DCMedical News: Wednesday, October 3, 2018
DCMedical News
Washington, D.C.
Wednesday, October 3, 2018
DCMedical News is published every day either the House or the Senate is in session. To subscribe, please see below.
THE BIG STORY TODAY IN HEALTH CARE
MIPS: Participation High, Satisfaction Low: At the Medical Group Management Association annual meeting in Boston the consensus on results from the Merit-based Incentive Payment System was meh, not worth it, according to reports in FiercePracticeManagement (here). Scores from 2017 which will be reflected in 2019 payments suffered from high participation rates: “In 2017, the first year of the program, CMS estimated that 91% of eligible physicians participated in the payment program. That kept them from avoiding a penalty that would have resulted in a 4% cut in their Medicare reimbursement—money that would have funded incentive payments to others.” Budget neutrality mandated that, without enough losers, there were few winners: “Doctors who scored the maximum 100 points under MIPS received only a 2.02% positive payment adjustment.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
And Another Thing: Physicians and physician groups reacted to the proposed FY2019 Medicare physician fee schedule rule (here) with more than 15,000 comments. The comment period closed September 10, and all of the comments are here: https://www.regulations.gov/docketBrowser?rpp=50&so=DESC&sb=commentDueDate&po=0&dct=PS&D=CMS-2018-0076.
The comments can be exported to an Excel file (here), and each comment accessed with its own URL. The first comment, from a doctor in New Jersey, reads as follows: “Decrease in reimbursement for cognitive care is NOT appropriate. Decreased documentation requirements would not change our documentation need without eliminating malpractice risk. I would seriously consider cutting my Medicare panel if this would occur.” And 15,315 more.
HOSPITALS AND OTHER HEALTH CARE FACILITIES
Price Transparency an Elusive Goal for Hospitals: CMS has published an FAQ (here) on the January 1, 2019 requirement that hospitals publish on the internet their chargemaster prices. (XML is okay, PDF is not—the posting needs to be “machine readable.”) A study of one set of prices (for Total Hip Arthroplasty) in JAMA Internal Medicine (here) examined the question, noting “it is unclear whether increasing interest in price transparency has translated into tangible improvements in the ability of hospitals to provide price information. We examined whether a group of 122 hospitals we originally surveyed in 2016 had improved in their ability to provide price for a total hip arthroplasty (THA) when resurveyed in 2016.” The results were not positive: “We found no evidence of improvement in hospitals’ ability to provide price estimates or reductions in the estimated price for THA between 2012 and 2016. Our results provide sobering evidence that substantial efforts from government and industry to improve pricing transparency have had little tangible effect on availability of prices.”
Nursing Home Occupancy Drops. May Plummet Further: A profile of the industry in The New York Times (here) says that “In the nursing home, [there are] empty beds and quiet halls.” A drop from nearly 90% occupancy (historical average) to 80%, and in many homes to 70%, has taken place even in the face of an aging population, a consequence of changing federal policy. Where Medicare would pay for short-term rehabilitative care in nursing homes after a hospital stay, it won’t pay for patients who have been in hospitals “under observation,” a frequent designation of patients by hospitals eager to minimize or avoid financial penalties for readmissions. Where skilled nursing homes would have been used for recovery subsequent to inpatient surgical procedures, Medicare won’t pay for SNF coverage following outpatient procedures, although the diagnosis and surgery may be identical in both settings. Where 90% of Medicaid long-term care funds formerly went to skilled nursing facilities, with 10% to home and community-based services, nursing homes now receive only 43% of Medicaid long-term care expenditures. A peril to the remaining patients: a declining level of staffing since, as with hospitals, there is no federal or (almost any) state statutory minimum staffing requirement.
If You Are Not Having an Emergency, Don’t Use an Ambulance: Advice underscored in Austin Frakt’s New York Times “Upshot” of October 2nd (here). Affordable transportation to health care is a barrier, too often overcome by ambulance rides paid for by insurance, compared to Uber, Lyft or other commercial rides not paid for by insurance. Uber Health and Lyft Concierge are looking for that market. Frakt notes that one study found that the Patient Protection and Affordable Care Act, by expanding coverage and financial access to ambulance rides (including non-emergent purposes) slowed ambulance response times by almost 20%.
Jump the Liver Transplant Queue at UPMC: The University of Pittsburgh Medical Center put a full-page ad in The New York Times urging prospective liver transplant recipients to “stop waiting and get out of line now.” “As transplant pioneers,” says the ad, “UPMC leads the nation in living donor liver transplants. What are you waiting for? Get the facts at lifechangingliver.com.”
Another Behavioral Economics Problem? USA Today (here) reports massive cancellation of radiology examination orders at multiple Veterans Administration hospitals. “VA hospitals came under increasing pressure to address outstanding diagnostic orders after a conference call that national officials convened with radiology managers across the country in January 2017. More than 325,000 orders for scans of veteran patients had not been completed nationwide.” The mass cancellation recalls the “workaround” of primary care physician appointments at the Phoenix VA hospital and other VA hospitals in 2014, leading to the resignation of decorated war hero and Secretary of Veterans Affairs Eric Shinseki. In that 2014 investigation managers in the VA system were found to have been pressuring front line schedulers, in hopes of achieving bonus payments (“incentives”) for reducing the primary care appointment backlog.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Supremes to Hear Medicare Appeal: The Supreme Court will hear a Medicare appeal case (Azar v. Allina Health Services) involving the question of whether CMS can make policy through “interpretive rules,” or, in the alternative, whether “notice and comment” (through the Administrative Procedures Act) is required. The case (docket log with links to appeal documents here) will be the first Medicare-related case the Court has taken up in five years, and comes after a decision favorable to the hospitals in the DC Circuit Court, including Judge Brett Kavanaugh in the majority. The hospitals bringing the case alleged that CMS undercounted their number of Medicare beneficiaries, thus affecting DSH (Disproportionate Share Hospital) calculations. The question presented to the Supreme Court, however, is limited as follows: “Whether Section 1395hh(a)(2) requires HHS to conduct notice-and-comment rulemaking before providing instructions to a Medicare Administrative Contractor that makes initial determinations of payments due under Medicare, when those instructions rest on a non--legally-binding administrative interpretation of a relevant statutory provision.” (See also DCMN 7-11-2018, on Judge Kavanaugh’s opinions on administrative and regulatory matters, here.)
CMS Promotes Medicare Advantage and Part D: As noted in DCMN 10-2, CMS has given additional emphasis to enrolling Medicare beneficiaries in Medicare Advantage programs during the current “open enrollment” period (those eligible choose to remain in traditional Medicare or sign up for one of the commercial MA alternatives). The CMS “landscape” description for MA and Part D (here) is also extolled by the Chairman of the House Ways and Means Committee (here).
Commonwealth Fund Develops Exchange Insurance and Medicaid Map: The state of health care coverage and access is shown in one-page state profiles (example here, Texas; all states, here) showing the number of uninsured adults before and after the Patient Protection and Affordable Care Act, the number of adults who went without care because of cost, “marketplace” and Medicaid enrollment and the total change in federal dollars spent for health insurance in the state.
EVENTS & MEETINGS
Oct. 3
National Association of Accountable Care Organizations Fall 2018 Conference, Washington, DC, through Oct. 5, agenda here: https://www.naacos.com/agenda-fall-2018
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. Additional information 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
October publications dates: 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