DCMedical News: Friday, January 4, 2019
DCMedical News-DCMN
Washington, D.C.
Friday, January 4, 2019
DCMedical News is published every day either the House or the Senate is in session.
THE BIG STORY IN HEALTH CARE
2019 Off and Running: Under newly again-elected Speaker Nancy Pelosi, the House passed (234 to 197) budget rules which would automatically approve a suspension of the debt ceiling on the adoption of a budget resolution, lower the requirement for increasing income tax rates from three-fifths of the vote to a simple majority, and apply “pay-go” rules to both increased spending and tax cuts.
Also pending: A new Medicare Advantage (MA) open enrollment (change plans, revert to traditional Medicare) period January 1 through March 31; decisions by risk-averse Accountable Care Organizations to stay in or bolt the Medicare shared savings program; and numerous IT, Part D and MA rules; “innovative” albeit mandatory bundles and drug pricing experiments; and a wide variety of lawsuits concerning PPACA, 340B, site-of-service differentials and other payment disputes.
HOSPITALS AND OTHER HEALTH CARE FACILITIES
Readmissions Reduction: Waste of Money, Danger to Patients, Both, or Neither: Modern Healthcare’s Merrill Goozner drew attention this week to the forthcoming 20th anniversary of the Institute of Medicine’s (IOM) studies on patient safety (or its absence). He wrote (here) that it may be time for an evaluation by the IOM of the “quality” and “cost reduction” programs developed by CMS. Goozner pointed to the study in JAMA in late December (here, JAMA editorial here, New York Times coverage here) which showed that post-discharge mortality for heart failure, myocardial infarction and pneumonia all increased after the imposition of fines against hospitals for readmissions.
Housing-for-Health Money May Be Claimed by Public Housing Authorities: Bruce Japsen writes in Forbes (here) that the Council of Large Public Housing Authorities is stepping up interest in claiming third party payer funds addressed to housing as a “social determinant of health.” He says, “The interest by public housing authorities in these new relationships comes as the nation’s largest health insurers including Aetna, UnitedHealth Group, Anthem, Humana and Cigna are investing hundreds of millions of dollars to address social determinants of health whether it be housing, medicine or even food to reduce health care costs. As one example, UnitedHealth has invested $384 million to help build 3,400 units of affordable housing in more than 16 states since 2011, the insurer said last month at its annual investor day meeting in New York.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Money, Doctors and Cancer: A report in JAMA Oncology (here) indicates that in a “[S]ystematic review of 18 studies that evaluated physicians’ response to reimbursement incentives across various clinical settings, most studies found evidence of an association between reimbursement incentives and delivery of cancer care. The ability to self-refer for radiation oncology services was associated with increased use of radiotherapy, and greater profitability of an anticancer drug was associated with increased use of that drug.”
MEDICARE, MEDICAID, COMMERCIAL HEALTH INSURANCE
Federal Health Insurance Exchange Enrollment: CMS reports (here, with state-by-state totals) that “Approximately 8.4 million people selected or were automatically re-enrolled in plans using the HealthCare.gov platform during the 2019 open enrollment period.” This is the final “snapshot” report on enrollment, with plan selection information coming in March. In its announcement, CMS wrote “By comparison, 8.7 million people had enrolled at the same time last year. This represents remarkably steady enrollment at a time when a strengthening economy and job market may be reducing the need and demand for subsidized health coverage.”
DRUGS & DEVICES
PhRMA and the Donut Hole: A Harvard professor of government calls it the biggest political loss by the pharmaceutical industry in years. STAT reports on it, here. A half page addition to the budget bill in February 2018 “requires drug makers to pay a larger share of a Medicare beneficiary’s prescription costs when that person is in something known as the ‘donut hole.’ Beneficiaries pay 100 percent of their drug costs until they meet their deductible, and insurers pick up a portion of the tab in the initial coverage phase, until someone has spent about $3,750 in drug costs. Beneficiaries pay even less once they hit the catastrophic phase, after they’ve spent $5,000. In between, though, patients, drug makers, and insurers are together responsible. . . Before February, drug makers paid 50 percent of those costs. Now, however, they’ll pay 70 percent — an increase that, spread across the 43 million people who have Medicare drug coverage, adds up to billions in extra funding from pharma.”
READINGS AND REFERENCES
Mid-Term Elections and Health Policy: Gail Wilensky writes about the 116th Congress and likely health policy changes in the JAMA Forum (here).
MACPAC Medicaid Expansion Waiver Profiles: Arkansas (here), Kentucky (here), New Hampshire (here).
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
Publication dates are the regularly scheduled days the House or the Senate is in session.
Remaining January publication dates: 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.