DCMedical News: Wednesday, Sept. 26, 2018
DCMedical News
Washington, D.C.
Wednesday, Sept. 26, 2018
DCMedical News is published every day either the House or the Senate is in session. Subscription information is below. Please subscribe to assure your continued receipt of this newsletter.
THE BIG STORY TODAY IN HEALTH CARE:
The Senate Judiciary Committee hearing on Judge Kavanaugh takes place Thursday at 10:00 a.m. The Committee has announced it will vote on the nomination Friday morning at 9:30 a.m.
Public Charge Proposal Alarms Hospitals, Advocates: The proposed rule (here) from the Department of Homeland Security is analyzed by the Kaiser Family Foundation (here). Background from the KFF report: “On September 22, 2018, the Trump Administration announced a proposed rule that would make changes to ‘public charge’ policies . . . the federal government can deny an individual entry into the U.S. or adjustment to legal permanent resident (LPR) status (i.e., a green card) if he or she is determined likely to become a public charge. Under the proposed rule, officials would newly consider use of certain previously excluded programs, including Medicaid, the Supplemental Nutrition Assistance Program, the Medicare Part D Low-Income Subsidy Program, and several housing programs, in public charge determinations. The changes would likely lead to broad decreases in participation in Medicaid and other programs among legal immigrant families and their primarily U.S.-born children beyond those directly affected by the changes. Nationwide, over 19 million . . . children live in a family with an immigrant parent, and nearly nine in ten (86%) of these children are citizens.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
The Physicians Foundation Releases 2018 Survey of America’s Physicians: The sixth biennial “State of the Union” physician survey (here) found rising burnout rates and general pessimism among the 8,774 respondents. Key findings include: 23% of physician time is devoted to non-clinical paperwork; 80% of physicians describe themselves as at full capacity or overextended; 46% plan to change career paths; 49% would not recommend a career in medicine to their children. Survey respondents identified patient relationships as their greatest source of professional satisfaction and EHRs as their most significant source of dissatisfaction. Of those physicians who receive value-based compensation, 57% indicated they do not believe it improves quality or lowers costs. Social determinants of health care: 88% of responding physicians describe poverty and unemployment as major barriers to health for their patients. Continued in tomorrow’s edition.
HOSPITALS AND OTHER HEALTH CARE FACILITIES
Community Health Systems Reaches Settlement Over HMA: Seeking Alpha (report here) says “The settlement concludes the government’s investigations into whether HMA [Health Management Associates] and its affiliated hospitals billed Medicare, Medicaid and TRICARE for certain inpatient admissions following emergency room visits between January 2008 and December 2012 that should have been billed as outpatient or observation cases. The settlement also resolves allegations of Stark and Anti-Kickback Act violations at certain HMA affiliated hospitals.” Total settlement $262 million. The abuses, which took place prior to Community’s acquisition of HMA, were widely reported, including in a special CBS news investigation.
Senate HELP Committee Holds Hearing on “Health Care in Rural America: Examining Experiences and Costs.” The Health, Education, Labor and Pensions Committee got an earful of experiences. Among the points made by the witnesses and Members: Lack of physicians, high insurance rates, insurance carriers not interested in the small market, Medicare reimbursement rate too low (65% of cost). Also, the Committee was told that only 10% of physicians practice in rural areas, that Stark laws (prohibitions against self-dealing) hamper telehealth, and that many rural hospitals have closed in recent years and many others are at risk of closure. Bottom line: rural America is older, sicker and poorer, ill equipped in primary care, penalized in Medicare reimbursement rules.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Managed Medicaid Oversight: A presentation (here) to MACPAC (the Medicaid and CHIP Payment and Access Commission) illustrates the challenges involved in federal and state oversight of managed Medicaid (private insurers with contracts to provide services and benefits to Medicaid patients). For appeals and grievances, “Considerable variation among states in how grievance and appeals data are used for oversight,” and “Little is known about how states use data to identify concerns or follow up with MCOs” [managed care organizations]. These questions discussed at the MACPAC meeting September 13 illustrate how rudimentary policy is in this area: “Where are national standards appropriate and where is state variation OK? How do we assess performance vs. compliance? Where is process review sufficient? Where is outcomes monitoring valuable? What data are needed for oversight? What metrics are appropriate? When is self-attestation sufficient? When are external audits appropriate?”
2017 Actuarial Report on the Financial Outlook for Medicaid: The Office of the Actuary at the Centers for Medicare & Medicaid Services issued (here) a report on the financial future of the program. The report noted that $582 billion was spent on services for 72 million Medicaid beneficiaries in 2016, including the 11 million “expansion adults” covered by 31 states under PPACA. The federal portion of Medicaid outlays were $368 billion, 63% of total Medicaid spending. Total expenditures for Medicaid are expected to top $1 trillion by 2026. The actuary cautions that, given CMS’ difficulty in gathering accurate data, projections may not be as credible as they have been in the past: the most recent CMS actual data relied on in the report is from 2013.
DRUGS AND DEVICES
Integrity of Clinical Trials Questioned: A study reported in Contemporary Clinical Trials (here) indicates that three quarters of participants in such trials lie about matters which may affect the trial outcomes. “Deceptive practices by participants in clinical research are prevalent. It has been shown that as high as 75% of participants withheld information to avoid exclusion from studies. Self-reported adherence has been found to be largely inaccurate. Overcoming deception is a critical issue, since the safety of study participants, the integrity of research data and research resources are at risk.”
EVENTS & MEETINGS
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, agenda 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, agenda 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: 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