DCMedical News: Monday, December 10, 2018
DCMedical News-DCMN
Washington, D.C.
Monday, December 10, 2018
DCMedical News is published every day either the House or the Senate is in session.
THE BIG STORY TODAY IN HEALTH CARE
Health Care Continues to be a “Jobs Machine”: Healthcare added 32,000 jobs in November, according to the December 7 report of the Bureau of Labor Statistics (here), 19,000 in ambulatory care and 13,000 in hospitals. During the past 12 months, health care added an average of 27,000 jobs per month. In the period January 2014-December 2016 (the full “roll out” of the Patient Protection and Affordable Care Act, PPACA) healthcare added an average of 32,000 jobs each month.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Medicare Physician Fee Schedule: This is the second part of three on the final 2019 Medicare Physician Payment and Quality Reporting changes, published in the Federal Register November 23 (here), on “communication technology-based services.” Medicare expands reimbursement in 2019 for telephone, patient-submitted photos, and interprofessional consultations, in addition to Medicare telehealth services. The beneficiary has to be located in a rural geographic setting at a clinical facility, such as a physician office, hospital or skilled nursing facility.
For 2019, CMS has decided that “Medicare telehealth services” apply to a limited set of services that are ordinarily defined, coded and paid for as if they were furnished during a patient encounter. There are two newly defined physician services. First, the “brief non-face-to-face appointment” (e.g. a virtual check-in), using the HCPCS Code G2012, for example telephone contact which does not originate from a related Evaluation and Management visit furnished within the previous seven days, or lead to an in-person visit within 24 hours. Second, the “evaluation of patient-submitted images or video and subsequent follow up” using HCPCS Code G2010. This might involve telephone, audio-visual, text messaging, email or patient portal communication, with the same timeframe limitations. A physician who bills Medicare for E&M visits is eligible, as are his or her established patients who must, however, provide consent prior to each service, and who are responsible for co-insurance amounts.
HOSPITALS AND OTHER HEALTH CARE FACILITIES
Ambulatory Surgery Center Update: At its meeting December 6-7 MedPAC, the Medicare Payment Advisory (to Congress) Commission, heard an update on ambulatory surgery centers (ASCs). Staff reported (here) that there are now 5600 ASCs qualified to participate in Medicare, receiving $4.6 billion in Medicare fee-for-service payments in 2017 for services to 3.4 million Medicare beneficiaries. The centers will receive a 2.1% payment update in 2019. Most have some physician ownership, according to the report, with increasing corporate interest in consolidation.
The presentation noted that ASC rates are “about half” of those charged by hospital outpatient departments (HOPDs). While there is relatively low ASC concentration in rural area, “Studies show that presence of ASCs in markets is associated with higher volume of surgical procedures.” Increasing rates and utilization show that while “Medicare payment per FFS beneficiary” changed by 3.5% 2012 – 2016, the change 2016 – 2017 is 7.7%. Medicare accounts for roughly 20% of ASC revenue, about half of the percentage of Medicare in an average hospital payer mix. “CMS [is] concerned that large difference between ASC and HOPD rates cause shift to HOPDs,” and “believes using hospital MB [market basket] will encourage shift back to ASCs.” The Commission disagrees with CMS on this point, and also on the importance of pressing for the collection of cost data.
Hospital Update: At the same meeting (here), the MedPAC staff showed $190 billion in Medicare FFS hospital spending in 2017, up 4.3% per beneficiary. (MedPAC does not receive information from the Medicare Advantage programs, and only reports on Medicare fee for service spending.) A modest increase in volume (.7% 2016 – 2017) followed an average decline of 2.6% per year 2007 – 2016, and was due to short stay inpatient cases. Volume increases in the outpatient area (also .7%) represent a decline from the 3.4% average annual change from 2007 to 2016, a “flattening” of emergency department and observation growth. Outpatient spending growth (8.4% per beneficiary 2016 – 2017) was largely driven by Part B drugs, with higher prices for existing drugs (cancer), growth in spending for pass through drugs, and increased spending on “separately payable” drugs. Touching on another area of controversy, the presentation reported that “Medicare payments for outpatient Part B drugs exceeded costs at 340B hospitals, resulting in hospital profits.” MedPAC and Medicare both persist in reporting a “Medicare profit” for hospitals, based on measurement of a variant of marginal income and Medicare’s definition of hospital costs. Overall, based on claims and Hospital Compare data, patient experiences in 2017 were improving, readmission rates were declining and mortality rates were also declining.
MEDICARE, MEDICAID, COMMERCIAL HEALTH INSURANCE
Risk Adjustment: Today’s Federal Register (here) will have CMS’ announcement that “risk adjustment” for health insurance programs under PPACA would continue to use a 2017 benefit year formula. CMS had previously announced that—in the wake of a District Court ruling in New Mexico—it would discontinue making the risk adjustment payments. The New Mexico court had invalidated the use of a statewide average premium in the program. The reversal by CMS was seen as necessary to maintain insurer participation in the program. The proposed rule from the Federal Register, August 8, is here; comments on the proposed rule from the American Academy of Actuaries are here; and comments on the proposed rule from New Mexico’s “Health Connections,” one of the few remaining CO-OP programs from PPACA, are here.
DRUGS AND DEVICES
“Modernizing” Medical Device Approval Through the 510(k) Review: The FDA is taking steps to “modernize” the 510(k) program, contending that new devices should have their risks and benefits compared to those of newer technologies, not to similar technologies approved in the past. The program is named for that section of the Food, Drug and Cosmetics Act which allows the FDA to approve medical devices based on their resemblance to past devices already approved. The theory is that low to moderate-risk devices which are “substantially equivalent” to a “predicate” device, one already on the market, should not endure the delay and complexity of a new application. An example of a technology approved entirely on predicates is robotically-assisted surgery, never subjected to the evaluation given to a new device. In addition to possible future changes (website exposure of old technology; “sunsetting” of predicates ten years or older) noted in the announcement, a report was issued (here) on recent improvements in the 510(k) process.
EVENTS & MEETINGS (Events Newly Added to This List Noted in Bold)
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: 11, 12, 13, 14
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com