DCMedical News: Friday, October 19, 2018
DCMedical News-DCMN
Washington, D.C.
Friday, October 19, 2018
DCMedical News is published every day either the House or the Senate is in session. See scheduled sessions at the bottom of this newsletter. To ensure continued receipt of your copy please subscribe.
The Big Story in Health Care:
Are the Voters Right? Or are the Candidates? “Health Care is a Key Issue in Mid-Term Elections,” or Not: The Kaiser Family Foundation election tracking poll (press release here, report here) found health care to be voters’ “number one” issue, with 71% describing health care as “very important.” Despite health care’s reported significance in polling, “fewer than half of voters say they are hearing ‘a lot’ from candidates about specific health care issues.” Immigration is the issue that a majority of voters (58%) say they are hearing “a lot” about; half (51%) say they are hearing a lot about candidates’ support for or opposition to President Trump.” The health care issues that voters say they are hearing about from candidates include the opioid epidemic (38%), the Affordable Care Act (35%), pre-existing conditions (23%) and Medicare-for-all (17%).
HOSPITALS AND OTHER HEALTH CARE FACILITIES
CMS Requirement for Posting Hospital Prices as of January 1, 2019: The new requirement is leading to confusion, as shown by postings and interactions on the chief financial officer forum of the Healthcare Financial Management Association. (See pg. 2141 of the final 2019 Inpatient Prospective Payment System rule, here.) HFMA author Jamie Cleverley, president of Cleverley & Associates, writes that “CMS does not define ‘standard charges’ in the rule or in the responses to FAQs. However, we know that they are looking for list price and not reimbursement because they are looking for chargemaster information which contains the gross charge. Beyond that, though, there is no definition.” Cleverly adds that “A hospital could consider the following: Its default price; Its average price; Its most common price; Its highest price (this way a patient would never be shocked by something higher); Its lowest price (this, typically, outpatient price would likely be the lowest and the most preferable to report. While likely not the most commonly charged, it would likely be the most commonly charged for patients that are interested in shopping and where the price will likely make a difference.” (See below under Events, October 30.)
Group Purchasing Organizations: Lots of evidence, no indictment. Hard-hitting Hopkins researcher Martin Makary puts forward a summary of the few studies done of the hospital Group Purchasing Organization (GPO) industry. Makary and colleagues write (in JAMA, here) that “[T]he US Senate Finance Committee reported in 2010 that there was no empirical, peer-reviewed data to support GPO industry claims that these organizations generate hospital cost savings. In addition, a 2011 study of 8100 hospital purchases not mediated through a GPO found that hospitals negotiated lower prices compared with GPOs in 3 of 4 purchases and had an average savings of 10%. The authors from that study concluded, in another report from 2010, that payments from manufacturers to GPOs inflated health care costs up to an estimated $37.5 billion annually, including an estimated $17.3 billion in government payments for Medicare and Medicaid.” But the authors pull back from any recommendations, and neglect to mention the close financial association of GPOs, hospital trade associations and hospital industry executives.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
OIG Reports on States’ Responses to Medicaid Data Breaches: The HHS Office of the Inspector General released a report (here) on Medicaid data breaches. Was it hacking by a foreign power? Or incompetent management of paperwork? In a prior review of 1,260 State Medicaid agency data breaches OIG found that “The characteristics of these breaches varied widely, but they typically affected few beneficiaries; often resulted from misdirected communications, such as letters and faxes; and exposed beneficiaries’ names and Medicaid or other identification numbers. Breaches that resulted from hacking or other IT incidents were rare.” OIG notes that there is no incentive to manage otherwise: “Although CMS advised States in a 2006 State Medicaid Director Letter to report breaches to CMS, most States told us that they do not routinely inform CMS of Medicaid breaches that they or their contractors experience.”
DRUGS AND DEVICES
Another 340B Angle: A study in Health Services Research (here) finds that the 340B drug discount program for hospitals “creates financial incentives for 340B hospitals to change practice patterns to maximize the population receiving 340B drugs without using the increased revenue from the associated 340B subsidies to benefit low-income patients.” The study focused on cancer drugs, and concluded that “The probability of a patient receiving cancer drug administration in hospital outpatient departments (HOPDs) versus physician offices increased 7.8 percentage points more in new 340B markets than in markets with no 340B hospital. Per patient spending on other cancer care increased $1,162 more in new 340B markets than in markets with no 340B hospital . . . The 340B program shifted the site of cancer drug administration to HOPDs and increased spending on other cancer care.”
READING AND REFERENCE
HHS Semi-Annual Rule List: Two pages of proposed rules anticipated to be published or finalized by the Department of Health and Human Services this fall, three dozen of them for CMS, here.
EVENTS & MEETINGS
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. 22
8:00 a.m., Health Care Payment Learning and Action Network (LAN) holds its 2018 fall summit, top speakers (McClellan, Azar, Verma, Boehler and Conway, former and current CMS, HHS and CMMI leaders), information at https://www.lansummit.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
Nov. 27
9:00 a.m., Duke Margolis Center on “Root Causes of Drug Shortages and Finding Enduring Solutions,” Washington Marriott Metro Center, (McClellan, Gottlieb, FDA panel), agenda here.
Nov. 28
10:00 a.m., Senate HELP Committee Hearing: Reducing Health Care Costs: “Improving Affordability Through Innovation,” 430 Dirksen Senate Office Building, announcement here.
Nov. 29
The “Office of the National Coordinator” annual meeting, continuing November 30, two day tentative agenda (Jared Kushner!) here.
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
These publication dates are the days the House or the Senate is in Session.
October publications dates: 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