DCMedical News: Friday, March 8, 2019
DCMedical News-DCMN
Washington, D.C.
Friday, March 8, 2019
DCMedical News is published every day that both Houses of Congress are in session. Subscription information will be found below.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Prior Authorization by Medicare Advantage (MA) Plans, Doctors Object:
The Medical Group Management Association (and 95 other medical organizations) sent a letter (here) to the Centers for Medicare and Medicaid Services in an attempt to reduce the volume of prior authorization (PA) processes used by the MA plans. They urged, for example, that ordering or prescribing patterns that are aligned with “evidence-based guidelines,” or those with customary or historically high prior authorization approval rates, should not be subject to PAs.
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Maternity Studies:
HRSA (the federal Health Resources and Services Administration) reports (here) on promising global practices to improve maternal health outcomes, while USA Today reports on the front page (here) that 12% of U.S. hospitals have at least twice the childbirth complications of others.
Contract Prices Next Target of CMS:
The Wall Street Journal reports (here) that the administration is contemplating a requirement that hospitals disclose the “actual prices paid” by health plans.
England’s National Health Struggles to Sustain Public Support:
The King’s Fund reports in the Financial Times (here) that public satisfaction with Britain’s taxpayer-funded national health service is at its lowest level in a decade, 53%, compared to its peak approval of 70% in 2010. Big issues: waiting times, staff shortages, inadequate funding. On the other hand, more than 60% of respondents to the survey expressed support for the founding principle, that NHS services should be free at the point of use. Increased quality was another measure garnering support, with 71% of the respondents citing quality as a reason for their satisfaction. Dissatisfaction with general practice reached 63%, the highest since the survey began in 1983.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
CMS Answers Your Questions on MIPS:
CMS published a report on the “Quality Payment Program” and the MIPS (Merit-based Incentive Payment System) payment adjustments for 2019, here. Additional QPP and MIPS resources are linked on the document.
DRUGS & DEVICES
Does Reference Pricing Have a Place in Medicare?
The Medicare Payment Advisory Commission (MedPAC) meeting Thursday discussed establishing reference pricing for drugs covered by the Medicare Part B program. It was noted that Part B drug spending, totaling $32 billion in 2017, had grown nearly 10% a year since 2009, half of that growth attributed to price increases. Currently, Medicare pays for these drugs at the ASP (Average Sales Price) plus 6%.
READING AND REFERENCE
Federal Trade Commission Hearings on Competition Continue, Including the Health Field:
The FTC has announced that its hearings on competition will continue April 12th (announcement here). In making the announcement, the Bureau of Economics noted its long history of evaluations of consummated mergers, including the following studies:
The Competitive Effects on Non-Profit Hospital Mergers (from 1999), here.
Geographic Markets in Hospital Mergers (from 2001), here.
The Competitive Effects of Non-Profit Hospital Mergers (from 2001), here.
Price Effects of Merger, Sutter-Summit Transaction (from 2008), here.
Hospital Mergers and Inpatient Prices, New Hanover-Cape Fear Transaction (from 2009), here.
Two Hospital Mergers on Chicago’s NorthShore (from 2009), here.
2019 Alzheimer’s Disease Fact and Figures, Alzheimer’s Association, here.
H.R. 1, For the People Act of 2019: CBO explanation and report, here.
Poverty Guidelines:
Poverty guidelines (for federal programs and similar determinations) announced by the HHS Assistant Secretary for Planning and Evaluation, here, Federal Register notice 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
March publication dates: 11, 12, 13, 14, 25, 26, 27, 28
April publication dates: 1, 2, 3, 4, 9, 10, 11, 12, 29, 30
May publication dates: 1, 2, 7, 8, 9, 10, 14 15, 16, 17, 20, 21, 22, 23
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.