DCMedical News: December 13, 2017
DCMedical News
Washington, D.C.
Healthcare, Medical Education
December 13, 2017
Schedule for the Tax Bill
Public meeting of the conferees today 2:00 p.m., HC-5 Capitol Bldg., Senate plan to be filed by week’s end, Senate action early next week, House action mid next week, action needed by Friday the 22nd, per HJR 123, here.
Related tax matters: Ways and Means Chairman Brady introduced five additional tax measures, all aimed at “working toward a patient-centered health care system.” The tax relief aims to correct “Obamacare’s failures [which] are continuing to hurt families across the country.” H.R. 4617 would provide relief from that “job and innovation-killing” Medical Device Tax. H.R. 4618 would relieve (but only for two years) the tax on over-the-counter medications, allowing reimbursement under “consumer-directed accounts.” H.R. 4620 provides relief from the “Health Insurance Tax.” H.R. 4616 has retroactive relief and one year of prospective relief “from the harmful employer mandate paired with a one-year delay of the Cadillac Tax.” Even Puerto Rico is remembered (at least) here, with H.R. 4619, relief from the Health Insurance Tax for two years for health plans regulated by Puerto Rico.
MACPAC’s Thursday Meeting, and Previous Meetings
The MACPAC (Medicaid and CHIP advisory body to Congress) does not have “minutes” per se, but they do have transcripts. Here is the transcript of the September 14 meeting. Here is the transcript of the October 26 meeting. The agenda for this Thursday is here. Primary care physicians weighed in with a group of concerns/recommendations on Section 1115 waivers, here.
Documents, New and Old
That Treasury Document (a one pager) contending that growth will keep pace with revenue loss secondary to the tax law changes in H.R. 1? Here is the one page. The Tax Policy Center offers a profile of “Winners and Losers After Paying for the Tax Cuts and Jobs Act,” here.
Senate rules will constrain the contents of the final version of the Tax and Jobs Act, leading House conferees to give deference to Senate positions. Here are the rules, discussed by the Congressional Research Service.
The Congressional Budget Office examines the growth of risk scores among beneficiaries switching from fee-for-service (standard Medicare) to Medicare Advantage (MA) plans, here, finding that they grow. But there is also that business of MA up-coding, examined in a nice National Bureau of Economic Research paper here, as well as in previous studies here and here.
For general background, the Commonwealth Fund has a nice history of MA programs, here.
Twelve specialty societies have noticed that Ways & Means is bypassing the AMA’s RUC (not RVUC!) by rearranging coding reimbursement to fund part of the “Medicare extenders” package. Their protest is here.
The provision which is the subject of the protest would allow Medicare to move money from higher paying specialties to primary care, or, if spending targets are not met, to implement across the board reductions. Can you say “Sustainable Growth Rate?” Not unexpectedly, the risk, according to the specialist group, is that they won’t see Medicare patients, or not as promptly, or not as many. No, wait, that isn’t it. The risk is that the move "risks inappropriately undervaluing physician services and threatening patient access to care."
The “extenders” is another piece of overdue health care legislation, including the repeal of therapy caps, the Medicare Dependent Hospital Program, the Low-Volume Adjustment Program, the home health rural add-on, the Medicare geographic payment cost index, the ground ambulance add-ons and payment modifier, the special needs plans, the State Health Insurance Assistance Programs and the consensus based entity work on quality measures.
The “extenders” as a group (some House-Senate differences, but the pay-for/offsets are from the House) are expected to be added to the CHIP authorization, all part of a year-end “omni-bus.”
A number of other interest groups would be affected by the extender pay-fors, including telehealth providers, MAs generally, non-emergent dialysis transporters, nursing homes, home health agencies, CAHs and the aforementioned specialist physicians. This is for that group: “Extension of a policy that requires CMS to identify overvalued billing codes worth .5% of Medicare physician pay annually.” Ah, gov-a-mint.
Did you vote in Alabama yesterday? You were in an unhealthy state, at least according to the annual report of the “United Health Foundation,” here, slides here. The bottom five were Mississippi (50), Louisiana (49), Arkansas (48), Alabama (47) and West Virginia (46). True or false? Without the states of the Confederacy our health status looks like Finland.
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com