DCMedical News: Monday, January 14, 2019
DCMedical News-DCMN
Washington, D.C.
Monday, January 14, 2019
DCMedical News is published every day either the House or the Senate is in regular session.
THE BIG STORY IN HEALTH CARE:
Alternatives to National Action for Health Insurance Coverage: California (here) and New York City (here) proposals for universal coverage and care draw attention. In Governing magazine (here), a link between the two is described: “[Governor] Newsom’s push for universal health care dates back to his time as mayor of San Francisco. He pushed a plan that eventually became Healthy San Francisco. With federal money and local taxes on businesses, the program provides insurance to the uninsured and encourages low-income residents to seek care at local health clinics instead of hospital emergency rooms, which are more expensive. The program was seen as an overwhelming success. Currently, it covers around 14,000 people in the city. Furthermore, Healthy San Francisco enrollees were half as likely to depend on emergency room care as Medicaid recipients.”
“[Mayor] De Blasio's NYC Care mirrors Healthy San Francisco and was triggered by a report that showed public hospitals in the city were bearing the brunt of indigent hospital visits but being compensated far less than their private-sector counterparts. Public hospitals in the city projected a $6.1 billion shortfall through 2020, according to the city's independent budget office.”
The California proposal will require legislative action and may consume much more than that state’s projected $15 billion budget surplus. The proposal in New York City, which ended the fiscal year with a $2.6 billion surplus, will be funded through the city’s Department of Health and Mental Hygiene, and will utilize the facilities and staff of the NYC Health + Hospitals Corporation.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Pavement of Good Intentions: MedScape reports (here) that a new report (here) from an independent commission established by the American Board of Medical Specialties (ABMS) suggests that the “Maintenance of Certification” (MoC) process was “far enough off the rails that the term ‘maintenance of certification’ should be abandoned,” and the process greatly modified. The issues are monopoly control of the process through the 24 member boards of ABMS, the measures tested (seen as bureaucratic, artificial), the “stakes” (some credentialing organizations overly reliant on MoC), excessive testing fees and the overall value of the exercise.
HOSPITALS AND OTHER HEALTH CARE FACILITIES
Listing of List Prices: A report (here) in the New York Times says “On Jan. 1, hospitals began complying with a Trump administration order to post list prices for all their services, theoretically offering consumers transparency and choice and forcing health care providers into price competition. It’s turning into a fiasco.”
MEDICARE, MEDICAID, COMMERCIAL HEALTH INSURANCE
MedPAC Comes to Town, Ready to Make 2019 Recommendations: The Medicare Payment Advisory Commission meets this Thursday (the 17th) and Friday (the 18th) in Washington, agenda here.
Thursday’s topics for discussion (and action, in the form of recommendations to Congress) include The Medicare prescription drug program (Part D): Opioids and alternatives in hospital settings: Payments, incentives, and Medicare data; Assessing payment adequacy for hospital inpatient and outpatient services, and Redesigning Medicare’s hospital quality incentive programs; Physicians and other health professional services, and Medicare payment policies for advanced practice registered nurses and physician assistants; Ambulatory surgical centers and hospice; Post-acute care providers: Skilled nursing facilities; home health agencies; and inpatient rehabilitation facilities; Long-term care hospital services; and Outpatient dialysis services.
Friday’s topics are “Future policy directions to address Medicare prescription drug spending,” and an “Analysis of Medicare Shared Savings Program (MSSP) performance.” HFM checks in to note that (rather than hospital costs) MedPAC should look at other factors driving Medicare expenditures, including “expensive drugs and potentially wasteful spending in the outpatient and post-acute care settings,” here.
CMMI Too Innovative: Inside Health Policy reports (here) that the House Ways & Means Committee leaders from both parties are concerned that the “Center for Medicare and Medicaid Innovation” is “rewriting” Medicare, without appropriate limited pilot projects, proposed rules, public comment and other features of the Administrative Procedures Act. A letter from Chairman Richard Neal (D-MA) and Ranking Member Kevin Brady (R-TX) to CMS (here) expresses concern that “significant policy changes made unilaterally by the executive branch without sufficient transparency could yield unintended negative consequences…” The Committee leaders ask for an inventory of models under consideration, a description of steps CMMI and CMS will take to ensure transparency, and evidence that the agencies (which enjoy a strong “top down” reputation) have consulted to obtain input from the outside.
80 Years On: A new ten year plan for England’s National Health, with emphasis on mental health (here), finances (here), and the plan by NHS England chief executive Simon Stevens for development of regional integrated delivery systems (here). Challenges: gaps in the NHS workforce (the British Medical Association claims 100,000 staff vacancies in the NHS; the Royal College of Nursing cites 40,000 nurse vacancies); shortfalls in social care reform (“green paper” on social care, a companion to the new NHS 10-year plan, on the way, says the health and social care secretary); cutbacks (according to the Health Foundation) in funding. Reports the Financial Times, “Running through the document about NHS England’s proposed overhaul of the service is recognition of the need to ease demand on it by treating people before their health deteriorates to the point of needing an expensive admission to hospital. This drive is backed by a pledge that funding for primary, community and mental healthcare will grow faster than the overall NHS budget — a strategic shift from the hospital-centric model that has long prevailed.”
READINGS & REFERENCES
Chart of the Century: Economist/blogger Mark Perry’s “Chart of the Century” (here, with 30+ pages of reaction and commentary) shows that in the two decades since 1998 the CPI for all items increased by 56%, and that the greater the degree of government involvement in the provision of a good or service, the greater the price increase over time. Top of the list? Hospital services, college costs, child care and medical care. Reaction and comments take issue with causality, noting the role of labor costs (hard to outsource hospital care to other countries), for example.
U.S. House of Representatives: Members at https://www.house.gov/representatives, Committees and Members at https://www.house.gov/committees
U. S. Senate: Members at https://www.senate.gov/general/contact_information/senators_cfm.cfm, Committees and Members at https://www.senate.gov/committees/membership_assignments.htm
House and Senate 2019 Calendar of Regularly Scheduled Sessions, 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: 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.