ads, videos and at events. Republicans are affirming support for the protections too with legislation and ads of their own. More than half (52 percent) of all pro-Democrat TV advertisements in August mentioned health care, including 13 percent referencing the health care law specifically, according to an analysis by the Wesleyan Media Project. In the same month, 21 percent of pro-Republican TV ads referenced health care, and just 1 percent referenced the ACA specifically, the same analysis showed.”
Public Charge: The Administration has published a proposed rule (here, 447 pgs.) which would allow federal immigration authorities to deny green cards to legal immigrants if they've used Medicaid, Medicare Part D or other subsidized programs (food stamps, housing, welfare), but not including subsidized exchange-purchased health insurance.
Medicaid and Work: MACPAC (the Medicaid and CHIP Payment and Access Commission) has considered the practical problems associated with work requirements for Medicaid beneficiaries. At a presentation (here) entitled “Operational Considerations for Work and Community Engagement Requirements” the group explored issues in states which have requested §1115 waivers in order to impose such work requirements. The report: “The Centers for Medicare & Medicaid Services (CMS) granted Section 1115 demonstration waivers to four states to adopt Medicaid work and community engagement requirements [in] AR, IN, NH [with] Approval for KY vacated. Nine additional states have formally applied for similar waivers, AZ, KS, MI, ME, MS, OH, UT, SD, WI. States and CMS view requirements as likely to increase employment, participation in job search and training, earned income.” The report includes initial results from Arkansas, and continuing challenges in tracking compliance and enforcement.
Red-Tape Relief: The Ways and Means Committee published (here) a compendium of its efforts on Medicare red-tape relief, as well as a letter to CMS (here) on rural hospital and health care red-tape relief.
DRUGS AND DEVICES
Medicaid Coverage of New and High-Cost Drugs: At its recent meeting MACPAC considered options (here) to limit expenditures on high-cost drugs. The Medicaid “grand bargain” (state Medicaid programs generally must cover all outpatient drugs on approval by the Food and Drug Administration, unique among federal payers) puts many new drugs on the formulary after 90 days, others after 180 days. Without limits, Medicaid claims and gross spending on drugs over $1,000 per claim amount to 44% of total drug spending in 2017.
More Free Services from Drug Companies to Doctors: Report from the Wall Street Journal, here.
READING AND REFERENCE
Health United States 2017: The annual update of American health (here) released Monday shows this:
“In 2015, the first significant decrease in life expectancy at birth since 1993 was observed, and these declines have continued through 2016. The leading causes of death differ by age group. For those aged 1-44, unintentional injuries were the leading cause of death. For those aged 45 and over, heart disease and cancer are the leading causes of death. Three causes of death are the primary contributors to the recent decrease in life expectancy—drug overdose, suicide, and chronic liver disease. The age-adjusted death rate for drug overdose increased 72% between 2006 and 2016 to 19.8 deaths per 100,000 population in 2016. In 2016, age-adjusted drug overdose death rates varied by state, ranging from 6.4 deaths per 100,000 population in Nebraska to 52.0 deaths per 100,000 in West Virginia. Between 2006 and 2016, the age-adjusted suicide death rate increased from 11.0 to 13.5 deaths per 100,000 resident population. Chronic liver disease death rates increased by an average of 5.3% per year during 2012–2016 after an initial period during 2006–2012 of no change. During 2006–2016, death rates for chronic liver disease and cirrhosis increased the fastest among men and women aged 25–34.”
More at: cdc@service.govdelivery.com, tables at https://www.cdc.gov/nchs/hus/contents2017.htm#Table, also 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).
10:00 a.m., Energy & Commerce Subcommittee on Health holds a hearing on “Better Data and Better Outcomes: Reducing Maternal Mortality in the U.S.” Webcast at http://energycommerce.house.gov/, announcement here.
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: 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