DCMedical News: Friday, February 1, 2019
DCMedical News-DCMN
Washington, D.C.
Friday, February 1, 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:
Following the Rules: SCOTUSBlog (informal but informed writings on cases coming before the Supreme Court, here and here) is focused on the Auer rule, under which federal courts have given deference to federal administrative agencies for those agencies to interpret their own rules. A consistent theme in these writings is that the Court has accepted a case for purposes of re-thinking or possible overturning that rule. A related theme (see for example a report in The New York Times, here) is that the administration has suffered setbacks in its policy initiatives for failure to follow the “rule-of-rules,” namely the Administrative Procedures Act. In this week’s New England Journal of Medicine Pauly writes (here) about the seeming alacrity with which HHS proposes to dispose of rules to prohibit fraud and kickbacks, in honor of vague, untested or tested-and-found-wanting theories of flexibility and coordination of care.
HOSPITALS AND OTHER HEALTH CARE FACILITIES
HCA Grows Volume, Revenue: Hospital Corporation of America CEO Sam Hazen reporting on the company’s fourth quarter (transcript here) said “We finished the year with the strong quarter and ahead of our expectations. Solid volume increases and strong revenue growth drove this quarter's results . . . Inpatient admissions and equivalent admissions on a same facility basis grew almost 2% respectively in a quarter . . . Revenues on a same facility basis grew by 6.4% . . . Revenue per equivalent admission grew by 4.4%.” Emergency department volume was down 2%, especially in levels 1-3, up 1% in levels 4-5 (greater intensity, higher charges), with resulting 2% increase in ED-to-inpatient admissions. EBITDA in the fourth quarter was 20%. Case mix growth of 3% in each of the last three years resulted from investment in high complexity clinical care (trauma up 7% in 2018, bone marrow transplant up 17% in 2018).
MEDICARE, MEDICAID, COMMERCIAL HEALTH INSURANCE
How Many Uninsured, and Who Are They?: Gallup reported (here) that while the U.S. adult uninsured rate rose to 13.7% in the fourth quarter of 2018, distribution was uneven. In the South, the uninsured rate rose by 3.8%, to 19.6% overall. Adults under age 35 had an uninsured rate of 21%. Among women, the rate of uninsured rose from 8.9% in 2016 to 12.8% in 2018.
Analyze This: A new report (here) “[D]escribes how the Congressional Budget Office and the staff of the Joint Committee on Taxation (JCT) analyzed the new rules [for Association Health Plans and Short Term Limited Duration health insurance plans] and determined how those rules would affect the agencies’ projections of the number of people who obtain health insurance and the costs of federal subsidies for that coverage. It also provides details about the projected effects.”
CMS on MIPS’ QPP: The Centers for Medicare & Medicaid Services (CMS) is hosting a webinar on Tuesday, February 5 at 12:30 PM ET to provide an overview of the Quality Performance category of the Merit-based Incentive Payment System (MIPS) in Year 3 of the Quality Payment Program. Registration https://engage.vevent.com/rt/ketchum/index.jsp?seid=160
DRUGS AND DEVICES
OIG Proposes Change in PBM Rebates: The HHS Office of Inspector General published in the Federal Register (here) a proposed rule to amend OIG’s safe harbor regulations under the Anti-Kickback Statute (AKS). The AKS is a criminal statute that prohibits the knowing and willful offer, solicitation, payment or receipt of value in exchange for federal health care program business. The importance of “safe harbor” regulations is that they describe practices not subject to AKS liability.
This proposed rule, “Removal of Safe Harbor Protection for Rebates Involving Prescription Pharmaceuticals etc.” would exclude the rebates drug makers pay to pharmacy benefit managers from protection against AKS liability. The proposed rule would apply to Medicare Part D and Medicare Advantage plans. "This proposal has the potential to be the most significant change in how Americans' drugs are priced at the pharmacy counter, ever, and finally ease the burden of the sticker shock that millions of Americans experience every month for the drugs they need," according to HHS Secretary Azar. “Fact sheet” on the proposal here, news release here. Ending federal protections for drug manufacturer rebates to pharmacy benefit managers and health plans is an attempt to promote discounted prices to patients.
READING AND REFERENCE
On Primary Care: A Boston group reports on the “Quality and Experience of Outpatient Care in the United States for Adults With or Without Primary Care” in JAMA Internal Medicine (here). “Receipt of primary care was associated with significantly more high-value care, slightly more low-value care, and better health care experience. Policymakers and health system leaders seeking to improve value should consider increasing investments in primary care.”
MACPAC Meeting (January 24-5) Presentations:
“Physician Acceptance of New Medicaid Patients,” MACPAC Presentation, January 24, 2019, here.
“Review of Draft March Chapter and DSH Allotment Recommendations,” MACPAC Presentation, January 24, 2019, here.
“Utilization Management of Medication-Assisted Treatment,” MACPAC Presentation, January 25, 2019, 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 February publication dates: 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.