DCMedical News: Monday, October 15, 2018
DCMedical News
Washington, D.C.
Monday, October 15, 2018
DCMedical News is published every day either the House or the Senate is in session. See schedule session at the bottom of this newsletter. To ensure continued receipt of your copy please subscribe.
THE BIG STORY TODAY IN HEALTH CARE
Open Enrollment (Starts Today!) Favors Medicare Advantage Plans, But the Inspector General has Reservations: CMS released the Medicare Advantage (MA) “star” ratings in time for the open enrollment period, which begins today and ends December 7. The CMS “star” statement (here) said: “Each year, CMS publishes the Part C and Part D Star Ratings to measure the quality of, and reflect the experiences of beneficiaries in, Medicare Advantage and Part D prescription drug plans . . . Based on current enrollment, approximately 74 percent of Medicare Advantage enrollees with prescription drug coverage are projected to be in plans with four and five stars in 2019 as compared to 73 percent in 2018. Approximately 45 percent of Medicare Advantage plans that offer prescription drug coverage will have an overall rating of four stars or higher in 2019.”
As noted by Robert Pear in the NY Times (here), however, violation of Medicare rules and audit violations by the MA plans are no longer included in development of the (one to five) star ratings. There are plenty of other problems with MA plans, as well, says Pear. He cites as his primary authority a new Department of HHS Inspector General’s report (here) which says that the plans have an incentive to deny claims “in an attempt to increase their profits.” The IG’s report went on to describe “widespread and persistent problems related to denials of care and payment in Medicare Advantage.” (Discussion of this OIG report will also be found in DCMN of 9-28-2018.)
This year there is a perceived “thumb on the scale,” favoritism to the MA plans, that is, reasons provided by CMS which would persuade a beneficiary to leave traditional Medicare and enroll with an MA plan. Those reasons include a reduction in some payments which are the responsibility of the enrollee, made possible by significant increase in CMS payment to the private plans and relief to the plans from a health insurance tax. In addition, CMS has provided flexibility for the MA plans (but not for traditional Medicare) to pay for medically related transportation, home delivery of hot meals and home safety features. CMS denies steering Medicare enrollees to MA plans. Also, MA plans (unlike traditional Medicare, at least for the most part) can shift financial risk to participating physicians (see DCMN of 10-11-2018, here, and Kaiser Health News report, here). The bias is not an accident, but rather a policy priority, as noted in an announcement (here) from the Chairman of the House Ways and Means Committee. Unrelated but possibly important to enrollees: STAT+ reports (here) on MA plans taking advantage of a “step therapy” option for drugs.
Information on premiums and costs of 2019 Medicare plans can be found at https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovGenIn/index.html. To see how the star ratings are developed go to this address: https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovGenIn/PerformanceData.html
HOSPITALS AND OTHER HEALTH CARE FACILITIES
The Bottom Line on Electronic Health/Medical Records: Modern Healthcare’s cover story asks (here), “What is the Point of EHR?” and reports that “EHRs still cause operational and financial headaches, while benefits are slow to materialize.” The articles cites a recent literature review in the Journal of the American Medical Informatics Association as saying “Although no one suggested going back to paper, this study provides evidence that data entry requirements, inefficiently designed user interfaces . . . information overload and interference with the patient-physician relationship are . . . factors associated with physician stress.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
How Do Medicaid Programs Set Hospital Payment Rates? Interviews in a report (here) to MACPAC (the Medicaid and CHIP Payment and Access Commission) collected insights from Arizona, Louisiana, Michigan, Mississippi and Virginia. Three themes emerged, according to the authors: uncertain financing for the non-federal share of Medicaid payments affects the rates; Medicaid managed care has had little effect on Medicaid payment rates to hospitals, at least in these states; and state representatives would like to adopt “more sophisticated payment models,” such as “value-based payment.”
Unified Payment for Post-Acute Care: A likely candidate for further MedPAC and ultimately Congressional review in 2019. MedPAC staff presented current thinking on such a “unified” payment plan to the Congressional advisory group on October 5 (slides here). Medicare fee for service spending on home health, skilled nursing, inpatient rehabilitation and long term acute care was $60 billion in 2016. The “unified” post-acute care prospective payment system (PAC PPS) would have a uniform unit of service; a base rate adjusted using patient and stay characteristics; payments adjusted for home health (less expensive) episodes; and short and high cost outlier policies. The point? “Equity of payments across conditions would increase compared to current policy,” and a unified PAC “would discourage overuse of care, stinting on services and shifting of care to other providers.”
READINGS AND REFERENCES:
Wesleyan Media Project Analysis of Mid-Term Campaign Advertising, here: “Pro-Democratic airings continue to concentrate on healthcare, with one in every two mentioning the subject, and a fifth of those healthcare ads (10 percent of overall airings) explicitly defend the Affordable Care Act (ACA) and/or attack Republican health reform attempts. Pro-Republican airings continue to split their time between taxes (32 percent, roughly a third of which tout the 2017 tax bill) and healthcare (28 percent), with immigration (17 percent) and jobs (15 percent) fading a bit to third and fourth in the set.”
“No Silver Bullet for the Drug Pricing Conundrum,” CQ Magazine feature, 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. Additional information here.
Oct. 16
9:30 a.m., U.S. Chamber of Commerce seventh annual Health Care Summit, press invited at 202-463-5682.
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: 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