DCMedical News: Tuesday, November 13, 2018
DCMedical News-DCMN
Washington, D.C.
Tuesday, November 13, 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. Subscribe to ensure continued receipt of your copy.
The Big Story in Health Care: Medicaid. HHS Secretary Azar addresses the National Association of Medicaid Directors today. (NAMD annual meeting agenda here.) 37 states and the District of Columbia have decided to implement the Medicaid expansion provisions of the Patient Protection and Affordable Care Act. More on Azar’s remarks and state plans in tomorrow’s DCMN. Managed Medicaid companies Centene, Molina and WellCare saw their share prices increase nine percent following election results supporting expansion in Utah, Idaho and Nebraska, as well as changes in Governorships in other states which may affect Medicaid.
More on the States: CMS releases the L&M Policy Research Report (here, dated 8-24-2018) on “Innovation Center State-Based Initiatives: A Systematic Review of Lessons Learned.” The report is a review of 47 evaluation reports done for CMS’ Center for Medicare and Medicaid Innovation (CMMI) in a variety of models (Strong state role=e.g. Maryland; Medicaid-focused=e.g. enhanced prenatal care, emergency psychiatric care; and Other=e.g. avoidable nursing facility hospitalizations).
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Medicare Physician Fee Schedule for Calendar Year 2019 Finalized: The “final rule” for the CY 2019 physician fee schedule was released, pending publication in the Federal Register November 23. The rule (2379 pages, here), also covers Medicare shared savings program requirements, the “Quality Payment Program” (MIPS or APMs), expanded payment for telehealth and changes in Medicare Shared Savings Accountable Care Organization requirements. More this week.
At Lake Wobegon: Modern Healthcare reports that of the 1.06 million eligible clinicians who participated in the Medicare Merit-based Incentive Payment System (MIPS) 93% will receive a bonus on their Part B claims beginning January 1, 2019.
Physician Specialties, 2018 Report from AAMC: The Association of American Medical Colleges reports (here) that:
Primary care: “In 2017, the specialties with the largest numbers of active physicians were the primary care specialties of internal medicine (115,557), family medicine/general practice (113,514), and pediatrics (58,435).” And, “In 2017, more than one-third (35.2%) of the active physician workforce in the United States was female. Percentages of females in the top specialties ranged from a high of 63.3% in pediatrics to a low of 5.3% in orthopedic surgery.” Practitioner Age: “In 2017, 44.1% of active physicians in the United States were age 55 or older,” from 88.8% in pulmonary disease to 9.2% in internal medicine/pediatrics.
Growing (and declining) specialties: “The five-year period from 2012 to 2017 saw notable growth in some specialties, particularly interventional cardiology, which grew 58.0%, from 2,435 to 3,847. Other specialties decreased in number, including pulmonary disease (-9.5%) and anatomic/clinical pathology (-8.3%).” In training: “In 2017, the specialties with the largest number of first-year ACGME residents and fellows were the primary care specialties of internal medicine (9,825), family medicine/general practice (3,886), and pediatrics (2,854).”
And, “Percentages of females in the largest specialties ranged from a high of 82.9% in obstetrics and gynecology residencies to a low of 10.2% in interventional cardiology residencies.” Also, “In 2017, the largest proportion of residents and fellows in ACGME-accredited programs were U.S. MDs (63.6%), while international medical graduates comprised 23.8% and DOs made up 12.5%.”
No Longer Presidential Candidate Whispering: Writer, surgeon and now executive Atul Gawande writes a compelling piece in The New Yorker (here) on “Why Doctors Hate Their Computers.” Gawande was a favorite in the administration when a $35 billion bet was made that the emerging technology was ready for prime time.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Indemnity Coverage Returns, as “Reference Pricing”: Blue Cross Blue Shield of North Carolina has announced (report here, Winston-Salem Journal) a new health plan costing one-third less than similar products, covering pre-existent conditions. The trick? There is no network of providers with negotiated prices, so doctors and hospitals have no limitations as to what they can charge. The plan will pay up to 40% above what Medicare pays.
EVENTS & MEETINGS
Nov. 13
National Association of Medicaid Directors. Meeting began November 12, continues through November 14, Washington Hilton, Agenda (10 pgs.), here.
Nov. 14
8:00 a.m., Roll Call sponsors a discussion on "Election Impact: Improving Patient Care Under a New Congress." Contact: Jonathan Thompson at 202-292-6353 jothompson@newseum.org
9:00 a.m. to Noon, Wall Street Comes to Washington, Health Care Roundtable, investment professionals (Matthew Borsch, BMO Capital Markets; Ana Gupte, Leerink Partners; Paul Heldman, Heldman Simpson Partners) on a panel moderated by Paul Ginsburg, information at www.jktgfoundation.org.
Nov. 15
8:30 a.m., AHRQ Meeting of National Advisory Council for Healthcare Research and Quality, 5600 Fishers
Lane, Rockville, MD, contact: Karen.Migdail@ahrq.hhs.gov
Noon: Rural Health Information Hub and National Organization of State Offices of Rural Health, Access to Healthcare in Rural Communities,” accessed through #RuralHealthChat.
Nov. 16
9:30 a.m. to 11:45 a.m., The Century Foundation, Health Affairs, the Commonwealth Fund, present a star panel (e.g. Wagner Dean Sherry Glied on Medicare-Like Plans for the 2020 Health Reform Debate) on “Health Reform: From the Midterms to 2020,” National Press Club, announcement here.
Nov. 27
9:00 a.m., The American Enterprise Institute for Public Policy Research (AEI) holds a discussion on "The new Medicare physician payment regulation: What does it mean for physicians and patients?" Seema Verma, Robert Berenson, AHIP, AMA. Contact: 202-862-5829 mediaservices@aei.org
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.
8:00 a.m. to 11:00 a.m., STAT Plus correspondents in a discussion of drug pricing, at Hogan Lovells
in Washington, information at https://www.statnews.com/conversation-drug-pricing-2019/?utm_source=STAT+Newsletters&utm_campaign=bb45b691af-STATPlus_1113_event_subs_COPY_01&utm_medium=email&utm_term=0_8cab1d7961-bb45b691af-149691333
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
November publication dates: 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