DCMedical News: Tuesday, December 4, 2018
DCMedical News-DCMN
Washington, D.C.
Tuesday, December 4, 2018
DCMedical News is published every day either the House or the Senate is in session.
THE BIG STORY TODAY IN HEALTH CARE: December 7, federal funding fiscal cliff pushed back to December 21.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Pre (Prior) Authorization: Interest ramps up in taming this productivity drain for physicians. The AMA (here) made a presentation to the Managed Care Committee of the National Association of Insurance Commissioners, contending that pre-authorization took an “Average of 14.6 hours (approximately two business days) spent each week per physician to complete this prior authorization workload,” that “34% of physicians have staff who work exclusively on prior authorization” and that 79% of physicians are sometimes, often or always required to repeat prior authorizations for prescriptions when a patient is stabilized on a treatment for a chronic condition.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
MedPAC (Medicare Payment Advisory Commission) Meeting this Thursday and Friday: Medicare’s advisory commission to Congress meets this week to assess the adequacy of provider payments.
Payment adequacy and update will be discussed (here) for ambulatory surgery centers. The Commission gives consideration to ASCs’ access to capital, quality of care and changes in ASC revenue from the Medicare program.
Hospital inpatient and outpatient services, and payment for those services, are assessed (here). Considerations include beneficiary access to care, supply of hospitals, changes in the volume of services furnished, quality of care, providers’ access to capital, and Medicare’s payments and costs.
Inpatient Rehabilitation Facilities (here): Considerations of access, supply of IRFs, changes in the volume of services furnished, quality of care and, Medicare payment and costs. LTAC (here): Long-term care hospital services, considerations the same as those for other institutional providers, above.
Physician and other health professional services, Advanced Practice Registered Nurses and Physician Assistants (here): considerations of the adequacy of Medicare’s fee schedule, beneficiary access, volume growth, and variation in compensation across specialties. Redesigning Medicare’s Hospital Quality Incentive Program (here): MedPAC had proposed a new hospital value incentive program (HVIP) in its June 2018 Report to Congress, focusing on outcomes, aiming for simplicity. A revised “HVIP Design” will be discussed.
SNF: Skilled Nursing Facility payments will be discussed (here), with considerations similar to those for other institutional providers, above. The Kaiser Family Foundation report on readmissions to hospitals from nursing homes (here) is certain to draw attention, since the October 1 payment changes in which for “2019, the best-performing homes will receive 1.6 percent more for each Medicare patient than they would have otherwise” and “The worst-performing homes will lose nearly 2 percent of each payment.”
Home Health Care (here): Volume, access, quality, Medicare Costs. Hospice (here): Payment adequacy, similar considerations to those of other institutional providers. Outpatient Dialysis (here): Access, quality and payment.
Medicare Advantage (here): Findings on the status of the MA program, including enrollment, access, payments, coding practices, and quality indicators.
READINGS & REFERENCES
Kaiser Family Foundation Public Polling on Health Issues, Update: The results (here) show that a majority support advertising of drug prices; one in five would buy a lower priced short term or other plan without “essential health benefits”; four in ten people age 18-64 who are uninsured or who buy their own coverage intend to go without health insurance in 2019; a majority would support individual state action to insure coverage of pre-existent conditions.
Fighting Fraud and Waste: Semi-annual report to Congress of the HHS Office of the Inspector General (here). See especially discussion of and proposals for “safe harbors,” appendix G.
EVENTS & MEETINGS (Events Newly Added to This List Noted in Bold)
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.
Dec. 5
9:00 a.m., Health Affairs and CMS’ National Health Expenditure Accounts Team hold a media briefing on "National Health Spending in 2017: Growth Slows to Pre-Great Recession Rates and Share of GDP Stabilizes,” National Press Club.
Dec. 6
9:00 a.m., to 5:45 p.m., MedPAC, 1300 Pennsylvania Avenue, agenda here.
9:30 a.m., Bipartisan Policy Center, “Bipartisan Leadership in Health Care: Chronic Care Act of 2018,” with Senators Hatch, Wyden. Register at https://bipartisanpolicy.org/events/bipartisan-leadership-in-health-care-chronic-care-implementation.
1:00 p.m., The Commonwealth Fund releases a state-by-state report, "The Cost of Employer Insurance is a Growing Burden for Middle Income Families,” conference call briefing, information at 301-280-5739, malexander@burness.com.
2:00 p.m. Business Roundtable CEO Innovation Summit: “America: The Innovation Nation.” 901 Wharf St., SW, Washington, Contact: Rayna Farrell rfarrell@brt.org, Agenda and Speakers here.
Dec. 7
8:00 a.m., to Noon, MedPAC, 1300 Pennsylvania Avenue, agenda here.
Noon, Alliance for Health Policy, “Aging in America,” information at 202-789-2300 info@allhealthpolicy.org
Dec. 10
The American Bar Association (ABA) holds the 16th annual Washington Health Law Summit, December 10-11, information at 202-662-1090 at 202-662-1000, registration at https://www.americanbar.org/events-cle/mtg/inperson/332144284/.
12:30 to 5:00 p.m., PTAC (Physician-Focused Payment Model Technical Advisory Committee) meeting, shortened to one day, Federal Register notice here.
Dec. 11
2:30-4:00 p.m., Bipartisan Policy Center, Financing Public Health Infrastructure, panel, 1225 Eye Street NW, Suite 1000, Washington, 202-204-2400
Dec. 18
First meeting, the HHS Deputy Secretary’s Innovation and Investment Summit. Program announced, here; participants selected, list here; FAQs 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), 2019 House Calendar (here).
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
December publication dates: 5, 6, 7, 10, 11, 12, 13, 14
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com