DCMedical News: Wednesday, October 24, 2018
DCMedical News-DCMN
Washington, D.C.
Wednesday, October 24, 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: Mid-term elections (November 6), Medicare open enrollment (through 12-7), open enrollment for individual market coverage for 2019 (through 12-15).
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
California’s Success in Limiting Maternal Mortality: Stateline reports (here) that “The United Health Foundation, which ranks states according to various health indices, using primarily a five-year average of federal data from 2011 to 2015, put the U.S. maternal mortality rate at 20.7 per 100,000 live births and California’s at 4.5.”
HOSPITALS AND OTHER HEALTH CARE FACILITIES
Anthem in the Emergency Room: A report in JAMA Network Open (here) says “Insurers have increasingly adopted policies to reduce emergency department (ED) visits that they consider unnecessary. One common approach is to retrospectively deny coverage if the ED discharge diagnosis is determined by the insurer to be nonemergent.” The findings of the study were that one “insurer’s list of nonemergent diagnoses would classify 15.7% of commercially insured adult ED visits for possible coverage denial. However, these visits shared the same presenting symptoms as 87.9% of ED visits, of which 65.1% received emergency-level services.” The study conclusion was that “A retrospective diagnosis-based policy is not associated with accurate identification of unnecessary ED visits and could put many commercially insured patients at risk of coverage denial.”
Got 22GB to Spare on Your Computer? You will need them all to analyze the HCUP (Hospital Cost and Utilization Project, overview here) 2016 emergency department (ED) files. HCUP says the file of 31 million ED visits—results projected to the estimated 143 million ED visits that year—is the largest all-payer ED database in the United States that is publicly available. Data elements include: all of the “clinical and resource-use information that is included in a typical discharge abstract . . . composed of more than 100 clinical and nonclinical variables for each hospital stay. These include: ICD-10-CM/PCS diagnosis, procedure, and external cause of morbidity codes; ICD-9-CM diagnosis, procedures, and external cause of injury codes; Current Procedural Terminology, Fourth Edition procedure codes on ED visits that do not result in an admission to the same hospital; Identification of injury-related ED visits including mechanism, intent, and severity of injury, based on ICD-9-CM coded data only; Admission and discharge status; Patient demographic (e.g., sex, age, urban-rural designation of residence, national quartile of median household income for patient's ZIP Code); Expected payment source (e.g., Medicare, Medicaid, private insurance, uninsured, and other insurance type); Total ED charges (for ED visits) and total hospital charges (for inpatient stays for ED visits that result in admission); (and) Hospital characteristics (e.g., region, trauma center indicator, urban-rural location, teaching status).”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
New Rules for Health Reimbursement Arrangements (HRAs): The Departments of Treasury, Labor and Health and Human Services published (here, 209 pages) new proposed rules on HRAs and other account-based group health plans. The rules would allow employers to utilize health reimbursement arrangements to pay for their workers’ health plans in the individual market, on or off the Obamacare exchanges. Employers that offer traditional group coverage could also offer, as an additional benefit, up to $1,800 per year to cover out-of-pocket worker expenses.
Estimates are that 10 million employees will eventually obtain health insurance coverage through HRAs; of this number, one million may be individuals who are currently uninsured. One theme promoted by the administration is that, taken in concert with association health plans and short term limited duration health insurance, options for lower cost coverage have been expanded. The proposed rule, to be formally published in the Federal Register October 29, would also include employer payment plans (the employer reimburses an employee for some or all of the premium expenses of individual health insurance coverage; arrangements under which an employer pays a premium directly for individual health insurance coverage; health flexible spending arrangements, and other, similar plans. The supplemented plans would include both underwritten and self-insured group health plans.
The proposed rules would expand the use of HRAs in several ways. First, the proposed rules would remove the current prohibition against integrating an HRA with individual health insurance coverage. “The Departments are of the view that allowing HRAs to be integrated with individual health insurance coverage could result in opportunities for employers to encourage higher risk employees (that is, those with high expected medical claims or employees with family members with high expected medical claims) to obtain coverage in the individual market, external to the traditional group health plan sponsored by the employer, in order to reduce the cost of traditional group health plan coverage provided by the employer to lower risk employees.” But the proposed regulations would “prevent a plan sponsor from intentionally or unintentionally, directly or indirectly, steering any participants or dependents with adverse health factors away from the plan sponsor’s traditional group health plan and into the individual market. In particular, the proposed integration rules prohibit a plan sponsor from offering the same class of employees both a traditional group health plan and an HRA integrated with individual health insurance coverage.”
READING AND REFERENCE
Axios on Investments in Fertility Technology: Axios reports that “The number of babies born per U.S. woman has dropped from 3.58 to 1.89 in the last half century. But women still want help getting pregnant — and answers about their health outside the doctor's office.” Report on investment in new technology here.
Obesity: In 2012 no state had more than 35% of its population characterized as obese; now 7 do. CDC reports in JAMA (here) that “Alabama, Arkansas, Iowa, Louisiana, Mississippi, Oklahoma, and West Virginia all had obesity rates of more than 35% in 2017. Colorado (22.6%), District of Columbia (23%), and Hawaii (23.8%) had the lowest rates of obesity in the country.”
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. 12
Through November 14, National Association of Medicaid Directors, Washington Hilton,
Agenda (10 pgs.), here.
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: 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