DCMedical News: Tuesday, January 15, 2019
DCMedical News-DCMN
Washington, D.C.
Tuesday, January 15, 2019
DCMedical News is published every day either the House or the Senate is in regular session.
THE BIG STORY IN HEALTH CARE:
Is Congress Still Relevant to National Health Insurance Policy? Politico’s Dan Goldberg notes that the Democratic governors steering their party toward universal health care include, in addition to California’s Newsom (see DCMN 1-11 and 1-14), Colorado’s Jared Polis, who wants Colorado to pioneer a multi-state single-payer system, and Minnesota’s Tim Walz, who would like to offer residents of that state an opportunity to “buy into” the state’s Medicaid program. (Other coverage, from the Associated Press, “Democrats roll out big health care proposals in the states,”; from The Hill, “Blue States buck Trump to expand health coverage,”; and from CQ, “States prep bold health care moves as Washington stalls.”)
Politico reports indicate a concerted CMS strategy to “go around” Congress, especially through “innovative” experiments for Medicaid waivers sponsored by the Center for Medicare and Medicaid Innovation. These innovations may involve caps on total expenditure, combined with increased spending flexibility. The Wall Street Journal (here) reports that changes in the Medicaid program would take the form of “guidance” from CMS to the states, rather than a posted notice of proposed rulemaking. The use of guidance (and “templates” or instructions concerning how states might apply for such flexibility) was the subject of reports in November (e.g., here). Senator Murray of Washington described the templates at the time as a “how-to guide for health-care sabotage.” Her reaction was to health insurance plans non-compliant with the “essential health benefits” of the Patient Protection and Affordable Care Act (PPACA). Such non-compliant plans could exclude maternity, mental health or other expensive care. CMS officials were quote by the Journal as noting that “only when states are held accountable to a defined budget can the federal government finally end our practice of micromanaging every administrative process.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Fraud Down, Health Care Holds Its Own: Law360 reports (here) that total Department of Justice receipts from False Claim Act fraud were down in 2018, but that healthcare—not 20% of the economy—accounted for 85% of the total. Said the report, “If there’s a bright spot for the government, it is unquestionably health care, which spawned more than 85 percent of FCA dollars last year. The industry even saw its recoveries rise 15 percent from 2017 to 2018 as overall FCA recoveries fell. Since 2010, FCA cases involving health care have delivered an average of $2.5 billion annually. The dollar amounts have been noticeably stable, never departing from the average by more than 25 percent in either direction.” More detail (here) in a Gibson Dunn report to clients on 2018 FCA awards.
The National Health: The Financial Times’ focus (here) on a new ten-year plan (see DCMN 1-14-2019) for England’s National Health Service says “Redesign patient care to treat the ills of the health system” and “Defuse the politics and leave doctors and managers to bridge divides in the medical service.” Past rearrangements which have not worked: “After the creation of the NHS in 1948, hospitals, GPs and community services were put on different footings. The purchaser-provider split introduced by Ken Clarke, as health secretary, in 1990 was designed to stop the professions creating monopolies. But we have ended up spawning a vast bureaucracy, to oversee payments between different parts of the system. The resulting transaction costs are estimated to be up to 14 per cent of the NHS budget.” And planning? “It took almost 20 years to reorganise stroke services in London, which involved concentrating specialists in only eight hospitals, because of fears about patient safety. The strategy succeeded in virtually halving deaths. As one of the architects of that strategy said to me, in any other country it would have been done overnight.” Well . . .
HOSPITALS AND OTHER HEALTH CARE FACILITIES
With a Positive Outlook Like This, Who Needs . . . : The Bond Buyer (here) reports that “Looming clouds, from a possible recession that could dampen investment revenue and philanthropy to potential federal actions and Medicaid changes, threaten the not-for-profit healthcare sector’s stable outlook this year, S&P Global Ratings warns.” The article noted that “S&P is the most positive among three sector outlooks,” and added that “Fitch Ratings assigned a negative outlook to the sector in December, though it also assigned a stable credit outlook. Moody’s Investors Service also in December maintained its negative view on the sector. It revised its outlook to negative from stable for 2018.”
CLABSI Measurement Error in CMS Payment Scheme: A study in the American Journal of Infection Control (here) contends that use of the Standardized Infection Rate (SIR) by CMS to assess Central Line-Associated Bloodstream Infection may lead to overly optimistic results, compared to a different measure used by the CDC (the hospital- and unit-level standardized utilization ratio). According to the authors, “This CDC metric is a risk-adjusted rate that compares the actual central line device days reported to what would be predicted for a hospital with similar characteristics. While CMS 2019 value based purchasing methodology will still rely on the SIR, our results suggest that incorporating the standardized utilization ratio into the methodology for calculating financial penalties may more appropriately measure infection prevention than an SIR that is adjusted for each hospitals’ rate of central line use . . . Our analyses demonstrate that similar hospitals can have the same SIR but very different numbers of central line days and CLABSI rates. This variation in infection burden may translate to nontrivial differences in patient safety.” [Italics added.]
READINGS & REFERENCES
Privatization of Veterans Health Administration services: The New York Times on the latest endeavor, here. For perspective, a bibliography of articles on VA health quality, cost and access, here; VA giant Ken Kizer and colleagues here; another giant, Ted Marmor, on the Phillip Longman books, here; FAQs from CRS (here), CBO on VA and non-VA costs, here, privatization problems described in CQ here, and in ProPublica here and by Dr. Shulkin (here). On quality, generally, http://vhahospitalqualitystudy.org/, id and p/w both = Legion.
More on Hospital “Price Transparency”: Modern Healthcare (here) adds to reports from The New York Times (see DCMN of 1-14) that “Price transparency stumbled out of the gate as hospitals complied with a new CMS requirement to publish their lengthy list of retail charges…”
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: 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.