DCMedical News: Thursday, February 7, 2019
DCMedical News-DCMN
Washington, D.C.
Thursday, February 7, 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:
Starting Gun for 2019 on HIV:
Following the President’s State of the Union address, HHS Secretary Alex Azar wrote that “Americans heard tonight how serious President Trump is about improving the quality and affordability of healthcare. In addition to maintaining a strong commitment to confronting the opioid epidemic and proposing a new dedicated initiative to tackle childhood cancer, the President announced his Administration’s goal to end the HIV epidemic in America within 10 years, and asked Republicans and Democrats to also make this commitment.” HHS plan here, “Fact Sheet” here.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Nearly Half of Americans Have Heart Disease: Or so says a headline in U.S.A. Today (here), reporting on the annual collection of heart health information by the American Heart Association and published in Circulation (473 pages, here). An important factor increasing the apparent epidemic: redefining normal blood pressure (130/80 vs. the former 140/90). Overall, age-adjusted deaths from heart disease were down, as were age-adjusted death rates for six other of the top ten causes of death in the U.S.
Cutler and colleagues in this month’s Health Affairs (here) found that health care spending slowed significantly among senior Medicare beneficiaries since 2005. They attribute much of the decline to lower spending on cardiovascular disease as interventions improve cardiovascular health.
You’re Not in the Minnesota Winter any More: The Cleveland Clinic announces (here) that it is building 350,000 sf worth of medical office buildings in Palm Beach County, FL.
Payment for Primary Care: Enhanced by Medicare Payment Experiments, or Endangered by Medicare Experiments? Harvard’s Bruce Landon presents a discussion in this week’s New England Journal of Medicine, here. With regard to recent payment experiments, Landon writes: “CMS has taken several concrete steps related to the first strategy, such as expanding the number and types of billable services for primary care — introducing payments for annual wellness visits, transitional care management, and chronic care management services, for instance. But the uptake of these auxiliary codes has been low, probably because complex requirements must be met in order to bill for these codes, and whether their use improves care remains unclear. Moreover, billing for services using these codes adds complexity to documentation and service delivery, an effect contrary to the spirit of the proposed payment rule.”
HOSPITALS AND OTHER HEALTH CARE FACILITIES
Are We Getting Better at Preventing Hospital Acquired Conditions or at Coding?
The Agency for Healthcare Quality and Research has announced significant improvement in the incidence and prevalence of hospital-acquired conditions (HACs), announcement here, paper here. CMS’ Director Verma has noted this improvement. In a peer-reviewed journal, on the other hand, a Boston group (here) found that there was “no evidence these programs had any measurable association with changes in catheter-associated urinary tract infection (CAUTI) rates in U.S. hospitals. This is the first study to look at how these federal payment programs impact healthcare-associated infections.” Neither the AHRQ report nor these authors discuss the phenomenon of “PoA,” that is “Present on Admission”: following the introduction of financial penalties for HACs, many hospitals saw emergency and admissions staff exert additional effort to find infections which may have been “Present on Admission,” therefore not to be reported as “hospital-acquired.”
Conflict of Interest or Coordination of Efforts? The Joint Commission has submitted its response (here) to the Centers for Medicare & Medicaid Services’ (CMS) Request for Information (RFI) related to Medicare-approved accrediting organizations and the provision of fee-based consultative services for Medicare-participating providers and suppliers.
High C-Section Rates to be Publicly Reported by TJC: The Joint Commission announced (here) that it will begin publicly reporting hospitals with consistently high cesarean birth rates by July 1, 2020, using data reported by hospitals during the calendar years 2018 and 2019. Had the rates for 2016-2017 been used, 20% of accredited hospitals would have been reported as having high C-section rates.
MEDICARE, MEDICAID, COMMERCIAL HEALTH INSURANCE
Will State Waivers (Section 1332) Save, Reform or Sabotage Obamacare? Stuart Butler, long-time conservative theorist, writes on this subject in the February 5 JAMA (here). He reviews the November CMS “guidance” and parenthetically mentions the broad scope of supposed “interpretive” rules by CMS (see reference below on Auer deference). Butler’s overall thesis is that “CMS is pushing the envelope with this new guidance,” but that “To reach the ACA’s overall goals…it is necessary to experiment and innovate,” that “Section 1332 is a powerful engine of innovation through federalism,” and that “CMS should give states the encouragement they need to find the best ways of meeting the ACA’s broad goals” using Section 1332 as a “valuable political safety valve – enabling states that want significant changes in the ACA to obtain them, without new laws altering the ACA for states that want to keep it as is.”
DRUGS AND DEVICES
Value Based Drug Contracts in Oklahoma: As the first state whose Medicaid program has federal approval to participate in “value based” drug payments, Oklahoma has cautionary findings for federal (or other state) action, (Morning Consult report, here). “If their drug doesn’t perform like they say it does, they’re going to have to pay us back, and that’s eventually going to get well-known across the country — whether their drugs perform or not.” Meanwhile, Washington is moving forward to pay for Hep-C medication through the “Netflix” (subscription) model, STAT report here.
READING AND REFERENCE
Chevron Deference v. Auer Deference, an Issue in Kisor v. Wilkie: The Supreme Court will hear oral argument on Kisor v. Wilkie (SCOTUSBlog record here) on March 27. At stake is deference to an agency (such as HHS or CMS) when that agency interprets its own rules. Deference to an agency which is developing rules to “fill out” legislative intent (“Chevron” deference from Chevron U.S.A. v. National Resources Defense Council, see Amicus brief of law professors, here) involves something very different (say the professors) from Auer deference (from Auer v. Robbins). A Chevron summary (from the professors’ brief) might be that “When an agency promulgates a regulation (or issues an order) interpreting a statute it is charged with administering pursuant to an express or implicit delegation from Congress, has the agency stayed within the bounds Congress set, or has the agency strayed beyond congressionally prescribed limits? Deference is due only if, and precisely because, the Court concludes that Congress left space for the agency to promulgate binding policy and the agency’s determination is not unreasonable.” But (again, from the administrative law professors) “A court applying Auer deference does not address the Chevron question—whether the agency has acted within the scope of authority set by Congress. Rather, Auer deference is meant to assist the court in determining the meaning of a regulation promulgated by the agency when that regulation is deemed ambiguous.” The impact on the health field may be significant: no agency of the federal government spends more money under more ambiguous terms (see an experienced health law leader’s essay here, for example) than CMS. From a “standing start” after the passage of Medicare in 1965, the organization now known as the American Health Lawyers Association has grown to more than 13,000 members, most highly specialized.
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: 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.