DCMedical News: Friday, Sept. 28, 2018
DCMedical News
Washington, D.C.
Friday, Sept. 28, 2018
DCMedical News is published every day either the House or the Senate is in session. Unpaid “subscriptions” will be removed from our mailing list at the end of each month. To subscribe, please see below.
THE BIG STORY TODAY IN HEALTH CARE
Kavanaugh Hearing: Following a nearly nine-hour hearing Thursday, the Judiciary Committee will vote on Judge Kavanaugh’s nomination to the Supreme Court this morning.
“Public Charge” Alarm Grows: Scrutiny and controversy grows concerning the proposed rule (here) to deny immigrants green cards if they have used Medicaid, Medicare Part D low income subsidies, or other public programs. The Kaiser Family Foundation has a background paper (here), Health Affairs has an article on the health impact of the proposed rules change, (here), in addition to trade and professional society statements (e.g., Association of American Medical Colleges, here).
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Survey of Doctors by The Physicians Foundation, continued: The advocacy group in its sixth survey of physicians (here) found support for reversal of policies currently pursued at the federal level. Sources of physician dissatisfaction as reported in an article on the survey in Forbes: “To no one’s surprise, the EHR design and interoperability problem was named by 39.2 percent in 2018 as the chief culprit, compared to 26.8 percent in 2016, clearly indicating that the issue of EHRs is getting worse. A full 65.7 percent felt that EHRs have reduced or detracted from patient interaction and another 56 percent believe that efficiency was likewise reduced. Only 28.6 percent of respondents actually attributed improved quality of care to EHRs. Typical of the physician comments were: ‘The EHR has shifted non-clinical work to the physician and has created more face-time with the computer than with patients. With EHRs, I can’t see as many patients as I used to. Requirements such as e-prescribing, PQRS, MIPs, etc. only slow me down, decrease the quality time I can spend with my patients, and don’t have a benefit for me or my patients.’ In second place, at 37.6 percent, were regulatory/insurance requirements, a standard daily aggravation to physicians since our first survey in 2008. As one physician included very succinctly in his comments: ‘I do more paper care than patient care!’ The third least satisfying factor about medical practice was the loss of clinical autonomy at 37 percent.”
HOSPITALS AND OTHER HEALTH CARE FACILITIES
Maternal Mortality Examined in the House: Grants would be given to develop or support maternal mortality review committees in legislation under consideration at the House Energy and Commerce Subcommittee on Health. The Subcommittee heard testimony on maternal mortality Thursday from Charles S. Johnson, IV., Founder, 4Kira4Moms, (here); Stacey D. Stewart, President, March of Dimes, (here); Lynne Coslett-Charlton, M.D., Pennsylvania District Legislative Chair, The American College of Obstetricians and Gynecologists, (here); and Joia Crear Perry, M.D., Founder and President, National Birth Equity Collaborative, (here).
A background briefing paper from the Subcommittee staff (here) reports that: “Although the pregnancy-related mortality ratio fell in the U.S. during the 20th century, more recently over the last two decades, the number of American women who die each year from a pregnancy-related cause has increased dramatically. Since the Pregnancy Mortality Surveillance System was implemented, the number of reported pregnancy-related deaths in the nation has steadily increased from 7.2 deaths per 100,000 live births in 1987 to a high of 17.8 deaths per 100,000 live births in 2009 and 2011. More recent data is even more alarming. A 2015 World Health Organization (WHO) report pointed out that the U.S. has a high maternal mortality rate and that half of the U.S. deaths were preventable. In addition, a 2016 report in the Journal of Obstetrics & Gynecology found that from 2000 to 2014, the maternal mortality rate for 48 states and Washington, D.C. increased nearly 27 percent from close to 18.8 deaths per 100,000 live births in 2000 to 23.8 deaths per 100,000 live births in 2014.” A review/editorial on the subject in JAMA is found here.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
What’s the Problem with Medicare Advantage Appeals and Audits? HHS’ Office of Inspector General (OIG) reported (here) that Medicare Advantage Organizations (MAOs) may have trouble managing appeals by enrollees, and audit shortcomings. They wrote, “A central concern about the capitated payment model used in Medicare Advantage is the potential incentive for MAOs to inappropriately deny access to services and payment in an attempt to increase their profits. An MAO that inappropriately denies authorization of services for beneficiaries, or payments to health care providers, may contribute to physical or financial harm and also misuses Medicare Program dollars that CMS paid for beneficiary healthcare. Because Medicare Advantage covers so many beneficiaries (more than 20 million in 2018), even low rates of inappropriately denied services or payment can create significant problems for many Medicare beneficiaries and their providers.”
OIG recommended “that CMS (1) enhance its oversight of MAO contracts including those with extremely high overturn rates and/or low appeal rates and take corrective action as appropriate; (2) address persistent problems related to inappropriate denials and insufficient denial letters in Medicare Advantage; and (3) provide beneficiaries with clear, easily accessible information about serious violations by MAOs. CMS concurred with all three recommendations.”
Premium Expense on the Exchanges Will Go Down by 2% in 2019 According to HHS Secretary Azar: Speaking to the Nashville Health Council, the Secretary indicated that premium expense has stabilized, notwithstanding the many changes in 2017 and 2018 in the Patient Protection and Affordable Care Act.
Premium Expense on the Exchanges Will Go Up by 3% According to Consulting Firm Avalere Health: 47-state survey (here) shows premiums going up overall, but down in a dozen states and in the District of Columbia.
The Passing of an Era in Social Security, and an American Hero: Rep. Sam Johnson, retiring as Chair of the Subcommittee on Social Security of the House Ways and Means Committee, opened his last hearing Thursday. In his 23 years on the Committee, and seven years as Subcommittee Chair, Mr. Johnson focused on modernization of the disability program, combatting fraud and guarding against identify theft. With his colleague John Larson of Connecticut, Mr. Johnson oversaw passage of the Strengthening Protections for Social Security Beneficiaries Act of 2018, to protect Social Security beneficiaries who are unable to manage their own benefits. Mr. Johnson’s distinguished Air Force career included seven years as a prisoner of war, including 42 months in solitary confinement.
READING AND REFERENCE
Final Federal Register Publication of FY 2019 Rules (Effective Dates for the regulations October 1, 2018, although some provisions are effective January 1, 2019): Hospital IPPS, here; Hospice payment, here; Inpatient psychiatric payment, here; Inpatient rehabilitation payment, here; and Skilled nursing facilities, here.
EVENTS & MEETINGS
Oct. 15
4:05-5:45 p.m., HHS Secretary Azar on “Affordable Medicines: Access, Innovation and the Public Interest,” at the National Academy of Medicine, Washington, DC.
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
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