DCMedical News: Monday, January 28, 2019
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Washington, D.C.
Monday, January 28, 2019
DCMedical News is published every day either the House or the Senate is in regular session.
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THE BIG STORY IN HEALTH CARE:
Back to Work: The President promises action on “surprise” medical and hospital bills (generally, those resulting from services delivered by out-of-network professionals during in-network hospitalization or emergency care). The Senate Finance Committee holds a hearing (tomorrow, entitled “Drug Pricing in America: A Prescription for Change,”) on drug prices, drug patent (“pay-for-delay”) policy. The House Ways and Means Committee schedules a hearing on coverage for pre-existent conditions, the House Oversight Committee on drug prices (“Examining the Actions of Drug Companies in Raising Prescription Drug Prices”). Senate Health, Education, Labor and Pensions Committee leaders will push forward Tuesday with a bill on teaching health center graduate medical education funds, as well as funding for FQHCs, the National Health Service Corps and other direct service health programs. HHS Deputy Secretary Hargan will discuss an administration initiative Wednesday to lower the cost of health care by weakening the Anti-Kickback Statute and Stark fraud and abuse measures.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Professionals Risk Averse in Gambling with Medicare: The General Accountability Office (GAO) has found that health care professionals are loathe to gamble with reimbursement for patient services to Medicare beneficiaries. In a report to Senator Wyden on the Finance Committee (here) dated December 21, now released, GAO found that “Providers participating in Medicare's voluntary bundled payment models often drop out when forced to assume downside risk,” that “groups did a risk-benefit analysis when deciding to participate in voluntary episode-based payment models in the first place, but when they entered the phase where they face financial penalties for failing to cut costs while providing high-quality care, they were more likely to leave the model altogether.”
Healthcare Dive reported that the finding does not augur well for voluntary bundled, incentivized or other “value-based” payment arrangements, and predicted that CMS may double down with increased emphasis on mandatory participation in such models. Said Dive, “CMS has either tested or is testing six bundled payment models: four versions of Bundled Payments for Care Improvement, the Oncology Care and the CJR models. Rather than paying providers based on the amount or complexity of service, CMS establishes a target payment amount that encapsulates the total cost of the health ‘event,’ such as a surgery or hospitalization, for a Medicare beneficiary.” The only current mandatory payment model is the remnant of Comprehensive Care for Joint Replacement (CCJR); that experiment had 67 hospitals in 2016 which were forced to participate, 34 in 2017 and none in 2018.
HOSPITALS AND OTHER HEALTH CARE FACILITIES
Avik Roy on Hospital Costs: Forbes’ “Apothecary” writes (here) that hospitals (to say nothing of the remainder of health costs) now take more from the average American household than federal taxes. “The . . . average family now hands over more of its paycheck to the hospital industry than it does to the federal government in taxes [and] it’s only going to get worse over time. Hospital spending continues to rise faster than inflation, but barring further changes to tax law, the federal tax rate for the median family will remain just under 14 percent.” In a longer paper on the web site of his foundation, Roy writes (here) that “[I]n competitive hospital markets, the average hospital charged $18,337 for a knee replacement; in a consolidated hospital market, the average hospital charged $26,713: a premium of 46 percent. However, the average cost to the hospital for performing the knee replacement was nearly identical: $11,870 in competitive markets and $12,096 in consolidated markets. In other words, nearly the entirety of the price premiums charged by consolidated hospitals flows down to the hospitals’ bottom lines . . . consolidated hospitals earned more than twice their competitive peers in contribution margin.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
MedPAC Presentations from January 17-18: The Medicare Payment Advisory Commission, preparing its recommendations for Congressional action in 2019. Ambulatory Surgery Centers and Hospice, here. Hospital Inpatient and Outpatient, here. LTCH, Long Term (Acute) Care Hospitals, here. Physicians, ARPNs, NPs, here. Outpatient Dialysis, Drug Part D plans, here. SNF, Home Health, Rehabilitation, here.
Also on the two-day program: presentations on opioid use in hospitals, here; on future policy directions for Medicare drug spending, here; and for Medicare shared savings performance measures, here.
Proposed 2020 Exchange and Related Rules (Benefit and Payment Parameters) Published in Federal Register: The January 24 publication (here) includes payment parameters and provisions related to the risk adjustment and risk adjustment data validation programs; cost-sharing parameters; and user fees for Federally-facilitated Exchanges (FFEs) and State-based Exchanges on the Federal Platform (SBE–FPs). “It proposes changes that would allow greater flexibility related to the duties and training requirements for the Navigator program and proposes changes that would provide greater flexibility for direct enrollment entities, while strengthening program integrity oversight over those entities. It proposes policies that are intended to reduce the costs of prescription drugs. It includes proposed changes to Exchange standards related to eligibility and enrollment; exemptions; and other related topics.” Comments are due February 19.
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: 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.