DCMedical News: Tuesday, March 12, 2019
DCMedical News-DCMN
Washington, D.C.
Tuesday, March 12, 2019
DCMedical News is published every day that both Houses of Congress are in session. Subscription information below.
THE BIG STORY IN HEALTH CARE:
President Unveils 2020 Budget:
The $4.7 trillion proposed budget of the United States government for the Fiscal Year 2020 (here, “A Budget for a Better America”) was released, containing (a) the budget message of the President, (b) information on the President’s priorities and (c) summary tables. Further information at the Office of Management and Budget’s “Analytical Perspectives” (here).
The proposed budget relies on ambitious growth projections and trillions in budget cuts to achieve balance by 2034. The proposed $2.7 trillion in spending cuts over the next ten years would include a $1.5 trillion cut from Medicaid and a $818 billion cut from Medicare. These amounts are similar to the proposals of $1.5 trillion for Medicaid and $560 billion for Medicare in the 2019 budget, not implemented. The new budget also has a 12% decrease in the discretionary funding of the Department of Health and Human Services; the complete HHS and health programs budget is here.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Who Owns Physician Practices?
IQVIA (IMS Health and Quintiles) reports (here) that “The Permanente Medical Groups continue to dominate this annual list with nearly three times the number of unique physicians as second ranked Ascension Health. . . Notable to our list is the University of California, which jumped to number three from number five last year. UC Health operates from six cities. All told, the 50 organizations that comprise this chart own and manage about 27,546 medical sites and employ 125,135 physicians.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Hospital Tax Exemption; Senator Grassley Ramps Up Examination of Tax-Exemption for Non-Profit Hospitals:
STAT had an excellent essay on the history of tax-exemption for modern American hospitals, here. Also, Senator Charles (Chuck) Grassley (R-Iowa), Chair of the Senate Finance Committee, has once again energized his campaign to scrutinize the rationale for the tax-exemption of non-profit hospitals (here). The Senator last mounted such a campaign in 2010 (here), an effort that resulted in section 501(r) of the Internal Revenue Code. STAT sources included Revenue Rulings from 1954 (here), 1956 (here), the well-known Ruling 69-545 from 1969, (here), 1983’s Ruling 157 (here) and the aforementioned 501(r), here. Also adding to the STAT analysis were a law review article (here) and a history of tax exempt organizations generally from the “Statistics of Income” folk, (here).
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE:
Medicare and Medicaid Changes in FY2020 Budget:
In the President’s proposed budget, the main source of Medicaid savings would be to replace the federal contribution to state Medicaid programs with block grants, with an estimated $1.4 trillion in savings. Additional elements of projected cost savings include tightened eligibility requirements and cost-sharing for non-emergency use of an emergency room.
Medicare savings in the proposed budget would come from changes in uncompensated care (presumably DSH, or Disproportionate Share Hospital money); decreased payment (site-of-service differential eliminated) for hospital outpatient care and hospital-owned practices not located on hospital campuses; and dramatic reduction in funds for graduate medical education, $210 billion over ten years.
MACPAC Was in Town:
The Medicaid and CHIP [Children’s’ Health Insurance Plan] Payment and Access Commission met March 7 and 8 (agenda here) in Washington. On Thursday the group discussed therapeutic foster care (here); financing and spending for the Medicaid program in Puerto Rico (here); Medicaid program integrity (deterrence of fraud, here); two aspects of drug coverage, the grace period (pending coverage, what limits can Medicaid programs impose), and the cap on rebates, which applies to drugs that have substantial inflationary rebates due to large price increases but where caps can limit a manufacturer’s incentive to moderate price increases once the cap is reached (both issues, here). Also discussed Thursday were support services for Medicaid beneficiaries with substance use disorders (here), and what to do about a recent court ruling disallowing the counting of third party payments (here) in the calculation of Medicaid shortfalls, an issue under discussion since 1993 when hospital-specific limits were established so that DSH [Disproportionate Share Hospital] payments to an individual hospital would not exceed a hospital’s uncompensated care costs for Medicaid and uninsured patients.
On Friday MACPAC discussed care coordination requirements in integrated care models (here); the proposed rule affecting safe harbors for prescription drug rebates, (here); and how best to approach new legislative requirements (here) to “publish a report with comprehensive data on the prevalence of substance use disorders in the Medicaid population and the services provided under Medicaid for the treatment of such disorders,” with the “number and percentage of individuals in each of the major Medicaid enrollment categories who have been diagnosed with a substance use disorder.”
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: 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.