DCMedical News: Thursday, October 25, 2018
DCMedical News-DCMN
Washington, D.C.
Thursday, October 25, 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: Special mid-term election issue of DCMN tomorrow, last issue until November 13.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Doctors Don’t Like Risking Their Patients’ Health Care in Government-Sponsored Reimbursement Gambles: A RAND-AMA study (reported here) finds doctors averse to both business risk (practice infrastructure investment to support government alternative payment model experiments) and financial risk. “Payment models are also becoming more complex, with more performance measures, confusion about performance thresholds and interactions between different payment models. Understanding the newer payment models requires significant investment, which can be a barrier to participation.” HealthcareDive reports “CMS is still being tight-lipped about how much it will force physicians to assume downside risk. The agency has proposed an overhaul of the Medicare Shared Savings Program that would shorten the time accountable care organizations have to shift to a risk-bearing model. This study suggests an aggressive approach to imposing financial risk would not go over well.”
Physician Practices Which Were Early Participants in ACOs: Early participant practices were large and capable, but their performance was modest, report Shortell and Casalino (reported here) for the Commonwealth Fund. They write, “Physician practices that intended to join Medicare ACO programs in 2012 had greater capabilities to manage risk and succeed under a value-based payment model than practices that did not, but the performance of these ACOs has been modest.”
HOSPITALS AND OTHER HEALTH CARE FACILITIES
Hospital Community Benefit, Charity Care and Tax Exemption: A study in Inquiry (here) gains attention, concluding that “Taken as a whole, our analyses demonstrate that the provision of all community benefits, charity care alone, and the value of the tax exemption vary substantially across nonprofits. Moreover, neither combined community benefits nor charity care alone (whether measured as totals or incremental amounts relative to for-profits) is strongly correlated with the value of the tax exemption.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Medicare Advantage Payments to Hospitals: A report in Inquiry (here) says “We found MA [Medicare Advantage] prices to be roughly equal to Medicare FFS [Fee-for-Service, traditional Medicare] prices, on average, but commercial prices were 89% higher than FFS prices. In addition, commercial prices varied greatly across and within MSAs [Metropolitan Statistical Areas], but MA prices varied much less.”
How Accountable are Accountable Care Organizations for “Non-Accounted” Care: A study in Inquiry (here) of hospital admissions for acute myocardial infarction, abdominal aortic aneurysm repair, coronary artery bypass grafting and pneumonia suggestions that “on average, Medicare ACO hospitals are not associated with improved mortality rates.” The authors write: “There is some (mixed) evidence showing how Medicare Accountable Care Organizations (ACOs) are implementing organizational change and improving cost and quality on graded outcomes . . . Our study is the first, to our knowledge, to examine the association between Medicare ACO affiliation and inpatient quality measures on which hospitals are not explicitly evaluated by the Medicare ACO programs . . . ACOs are supposed to affect broad-based organizational change; however, if ACOs are not improving quality for outcomes on which they are not explicitly evaluated by the ACO program, this would suggest that the ACO model is not as comprehensive as it was intended to be.”
DRUGS AND DEVICES
Insys in the Spotlight: The minority staff of the Senate Homeland Security & Government Affairs Committee has published (here) a 193 pg. profile of Insys, “Fueling an Epidemic: Inside the Insys Strategy for Boosting Fentanyl Sales.” The tragic/comic sales promotion e-mails include this analysis of sales over the holiday period: “After two weeks, those who consistently fail this company by not getting 1 lousy doctor in their entire territory to generate 1 rx a day - will be terminated. They failed - because the[y] neglected to listen. They did not put in the work to own their physicians over the past 9 months, and now they are blaming it in the 'holidays'. WHAT A JOKE! This is not my first holiday season in this market, Hence - I will not buy this nonsense for one split second.”
READING AND REFERENCE
National Plan to Address Alzheimer’s Disease: HHS, here.
2017 National Healthcare Quality and Disparities Report, from the Agency for Healthcare Research and Quality (AHRQ), introduction and links here.
October 2018 Chartbook on Patient Safety, also from AHRQ, report here, slides here.
EVENTS & MEETINGS
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. 26
12:00 to 1:00 p.m., Healthcare Leadership Council Briefing “State of the Healthcare Workforce,” 2322 Rayburn Bldg., Washington, DC, contact: Kelly Fernandez, (202) 449-3452, kfernandez@hlc.org
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. 14
9:00 a.m. to Noon, Wall Street Comes to Washington, Health Care Roundtable, investment professionals on a panel moderated by Paul Ginsburg, information at www.jktgfoundation.org.
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: 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