DCMedical News: Monday, October 22, 2018
DCMedical News-DCMN
Washington, D.C.
Monday, October 22, 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:
Gone Home: News organizations report that both the House and the Senate have gone home to campaign. However, the Senate calendar (here and here) shows activity this week. DCMN will follow the calendars, with a final pre-mid-term edition this Friday, October 26, resuming publication when Congress returns for its post-election (“lame duck”) session November 13.
November 6, In the Campaigns: The Senate Majority leader indicates (here) that, with enough seats in Congress after the mid-term elections, he would try again for “Obamacare repeal.” And the growing deficit? The fault of social programs, Social Security and Medicare. The Wall St. Journal reports (here) on Medicaid-expansion fights pitting hospitals and labor against tobacco companies, which would be taxed in some Medicaid expansion proposals. CQ Magazine reports (here) that “For all the talk about health care this election season, politicians of both parties are ignoring a giant sucking sound,” that is, health care costs “draining revenues and raising deficits.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Hospital Executive Compensation a Continued Irritant to Physicians: A study in Clinical Orthopaedics and Related Research (here) found increasing “wage gaps.” “The wage gap between hospital CEOs and orthopaedic surgeons increased from 3:1 in 2005 to 5:1 in 2015. The wage gap between hospital CFOs and orthopaedic surgeons increased from 1.5:1 in 2005 to 2.2:1 in 2015. The wage gap between hospital executives and pediatricians and registered nurses increased at an even greater rate. The wage gap between hospital CEOs and pediatricians increased from 7:1 in 2005 to 12:1 in 2015. The wage gap between hospital CEOs and registered nurses increased from 23:1 in 2005 to 44:1 in 2015. The wage gap between hospital CFOs and pediatricians increased from 3:1 in 2005 to 5:1 in 2015. The wage gap between CFOs and registered nurses increased from 11:1 in 2005 to 19:1 in 2015.”
Facts and Faxes: Medical Economics (here) puts the spotlight on the fax machine, the one indispensable device available to physicians for the accurate and focused transmission of patient information. The fax is (a) under attack from CMS whose administrator has announced that physicians should stop using them by 2020; (b) “a vital part of getting the information needed to provide quality care”; (c) more highly rated by practicing physicians than their EHR devices; (d) less time-consuming than logging on for possibly hundreds of pages of unneeded data; (e) less susceptible to wholesale identity theft; or (f) all of the above.
HOSPITALS AND OTHER HEALTH CARE FACILITIES
More on Variation: Desai, Krumholz and colleagues at Yale study variation in care of and payment for patients with acute myocardial infarction (MI), heart failure (HF) and pneumonia (PNA) (here). The study sample was large (4,300 or more hospitals for each diagnosis). The study purpose: a study of 30-day risk-standardized mortality rates (RSMRs) and risk-standardized payments (RSPs) to “identify hospital characteristics associated with high-value care.” The main finding? “A statistically significant but weak inverse correlation between RSMR and RSP” for all three conditions, or, stated in the alternative, “[H]ospitals with higher spending intensity had lower rates of 30-day mortality” and “[T]hat there are instances where greater resource use may lead to improved quality and outcomes.” But also, “The lack of a strong association between RSMRs and RSPs for AMI, HF, and PNA highlights the opportunity to improve efficiency and value in health care.”
Psychiatric Patient Boarding in the Hospital Emergency Department: Stat reports (here) that “Mental health patients, with nowhere else to go, are overwhelming emergency departments.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
MACPAC Meets as Medicaid Issues Heat Up: The Medicaid and CHIP Advisory Commission will meet this Thursday (the 25th) and Friday (the 26th) (agenda here) as Medicaid expansion, work rules and access to services are discussed in mid-term election contests. On the MACPAC discussion docket: DSH (Disproportionate Share Hospital) allotments, and “policy options for structuring DSH allotment reductions.” Also, work and community requirements in Arkansas. The “public charge” (proposed rule here) and its effect on Medicaid and CHIP will be discussed Thursday afternoon. (See DCMN 9-26 and 9-28 for more on the “public charge,” a change in the rules for entry into the country or obtaining and retaining a “green card” for those who may become a “public charge” by using Medicaid or other federal low income subsidy programs.) Also on Thursday, discussion of Medicaid in Puerto Rico and Medicaid drug coverage compared to Medicare Part D and commercial drug plans. The Friday morning session will focus on the states, with two panels on dual eligibles (Medicaid and Medicare) and enrollment processes.
Meanwhile, Drug Prices may Increase for Medicaid: Stat+ reports (here) that “The White House on Wednesday provided the clearest evidence yet that, eventually, some drug makers might not have to cut Medicaid the best deal on prescription drugs. It would be a big win for drug makers, who say the current rules — which require every drug company to give Medicaid programs the lowest possible price, or ‘best price,’ for any drug they sell — don’t give them the flexibility to test new payment ideas, like paying for drugs based on how well they work.” The proposal was included in the fall 2018 list of upcoming regulations (list here, see DCMN 10-19-2018).
READING AND REFERENCE
The MOC Fight: An exploration of legislative opposition to the “Maintenance of Certification” requirement for board certified physicians (see DCMN 10-17-2018), from Medical Economics, here).
EVENTS & MEETINGS
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: 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