DCMedical News: Friday, December 7, 2018
DCMedical News-DCMN
Washington, D.C.
Friday, December 7, 2018
DCMedical News is published every day either the House or the Senate is in session.
THE BIG STORY TODAY IN HEALTH CARE
Fiscal Cliff Deferred: The House and Senate both voted to continue spending in federal agencies (about 25% of the total, the remaining 75% already approved for FY 2019) until December 21. Nine cabinet departments are funded through the remaining seven appropriations bills (Agriculture, Commerce-Justice-Science, Financial Services, Homeland Security, Interior-Environment, State-Foreign Operations and Transportation-HUD).
2017 Health Spending in the U.S.: The CMS Office of the Actuary released its report on 2017 health spending in the United States (here and here). Highlights: Total $3.5 trillion, $10,739 per person, growth rate slowing, lower utilization increases.
“Overall national health spending grew at a rate of 3.9 percent [3.2% per capita] in 2017, almost 1.0 percentage point slower than growth in 2016. Medicare spending grew at about the same rate in 2017 as in 2016, while Medicaid spending grew at a slower rate in 2017 than in 2016.”
“Overall healthcare spending growth slowed in 2017 for the three largest goods and service categories – hospital care, physician and clinical services, and retail prescription drugs. Hospital spending (33 percent of total healthcare spending) decelerated in 2017, growing 4.6 percent to $1.1 trillion compared to 5.6 percent growth in 2016. The slower growth for 2017 reflected slower growth in the use and intensity of services, as growth in outpatient visits slowed while growth in inpatient days increased at about the same rate in both 2016 and 2017. Physician and clinical services spending (20 percent of total healthcare spending) increased 4.2 percent to $694.3 billion in 2017. This increase followed more rapid growth of 5.6 percent in 2016 and 6.0 percent in 2015. Less growth in total spending for physician and clinical services in 2017 was a result of a deceleration in growth in the use and intensity of physician and clinical services.”
“The 3.9 percent growth in healthcare spending was slightly slower than growth in the overall economy (4.2 percent) in 2017. As a result, the healthcare spending share of the economy (17.9 percent) was similar to the share in 2016 (18.0 percent). Growth in overall healthcare spending slowed for the second consecutive year, following elevated rates of growth in 2014 and 2015 that were affected by expanded Medicaid and private health insurance coverage and increased spending for prescription drugs, particularly for drugs used to treat hepatitis C.” See also Reading & Reference below.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
My Patient is Sicker Than Yours: A study in JAMA Network Open (here) of 2.5 million Canadian adult records showed “[S]ubstantial differences in markers of complexity for patients seen by different types of physicians, including medical subspecialists. Patients seen by nephrologists, infectious disease specialists, and neurologists were consistently more complex, whereas patients seen by allergists, dermatologists, and family physicians consistently tended to be less complex.”
MEDICARE, MEDICAID, COMMERCIAL HEALTH INSURANCE
MedPAC on Primary Care: Members of the Medicare Payment Advisory Commission meeting Thursday discussed recommendations to Congress for 2019 for improving access to primary care, then voted to cut payments to PAs and APRNs who work with physicians. Reports CQ, “MedPAC members supported the idea of requiring non-doctor practitioners, such as physician assistants, to bill Medicare directly, doing away with so-called ‘incident to’ services they provide that are paid higher rates under the Part B physician outpatient payment program. ‘Incident to’ services are considered integral – but incidental – to a doctor’s treatment of a patient. A PA, nurse practitioner or other non-physician provider can get a higher payment by using ‘incident to’ billing for care they provide after a doctor performs an initial service. Non-physician providers receive lower Medicare reimbursements when they bill directly.” MedPAC policy explanations on physician and other professional payment (updated 11-15-2018) can be found here, data on billing here, pg. 101.
The Commission, after recognizing that free-standing ambulatory surgery centers (ASC) were paid less than hospitals for outpatient surgery, agreed to recommend eliminating next year’s 2% increase for the ASCs, on grounds that the ASC community has resisted standardized cost reporting. Finally, the group supported a 2% increase for hospitals in FY 2020. All of the MedPAC recommendations will be revisited at the group’s January meeting. See also Reading & Reference below.
READING & REFERENCE
CMS Actuary Report on 2017 Health Spending: For more information, see https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsHistorical.html.
MedPAC: June, 2018 “Data Book,” here; transcript of last meeting (November 1-2), here.
EVENTS & MEETINGS (Events Newly Added to This List Noted in Bold)
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
8:00 a.m., National Comprehensive Cancer Network (NCCN) holds a patient advocacy summit on "Equity in Cancer Care," National Press Club, 14th and F, https://www.press.org/events/nccn-patient-advocacy-summit-equity-cancer-care
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
10:15 a.m., the Subcommittee on Health of the House Energy and Commerce Committee will hold a hearing in room 2322 of the Rayburn House Office Building on “Implementing the 21st Century Cures Act: An Update from the Office of the National Coordinator.” This is the fourth in a series of hearings on the implementation of the 21st Century Cures Act, the previous ones on research and development, mental health initiatives, and FDA provisions. This hearing will focus on interoperability of Electronic Health Records (EHRs), as well as implementation of the law’s provisions regarding information blocking and the establishment of a Trusted Exchange Framework. According to the hearing announcement, “The Office of Management and Budget is currently reviewing a rule to guide implementation of these provisions of law and it is expected to be released this month.”
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. 12
9:00 a.m., Center for American Progress, Sen. Harris and full panel, “Eliminating Racial Disparities in Maternal and Infant Mortality,” 1333 H St., 10th floor, http://www.americanprogress.org.
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: 10, 11, 12, 13, 14
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com