DCMedical News: December 11, 2017
DCMedical News
Washington, D.C.
Healthcare, Medical Education
December 11, 2017
Time Bomb(s), Continued
Senate Begins Conference with House
Conference open meeting this Wednesday, 2:00 p.m., HC-5 Capitol Bldg. Joint Committee on Taxation comparison of the House and Senate bills found here. Full text of bill (Senate amends H.R. 1) found here. Senate HELP Committee holds hearing on drugs tomorrow, featuring the recent NAS report (“Making Medicines Affordable"), here. Congress to remain in town until December 22. Mr. Ryan announces 2018 will be the year to go after entitlements; after all, we have that big deficit now. House calendar for 2018 here.
MedPAC Inches Forward on How We Pay Doctors
Can’t watch in DC? DC Medical news is there for you. The players here. The 2018 schedule here. The slides here. The sub-text: MIPS going, going, possibly gone at January 11-12 meeting. The problem, apparently: some groups made too much money, others not enough. Another issue: for paying insurers in Medicare Advantage programs, MedPAC’s Dr. Ginsburg notes incentives get baked in, all the MAs end up above average (4-5 stars), once baked the “incentives” stay. Another sub-text: physician burn-out, “quality” measure reporting requires administaff found only in big groups and (gasp) hospitals. Also, relevance: MedPAC’s Dr. Redberg questions when outcomes will come to the fore, over process. Discussion of MIPS was featured in the transcript of the November 2 meeting, found here, pgs. 3-207.
At the other end of Pennsylvania Avenue, the Alliance for Health Policy worries about the workforce. AAMC consultant gives report on MDs, notes “outcome” results would be cholesterol lowering, BP control, etc. (Those used to be called “signs” in medicine, not “outcomes.”)
December 12 Executive Order on Short Term Policies
Making health insurance great again, or at least catastrophic, HHS will issue a proposed rule tomorrow on Association Health Plans (AHP) and Short-Term Limited Duration Insurance (STLDI) plans. See our December 7 edition (here) for summary of what you won’t get from AHPs or STDLIs.
Hospitals, Other Institutional Providers
Ascension (doing well, FYE 6-30-17 revenue $22.6B, Net $1.8B, profile and 2016 results in bond prospectus here) and Providence St. Joseph (not doing as well, laying off, operating loss of $255M on revenue of $22B) announce proposed 191 hospital merger (here),
minus much-ballyhooed Ascension adventure with Narayana in the Cayman Islands. Dignity and Catholic Health Initiatives (combined revenue $28B, neither doing that well) laboring over merger plans for a year. Church hospital corporations will be > secular hospital corporations if plans are consummated.
Insurers, TrumpCare, Medicaid Waivers
Will Santa visit Senator Collins? Hair-trigger criticism of the Maine Senator for supporting the tax bill. In return for her tax bill support, Alexander-Murray and Collins-Nelson were “promised” to Senator Collins, as part of the “must pass” Christmas tree. The first would fund the Cost-Sharing Reduction payments, the second would fund two years’ of state cost for reinsurance programs that help pay for high-cost patients.
More drama: CHIP continuation through 12-31 thin gruel, will allow CMS to “redistribute” left over funds. KFF publishes nice summary of state plans to throw 9 million children off the program here.
Medicaid Boffins and Managed Care Companies
The “rules” under which managed care companies work may be subject to more arm wrestling and possibly even disclosure in the future.Kentucky’s Department of Medicaid Services filed amendments to nearly every regulation of managed Medicaid.The Franklin Circuit Court enjoined the Department from modifying managed care policies through amendments to their contracts with managed care organizations. AHLA report here.
Thought for the Day: Tax Subsidies as Entitlements? Don’t tell Mr. Ryan:
Jessica Banthin, Deputy Assistant Director in CBO’s Health, Retirement, and Long-Term Analysis Division, gave a presentation Dec 7 at the Inforum Outlook Conference at the University of Maryland, with this theme: In 2017, net health insurance subsidies for people under age 65 will total $705 billion. Gosh.
Another Thought for the Day
Pharmaco-journalism: Health Affairs announces big push on health cost, “With support from the National Pharmaceutical Council.” Politico ads from astroturf (not real grass!) groups, such as RetireSafe, pump comment on federal drug regs. No pharma (or any other) ads here in DCMedical News (yet!)
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com