DCMedical News: Wednesday, October 10, 2018
DCMedical News
Washington, D.C.
Wednesday, October 10, 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
Justice Kavanaugh, continued: InsideHealthPolicy publishes (here) another assessment of Justice Kavanaugh’s potential impact on key health policy cases coming before the Supreme Court. Also, this excerpt (italics) from DCMN of 7-11-2018 discusses the Justice’s potential impact on abortion, drug and device cases:
Abortion and Contraception: In Garza v. Hargan (here), a dissenting Judge Kavanaugh criticized fellow judges for allowing an abortion for an undocumented minor. In Priests for Life v. HHS (here) Judge Kavanaugh concluded that PPACA’s contraception coverage mandate infringed on the rights of religious organizations, although he also noted that government may have a role to play in access to contraception.
Drugs and Devices: In Abigail Alliance for Better Access to Developmental Drugs v. Eschenbach in 2007 (here) Judge Kavanaugh was part of an 8-2 majority upholding a ruling that terminally ill patients had no constitutional right to access unapproved drugs. In Cytori Therapeutics, Inc., v. FDA in 2013 (here), Judge Kavanaugh supported the FDA after the agency had denied fast-track approval for a device meant to extract stem cells from fat tissue, noting differences between already approved devices and those of Cytori. In Ivy Sports Medicine, LLC v. Mathews in 2014 (here) Judge Kavanaugh ruled against the FDA, noting flaws in the FDA’s decision to approve marketing rights for surgical mesh, and its failure to follow procedure in rescinding those rights.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
It’s National Health IT Week (October 8-12)
HOSPITALS AND OTHER HEALTH CARE FACILITIES
Are Safety Net Hospitals Poor Performers With Disadvantaged Populations? Not according to Krumholz and others in JAMA Network Open (here). The question presented: “To determine whether disparities [in outcomes] were concentrated in specific institutions or represented a more systemic problem, we used patient-level Medicare claims data to investigate differences in outcomes in acute myocardial infarction (AMI), heart failure (HF), and pneumonia within and between hospitals.” The result: “Hospital performance according to race and socioeconomic status was generally consistent within and between hospitals, even as there were overall differences in outcomes by race and neighborhood income. This finding indicates that disparities are likely to be systemic, rather than localized to particular hospitals.”
Rural Hospitals Push on Average Wage Index: An analysis (here) in Healthcare Financial Management shows that legislation favored by rural hospitals and “red” state Senators would increase the “floor” for hospitals in the South and Midwest. Losers would be hospitals in California, New York, Connecticut and Massachusetts. Eighty-seven rural hospitals have closed since January 2010.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Bundled Payments Experiment Draws a Crowd: CMS announced (here) “Today, the Centers for Medicare & Medicaid Services (CMS) announced that 1,299 entities have signed agreements with the agency to participate in the Administration’s Bundled Payments for Care Improvement – Advanced (BPCI Advanced) Model. The Model participants include 832 Acute Care Hospitals and 715 Physician Group Practices. Of note, BPCI Advanced qualifies as an Advanced Alternative Payment Model (Advanced APM) under MACRA, so participating providers can be exempted from the reporting requirements associated with the Merit-Based Incentive Payment System (MIPS).” The program will run until the end of 2023. BPCI-Advanced includes outpatient episodes, “target prices” (the amount CMS will pay for episodes of care, set at the start of each “model year.”) CMS continues, “BPCI Advanced will initially include 32 bundled clinical episodes - 29 inpatient and 3 outpatient. Currently, the top three clinical episodes selected by participants are: Major joint replacement of the lower extremity, congestive heart failure, and sepsis.”
Impact of PPACA on Small Business: The Commonwealth Fund has a new study (here) concluding that “Because of the creation of the individual marketplaces and the expansion of Medicaid, more entrepreneurs and small-business employees have health coverage than before the ACA was implemented. Indeed, the uninsured rate for small-business employees fell by almost 10 percentage points post-ACA. The ACA also has helped stabilize health costs for many small businesses that provide coverage, with the rate of small-business premium increases falling by half following implementation of the law.”
Impact of Opioid Bill on Medicaid Services: The Kaiser Family Foundation has a report (here) on the many provisions affecting Medicaid coverage in the recently passed opioid legislation.
Short Term Life for Short Term Plans? Forty-seven Senators have signed a discharge petition for SJRes 63, “A joint resolution providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Secretary of the Treasury, Secretary of Labor, and Secretary of Health and Human Services relating to ‘Short-Term, Limited Duration Insurance'.” The final rule is here.
PHARMA
Managing Prescription Opioid Use in Medicare Part D: MedPAC tackled this problem October 4 (slide presentation here). Among the issues: aggressive opioid marketing, ambiguity about safe prescribing, and evidence of overuse, misuse and fraud in Part D. Nearly 1 in 3 Medicare enrollees had at least 1 opioid prescription in 2016, down 18% since 2012, 90% of which are unrelated to cancer care. Opioid prescription users were also higher users of drugs overall (70 annual fills vs. 40 for the average, and in twice the number of drug classes). Plan sponsors (insurers managing Part D plans) may limit access beginning in 2019 through “drug management programs” for “at-risk” enrollees.
EVENTS & MEETINGS
Oct. 10
“America’s Physician Groups” (APG) has its “Colloquium 2018” through October 12 in Washington (information here) on “The Essentials of Value-Based Care.” APG claims 300 member groups in 44 states “practicing capitated, clinically integrated care.”
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. 16
1:30-2:45 p.m., Potential Midterm Election Implications for Health Care, Alliance for Health Policy Webinar, for information contact Ann Nguyen at anguyen@allhealthpolicy.org.
Oct. 18
3:00-4:40 p.m., CMS Administrator Seema Verma at Brookings on Medicare Part D, followed by a panel (Kavita Patel, Samuel Nussbaum and others).
Information at: https://www.brookings.edu/events/a-conversation-with-seema-verma/
Oct. 19
12:00-1:30 p.m. (lunch at 11:30 a.m.), Flexibility and Innovation in Medicaid, Congressional Briefing, Alliance for Health Policy, for information contact Ann Nguyen at anguyen@allhealthpolicy.org.
Oct. 24
9:00-10:15 a.m., Health Policy in the Polls, Reporter Breakfast, Alliance for Health Policy, for information contact Ann Nguyen at anguyen@allhealthpolicy.org.
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.
Nov. 8
Through Nov. 13, 2018 AMA Interim Meeting, Gaylord Convention Center, National Harbor, Maryland
Dec. 4
9:00 a.m., CMS sponsors a “Town Hall” meeting “to discuss fiscal year (FY) 2020 applications for add-on payments for new medical services and technologies under the hospital inpatient prospective payment system (IPPS). Registration required by 11-19-2018, Federal Register notice here.
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: 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