DCMedical News: Friday, December 14, 2018
DCMedical News-DCMN
Washington, D.C.
Friday, December 14, 2018
DCMedical News is published every day either the House or the Senate is in session. This is the last edition for 2018. Publication will resume on January 3, 2019.
THE BIG STORY IN HEALTH CARE: The federal policy year in health care appears (see below) to be heavily weighted to administrative and regulatory actions, some activity associated with the courts. Most Congressional action took place through budget resolutions. (CQ reports “Jet fumes” in the corridor, Members going home for the holidays; some Congressional activity may take place next week, or not.)
Year-End Review
January:
340B funds can be cut, says Judge Contreras (here). Definition of “employer” changed (here), beginning fulfillment of the President’s Executive Order on competition (here), allowing the development of Association Health Plans. CMS announces (here) new initiatives for work requirement in Medicaid programs.
CMS creates new bundle, “BPCI Advanced” (here). Health care employment continues to grow; David Cutler writes (here) that in the medical system in the US in 2016 there were 22 times as many nonphysician and nondentist workers as there were doctors and dentists. HHS publishes Year of Accomplishment (here) review of 2017. CMS publishes 2016 national health expenditure review, here, which Ms. Verma says is what keeps her up at night. President’s State of the Union address (here) includes Veterans Choice, deregulation, “Right to Try,” opioid addiction and lowering the price of prescription drugs.
February:
Fifth Continuing Resolution (CR) passed to avoid government shutdown. Evidence continues (see DCMN 2-5-2018, here) of the negative impact of behavioral economics on health services. Warren Buffett says (here) the cost of health care is the tapeworm in the American body politic as Amazon, JPMorgan and Berkshire Hathaway announce new venture (further discussion of the venture here). Outcome of health provisions (DSH, FQHCs, MACRA, rural health, many others) in the CR discussed here. President’s $4.4 trillion Budget for FY 2019 presented, OMB summary here, HHS summary here. CMS’ Office of the Actuary reports health care spending at $3.5 trillion in 2017, projected (here) to reach $5.7 trillion by 2026. Short-Term Limited Duration Health Insurance plans proposed, here. Twenty states sue to challenge the constitutionality of the Patient Protection and Affordable Care Act, complaint here.
March:
Apple (AC Wellness) announces medical practice for employees. Market stabilization legislation debated, extensively. Medicaid work waivers approved for Arkansas, Kentucky and Indiana. Idaho and Iowa explore “skinny” health plans (non-PPACA compliant, light on “Essential Health Benefits.”) More than 43,000 attend Datapalooza health IT conference in Las Vegas where Ms. Verma reported on her husband’s medical records, “After the federal government has spent more than $30 billion on EHRs, I left with paper and a CD-ROM.” Wall Street Journal attacks the credibility of hospital accreditation organizations, also attacked by the House Energy and Commerce Committee. CSRs and premium stabilization omitted from 2,232-page omnibus budget bill, insurers turn to silver-loading.
April:
State innovation a focus (here). MedPAC sours on hospital quality programs (here); hospital quality payment programs contain too many overlapping metrics, rely on condition-specific readmission as opposed to all-condition measures, include process measures unrelated to outcomes, and further rely on provider measures that are inconsistently reported. Dr. David Grabowski of Harvard Medical School was particularly focused on the imprecision, overlap and general lack of impact of current Medicare “quality” measures. Big study (here) on disease burden, variability by state. Speaker Ryan announces retirement. Physician “burn out” articles appear, culprits include EHR, “overload with menial tasks,” loss of autonomy. New Jersey passes individual mandate. HHS and CMS press Medicare shared savings ACOs to assume risk. Hospital G&A expenses rise to over 20%, United reports $4 billion quarterly earnings, up 19%. American College of Physicians reports (here) that most clinical performance measures from the past 30 years are ineffective, inaccurate or otherwise of no use to patients. Proposed IPPS for FY2019 published, here. Moody’s turns south on hospitals.
May:
President announces his plan to control drug prices, here. Commonwealth (here) finds uninsured rates 11% in states expanding Medicaid, 22% in states which did not. CMS (here) finds results of §1115 waivers to have no consistent impact on outcomes. §1332 waiver requests submitted by multiple states to offset blockbuster premium increases. A report in the Annals (here) says U.S. physicians write four times as much as physicians in other countries, record bloat due to compliance and reimbursement documentation. Cooper, Gaynor and colleagues update their demonstration of the inflationary impact of hospital mergers, here. ICER dubbed the “private NICE” by Frakt, here. FY 2019 IPPS rates and rules summarized in DCMN (see editions of 5-15 for hospice, 5-16 for inpatient psychiatry, 5-17 for IRFs, 5-18 for SNFs, 5-19 for hospitals). U.S. birth rate drops to a 30-year low (here). CDC interview survey (here) shows 9% of persons of all ages uninsured, 26% in Texas. CBO reports (here) on federal subsidies for health insurance.
June:
HHS reports 74 million enrolled in Medicaid and CHIP, a 29% increase over 9-2013, half are children. OIG studies (here) Part D drug prices, finds 77% increase in payments 2011-2015, despite 17% decrease in the number of prescriptions. Rural health focus, see DCMN 6-602018, here. DoJ says it will not defend PPACA (here). SDOH (housing, transportation, food) often in the news, see June Health Affairs. Silver loading (CBO report here) will continue to be allowed for 2019, says Azar. Multiple initiatives, especially in the House, on opioid epidemic (DCMN 6-12, here). Pre-existent condition debate rises. Anthem limits ED visits, then backtracks. Final rule issued on AHPs, here. CDC reports (here) that maternal mortality rates have tripled in the past 25 years. Justice Kennedy delivered a blow to public hospital employee unions (Janus, here). Leapfrog says hospital-acquired infections are rising (here), but CMS removes the reports.
July:
Brett Kavanaugh nominated to the Supreme Court, his health-related decisions reported here. CMS proposes to upend E/M codes, later defers to 2021. CVS-Aetna move to merge, unopposed by DoJ. Cigna has acquired Express Scripts. PBMs and Pharma face off over rebates; Pew reports, here. State initiatives again in the spotlight (DCMN 7-20). TAVR to be expanded.
August:
Health themes emerge for mid-term elections. OPPS proposes end to site-of-service bump for hospitals. Physician pay rule proposed, AMA (and 169 other physician organizations) express concerns, here.
September:
Propose rule on “public charge” (here) alarms hospitals, health professionals. The Physicians Foundation releases comprehensive survey (here).
October:
Rural health, rural hospitals, a focus in the House (here and here). IMD limitation in Medicaid eliminated. MGMA reports on regulatory overload. Antitrust issues evoke interest. CMS accused of having a thumb on the scale in selection of MA over traditional Medicare. CMS to require hospital price posting January 1.
November:
Campaigning, voting, lame duck session, Social Security Trust Fund upside-down for the first time in 35 years. American life span declines for the second year, says the CDC (here).
December:
Competition and choice paper published as prelude to 2019, here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
Publication dates are the regularly scheduled days the House or the Senate is in session.
January publication dates: 3, 4, 8, 9, 10, 11, 14, 15, 16, 17, 18, 28, 29, 30, 31
February publication dates: 1, 4, 5, 6, 7, 8, 11, 12, 13, 14, 15, 25, 26, 27, 28
March publication dates: 1, 4, 5, 6, 7, 8, 11, 12, 13, 14, 15, 25, 26, 27, 28, 29
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com