DCMedical News: Tuesday, October 23, 2018
DCMedical News-DCMN
Washington, D.C.
Tuesday, October 23, 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:
November 6, In the Campaigns: By the end of this week, voting will have begun in 32 states and in the District of Columbia.
Is health care the “top issue?” It depends on what you mean by “top issue”: a Kaiser Family Foundation poll found that Republican voters who said that health care was their “top campaign issue” meant something different than Democratic voters who cited health care. Eighteen percent of the Republicans meant repealing the Patient Protection and Affordable Care act (PPACA), while 23 percent of the Republicans meant addressing high health care costs. CQ reports that “While Republicans say they could revisit legislation to overhaul the law, they’re also doubling down on a commitment to guarantee coverage for people with pre-existing conditions.”
But look here: The Hill reports that “More than half of Republicans in a new American Barometer poll say they support ‘Medicare for all,’ also known as a single-payer health-care system. The survey, conducted by Hill.TV and the HarrisX polling company, found that 52 percent of Republicans polled said they supported the option, while 48 percent said they opposed it. Twenty-five percent said they ‘strongly’ supported ‘Medicare for all,’ while 27 percent said they ‘somewhat’ supported it.”
And where is U.S. District Judge Reed O’Connor (Texas v. Azar) who said in September that he would issue a ruling on the case invalidating much of PPACA as soon as possible?
HOSPITALS AND OTHER HEALTH CARE FACILITIES
More Trouble for Accreditation: Ashish Jha and colleagues in this week’s British Medical Journal find (study here, HealthcareDive report here) that “US hospital accreditation by independent organizations is not associated with lower mortality, and is only slightly associated with reduced readmission rates for the 15 common medical conditions selected in this study. There was no evidence in this study to indicate that patients choosing a hospital accredited by The Joint Commission confer any healthcare benefits over choosing a hospital accredited by another independent accrediting organization.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Waiver Guidance: New guidance issued by CMS would allow states to offer a wider variety of lower-cost health plans outside of those offered through the exchanges established by the Patient Protection and Affordable Care Act. Assistance could be given to association health plans and short-term limited duration plans.
The “State Relief and Empowerment Waivers” or SREW (CMS news release here, announcement by Administrator Verma here, fact sheet here, preliminary Federal Register notice here) would allow states significant flexibility in the use of subsidies, so long as they do not increase the federal deficit or cause more people to become uninsured. The emphasis appears to be on increasing the numbers of individuals covered, rather than on the comprehensiveness of that coverage. For example, plans can exclude coverage for pre-existing conditions.
The introduction to the new §1332 puts forward this analysis (footnotes omitted here, but available in the Federal Register publication here):
“After the Exchanges took full effect in 2014, individual market insurance companies began experiencing substantial losses. Industry analysts estimate aggregate losses reached $7.2 billion (10.1 percent of premiums) in 2015. In response to these losses, many issuers (some of whom entered the market as a result of the PPACA) left the market, including issuers participating on the Exchanges. The percentage of counties with one Exchange issuer grew from 7 percent in 2016 to 33 percent in 2017 and to 52 percent in 2018, representing 2 percent, 21 percent, and 26 percent of enrollees respectively . . . average premiums for individual market health plans sold through Healthcare.gov rose by 105 percent. While subsidized enrollment in Exchanges remains stable, overall enrollment on and off the Exchanges dropped between 2016 and 2017 by over 10 percent, reflecting a sizable drop in unsubsidized enrollment. Kaiser Family Foundation further found that individual market enrollment dropped 12 percent between the first quarter of 2017 and the first quarter of 2018. This drop represents deterioration in the individual market for people who pay the full premium. Some states experienced premium increases in excess of 200 percent between 2013 and 2017. States with larger premium increases also tended to experience larger enrollment declines, with a few states losing more than a third of the individual market in 2017. According to Kaiser, there were 14.4 million people enrolled in the individual market as of the first quarter of 2018, compared to 10.6 million people in 2013. This gain in enrollment has come at a significant cost to the federal government as CBO estimates the premium tax credits will total about $50 billion in 2018.”
The new guidance renames and supersedes the State Innovation Waivers published in the 12-16-2015 Federal Register (here). New legislation will not be required in §1332 waiver states. The new guidance is for plans beginning in 2020. CMS says it will distribute “waiver concepts” to suggest what states might apply for. Comments on the proposed regulation will be due two months from the planned Wednesday (10-24-2018) official Federal Register publication.
Regulation Schedule, Continued: The semi-annual list published for federal agencies, including the Department of Health and Human Services (here), has important proposals scheduled for the near future. Care Coordination: A “request for information regarding the anti-kickback statute and beneficiary inducements civil monetary penalties” (0936-AA10 in the linked schedule) contends that there is a need to modernize the fraud and abuse laws in order to achieve coordinated care and the shift to a value-based health care system. HHS is expecting to issue a proposed rule in December addressing "any undue regulatory impact and burden of the physician self-referral law."
DRUGS AND DEVICES
CMS Moves Forward With TAVR: CMS took steps toward paying for more hospitals to offer Transcatheter Aortic Valve Replacement, in which a prosthetic valve is inserted percutaneously using a catheter, and implanted in the opening of the aortic valve. As part of the process described in its May, 2012 payment for TAVR under “Coverage with Evidence Development” CMS has now identified the Medicare approved registry and Medicare approved clinical trials reviewed and determined to meet the requirements of coverage. Announcement here, decision memo here.
EVENTS & MEETINGS
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.
Oct. 30
2:00 p.m. to 3:30 p.m., HFMA webinar, “Developing a Pricing Strategy for the 2019 CMS Transparency Requirement,” information at www.hfma.org.
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: 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