DCMedical News: Friday, January 18, 2019
DCMedical News-DCMN
Washington, D.C.
Friday, January 18, 2019
DCMedical News is published every day either the House or the Senate is in regular session.
THE BIG STORY IN HEALTH CARE:
Day 28, Shut Down: FDA Commissioner reports that his agency has “weeks” of funding left, but is not allowed to accept new user fees or applications until the shutdown is over. Federal courts report varying strategies, many saying they can “hold out” until January 25. CQ reports that the House of Representatives introduced a $271 billion, six-bill, 1,100-page appropriations measure for the currently unfunded departments, “after the Democratic majority spent the week passing numerous continuing resolutions to reopen government only to see them languish in the Senate.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Boston Globe Reports on Physician Burnout: The Globe (here), reporting on the Massachusetts Medical Society, Massachusetts Hospital Association and Harvard-sponsored report, noted that “Physician burnout has reached alarming levels and now amounts to a public health crisis that threatens to undermine the doctor-patient relationship and the delivery of health care nationwide . . . It [the report] urges hospitals and medical practices to take immediate action by putting senior executives in charge of physician well-being and by giving doctors better access to mental health services.”
How bad is the problem of physician “burnout”? The report estimates that dysfunction and loss of professional attention contribute to losing the equivalent of seven medical school graduating classes each year.
The overwhelming proportion of the 109 comments following the article, however, find that the issue isn’t physician “mental health,” and dispute the report recommendation that “the appointment of executive-level chief wellness officers (CWOs) is essential.” Some of the 109 reader comments label those observations insulting. Rather, the readers see a causal relationship between loss of autonomy in the medical profession and the plethora of dysfunctional health system designs, information systems, and payment systems associated with ersatz “quality” measures, mostly new in the past two decades. Ironically, a leader in that transformation from physician autonomy to clerical work, including the successful commercialization of artificial “quality” metrics, is quoted extensively in the brief, 12-page “burnout “paper (see the report, here).
Speaking of Which: This week’s NEJM Journal Watch General Medicine has a comment on the late December JAMA publication on increased mortality of patients caught up in the Hospital Readmission Reduction Program. The comment this week: “The increase in 30-day post discharge mortality was driven mainly by patients who were not ‘officially readmitted’ to the hospital, suggesting that HRRP might have led to patients being managed for acute issues in emergency departments or observation units instead of inpatient units following their index admissions. Given these potentially worrisome findings, better understanding is needed before continuing a policy that might be harming patients inadvertently.”
The original research (here) by Joynt Maddox and colleagues found that “In this retrospective cohort study that included approximately 8 million Medicare beneficiary fee-for-service hospitalizations from 2005 to 2015, implementation of the HRRP was associated with a significant increase in trends in 30-day post discharge mortality among beneficiaries hospitalized for heart failure and pneumonia, but not for acute myocardial infarction. There was a statistically significant association with implementation of the HRRP and increased post-discharge mortality for patients hospitalized for heart failure and pneumonia, but whether this finding is a result of the policy requires further research.” An editorial accompanied the article, here.
HOSPITALS AND OTHER HEALTH CARE FACILITIES
MedPAC on Pay Rates: The Medicare Payment Advisory Commission voted Thursday to recommend that Congress eliminate scheduled pay raises for skilled nursing and ambulatory surgical centers in 2020. Rehabilitation facilities and home health rates would be cut by 5%, hospice by 2%.
The group recommended that Congress maintain scheduled pay raises for physicians and to require advanced practice nurses and physician assistants to bill Medicare directly (at 85% of the Medicare fee schedule) instead of through a physician (so-called ‘incident to’ billing, paid at 100 percent).
CQ reports that, for hospitals, MedPAC voted to overhaul three value-based programs as part of the annual payment update for hospitals. “The commission recommended a 2 percent increase, below the 2.8 percent update scheduled under current law. The difference would be allocated to a new hospital value program, which would replace three current programs on value-based purchasing, reducing readmissions and reducing hospital-acquired conditions. The proposed Hospital Value Incentive Program, or HVIP, would also remove 0.5 percent in penalties associated with the current programs, resulting in a 3.3 percent increase in reimbursements overall.”
As with the “value-based” incentives, there is little or no research on “HVIP” to demonstrate that any value to patients would exceed the cost to hospitals of implementing such a scheme.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
CMS’ Notice of Benefit and Payment Parameters for 2020: CMS (fact sheet here) released the final version of its benefit and payment letter for 2020 exchange health plans. No changes are made in the “silver-loading process” for 2020; other changes proposed include allowing mid-year drug formulary changes, creating a new special enrollment period for people newly eligible for subsidies and increasing maximum out-of-pocket spending limits. InsideHealthPolicy reported that “CMS is calling for a legislative solution to reinstate cost sharing reduction payments to insurers and to end the silver-loading workaround by plan year 2021.”
On those out-of-pocket spending limits--this is insurance? “We propose that the 2020 reduced maximum annual limitation on cost sharing be $2,700 for self-only coverage and $5,400 for other than self-only coverage for individuals with household incomes between 100-200% of the Federal poverty level (FPL), and $6,550 for self-only coverage and $13,100 for other than self-only coverage for individuals with household incomes between 200-250% FPL.”
The National Health, Continued: The Financial Times reports (here) that “The government spending watchdog has cast doubt on the financial sustainability of England’s National Health Service and its capacity to deliver a much-vaunted plan to secure its future . . . The recent funding settlement for the taxpayer-financed service, which injected an additional 3.4 per cent a year, on average, over the next five years, excluded a number of key areas of expenditure such as capital investment for buildings and equipment, disease prevention initiatives and paying for doctors’ and nurses’ training.” Also, “There are now 4.1m patients on waiting lists for non-urgent treatment, up from 2.5m in 2012-13.”
READINGS & REFERENCES
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: 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.