DCMedical News: Friday, February 8, 2019
DCMedical News-DCMN
Washington, D.C.
Friday, February 8, 2019
The publication schedule and subscription information for DCMedical News will be found below.
THE BIG STORY IN HEALTH CARE:
Congress Buckles Down: Both the House and Senate (but especially the House) have brought new energy to health policy proposals, notwithstanding that partisan concerns may keep any of them from becoming law.
The Energy & Commerce Health Subcommittee examined Texas vs. Azar in which Attorneys General from conservative states have brought suit to declare unconstitutional the Patient Protection and Affordable Care Act (PPACA). Health Subcommittee Chair Rep. Anna Eshoo (D-CA) has scheduled a hearing for the 13th (announcement here) to examine Trump administration policies affecting the Patient Protection and Affordable Care Act; to revoke the rule concerning short-term, limited duration health insurance; to bolster the advertising budget for the health insurance exchange; and to undo the “guidance” on §1332 waivers.
The House Committee on Education and Labor received testimony from witnesses about threats posed by Administration action to employees with pre-existing conditions. Chairman Rep. Bobby Scott put forward a bill of particulars, here. Witness Chad Riedy described his challenges with cystic fibrosis, here. Conservative advocate Grace-Marie Turner promoted the work (here) of the “Health Policy Consensus Group,” namely a plan (“Health Care Choices 2020”) which appears to involve grants to the states to develop high risk pools, off-loading the expense of high cost patients from the premiums paid by everyone else. Dr. Rahul Gupta of the March of Dimes discussed the particular challenges posed by chronic disease to women of childbearing age, here. Georgetown’s Sabrina Corlette gave a talk (here) on the history of employment and health coverage in America, problems with the adequacy of coverage, and the response of specific initiatives of the Patient Protection and Affordable Care Act, well worth reading.
Finally, the House Appropriations Labor-HHS-Education Subcommittee began its review of administration policies aimed at undermining PPACA. The tone was set by Chair Rep. Rosa DeLauro, here. In her testimony, Aviva Aron-Dine of the Center on Budget and Policy Priorities focused attention (here) on the distribution of benefits from PPACA and the relationship of PPACA success and individual and family financial success. Edmund F. Haislmaier of The Heritage Foundation (here) pointed to shrinkage (by one third) in the unsubsidized individual market, and contended that “after four years the ACA’s coverage effects appear to have reached a point of diminishing returns, with the situation unlikely to change much going forward for several reasons.” Joshua Peck, Co-Founder of Get America Covered and Chief Marketing Officer for the Health Insurance Marketplace during the Obama administration testified (here) as follows: “I was responsible for Marketplace enrollment, retention and the $100 million outreach and advertising budget that the Trump administration cut by 90%. I am here today to testify to the impact that these cuts had on enrollment. However, it’s important to note that these cuts are just a single example of the current administration’s efforts to undermine the Health Insurance Marketplace. They’ve cut navigator funding by 80%, shortened the Open Enrollment period, championed the repeal of the individual mandate, encouraged the introduction of junk plans, didn’t engage with the news media to get out the word about the deadline and much more.” Peter Morley gave (here) an emotional and powerful testament of patient advocacy and suffering.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Insurance Companies Throw a Spanner into the Works: The AMA reveals (here) a survey of 1,000 practicing physicians on the subject of prior authorization (PA). Medical practices complete on average 31 PAs per physician per week; physicians and their staff spend an average of two business days or nearly 15 hours each week completing PAs; and 36% of physicians have staff who work exclusively on PAs. Big problem: how often do issues related to the PA process lead to patients abandoning their recommended course of treatment? 75% of physicians report this happening.
HOSPITALS AND OTHER HEALTH CARE FACILITIES
Fiddling With Diagnosis and Coding to Support PCI: In JAMA Internal Medicine this week a fascinating story (here) of unintended but predictable consequences. The authors write, “Recent health care policy initiatives have focused on reducing misuse or overuse of expensive cardiovascular procedures. The appropriate use criteria (AUC) for coronary revascularization were released in 2009 with the aim of reducing inappropriate percutaneous coronary interventions (PCIs). In addition, national efforts to provide hospitals with information about their performance on PCI appropriateness began in 2011. Since these initiatives were enacted, the volume of PCIs performed for nonacute indications in the United States has declined, as have rates of PCIs considered inappropriate. Some have declared this a policy success—that the fewer inappropriate PCIs performed nationally reflect better selection of patients likely to experience improved outcomes. However, it may be that these initiatives incentivized physicians to classify patients with stable chest pain as having unstable angina (UA) to meet AUC.” So finds this study. One example: in 2011 the State of New York announced that its Medicaid program would not pay for inappropriate PCIs, with this result: “In New York, the proportion of PCIs labeled as acute, but performed as outpatient procedures, increased 14-fold, driven largely by a rise in PCIs performed for UA.”
“Becker’s” has a new publication, “Becker’s Blockchain Report,” sample here.
MEDICARE, MEDICAID, COMMERCIAL HEALTH INSURANCE
Humana Reports on Q4 2018: Human’s CEO Bruce Broussard reported on the company’s fourth quarter and 2018 results, transcript here. Results: better than expected, due to Medicare Advantage, including 12% growth in membership
READING AND REFERENCE
Health Care Cost Institute: Annual Report webinar, Tuesday the 12th at 11:00 a.m., sign up here: https://register.gotowebinar.com/register/2207127052585162754
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: 11, 12, 13, 14, 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.