DCMedical News: Thursday, January 17, 2019
DCMedical News-DCMN
Washington, D.C.
Thursday, January 17, 2019
DCMedical News is published every day either the House or the Senate is in regular session.
THE BIG STORY IN HEALTH CARE:
Partial Government Shutdown, Continued: White House Council of Economic Advisors predicts negative economic impact, others discuss potential contraction in the economy (here). The House of Representatives, which couldn’t reach a two-thirds majority to pass a measure reopening closed parts of the federal government at current levels, will consider today (Thursday) a measure to reopen idle federal agencies through February 28th. The FDA is running out of user fees, can’t collect any more. Food stamps, welfare, other expenses bear down on states (here). Multiple plans and proposals (VA private care access, blue-state Medicaid demonstrations, health insurance exchange plans for 2020) stalled. Indian tribes and others dependent on federal workers running out of food, time and health care. Federal workers have missed an average of $5,000 in pay so far, according to a New York Times analysis of federal salaries by closed agency (here).
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Payment for Coordinated Care: This week’s JAMA contains a discussion and useful summary of Medicare’s approach to payment for services which promote coordination of patient care (here). In the 2019 physician fee schedule new codes are provided for virtual patient-clinician check-ins, asynchronous video or image review and storage, interprofessional consultation (provider-to-provider e-consults), and chronic care remote physiologic monitoring. Medicare reimbursement can be low ($13 estimated for the video image review) or modest (up to $73 for the interprofessional consultation). These new codes join thirteen introduced from 2014 to 2018, including two in advanced care planning, two in transitional care management, three in chronic care management, one for cognitive assessment and care plan services, four codes for behavioral health integration, and one code for remote patient monitoring. These codes are more generously reimbursed, with an estimated high of $264 for cognitive assessment and care plan services.
MGMA Reports MIPS Payment “Adjustments”: The Medical Group Management Association reminded members that the start of 2019 is the first time doctors and their practices (a million eligible clinicians in all) participating in the Merit-based Incentive Payment System will receive a payment “adjustment” based on 2017 “performance.” The CMS report (here) shows 93% of the adjustments to be positive, up to a maximum of 1.88%.
HOSPITALS AND OTHER HEALTH CARE FACILITIES
Name, Rank, Serial Number: GAO reported to Congress on “matching” of patients to records (here), with results echoing a Pew Foundation study published October, 2018 (here). Said the GAO, “Stakeholders GAO interviewed, including representatives from physician practices and hospitals, described their approaches for matching patients’ records—that is, comparing patient information in different health records to determine if the records refer to the same patient.” They noted, “A 2014 study found that as few as 50 percent of records are accurately matched when organizations exchange information. In AHA’s 2017 survey, 45 percent of large hospitals reported that difficulties in accurately identifying patients across health information technology (IT) systems limited health information exchange.”
The Latest Dirt on Hospital Cleanliness: “Medscape” (here) features a variety of updates and reports from the Society for Healthcare Epidemiology of America, including the cleanliness of hospital environments, bacteria in stethoscopes, infections on mobile devices, mistakes causing self-contamination in hospitals, C. difficile surviving hospital laundering, MRSA contamination of privacy curtains, and ambulance equipment contaminated with MRSA. A comprehensive bibliography is included.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Cigna’s Cordani on MA: In Forbes, Cigna’s chief executive Cordani says (here) that the company “[P]lans to broaden the insurer’s offerings to more seniors choosing Medicare Advantage plans as part of a major business expansion in coming years.” The article notes that “Cigna has more than 435,000 Medicare Advantage enrollees, which is far fewer than UnitedHealth, Aetna and Humana. But Cigna and an increasing number of other insurers see a bigger opportunity as the Centers for Medicare & Medicaid Services changes rules allowing health plans to provide richer benefit packages to attract more seniors to Medicare Advantage plans.” Cigna currently offers HMO-type MA plans, with narrow networks of physicians. It anticipates growth through PPO-MA plans. There is additional flexibility from CMS for MA plans (compared to traditional Medicare) to offer in-home assisted-living type care, transportation and possibly housing assistance and Apple watches with health apps in the future. Axios Vitals reports that three companies control more than half of the MA market, UnitedHealth Group with 5.7 million enrollees, Humana, with 3.9 million, and CVS Health-Aetna, 2.1 million.
DRUGS AND DEVICES
Hospitals, Drug Prices and Drug Supplies: AHA, the Federation of American Hospitals and the Society of Health System Pharmacists presented a consultant’s report on drug prices and supplies (here). Key findings: “Average total drug spending per hospital admission increased 18.5 percent between FYs 2015 and 2017. Outpatient drug spending per adjusted admission increased 28.7 percent while inpatient drug spending per admission increased 9.6 percent during the same period. . . . the growth in expenditures per hospital admission on inpatient drugs exceeded the Medicare reimbursement update five-fold during the study period. Hospitals experienced price increases in excess of 80 percent across different classes of drugs, including those for anesthetics, parenteral solutions, opioid agonists, and chemotherapy. . . One in four hospitals had to cut staff to mitigate budget pressures. Hospitals report that drug shortages put patient care at risk and create additional burden and cost.”
READINGS & REFERENCES
Thought Leaders on what is to be done with the Cost of Health Care: The Society of Actuaries and the Kaiser Family Foundation brought together more than 30 thought leaders from throughout the health care community on March 7, 2018 for an “inaugural event” now reported here.
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: 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.