DCMedical News: Monday, April 1, 2019
DCMedical News-DCMN
Washington, D.C.
Monday, April 1, 2019
DCMedical News is published every day both the House and the Senate are in session. Subscription information below.
THE BIG STORY IN HEALTH CARE
Administration Losing in the Courts, Pushes for Plan in the Senate
Redefinition of the word “employer” to facilitate development of Association Health Plans was declared invalid (here) by one Federal court, while another (see DCMN of 3-28) invalidated compulsory work and community service requirements as a condition of eligibility for Medicaid. At the same time, seeking to make his “the party of health care,” the President said he had “tasked” Sens. Bill Cassidy (R-La., a gastroenterologist), Rick Scott (R-Fla, chief executive of Columbia-HCA during its upcoding scandal), and John Barrasso (R-Wyo., an orthopedic surgeon) with developing "a really great plan" to replace the Patient Protection and Affordable Care Act, if PPACA is struck down entirely in court.
Eleven states and the District of Columbia had sued to invalidate the expanded definition of “employer.” A report (here) in January noted that twenty-eight such plans had been offered in thirteen states. Separate litigation against the short-term limited duration plans is also underway, also in the D.C. District Court.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
New Report on Surprise Bills:
HCCI issued a new report (here), based on 2016 claims, on out-of-network, “surprise” bills. “The share of in-network hospital admissions with at least one associated out-of-network professional claim ranged from 1.7% in Minnesota to 26.3% in Florida; Anesthesiology accounted for the largest share (16.5%) of out-of-network professional claims associated with an in-network admission; . . . independent labs most often billed out-of network as part of an in-network hospital admission (22.1% of the time).” The HCCI results sorted by state are here, sorted by specialty, here.
Behavioral Economists Adopt Hawthorne, Illinois Western Electric Works 1925 Image as Logo:
The San Diego meeting of health care behavioral economists (here) adopted the electric works plant (here), famous for the “Hawthorne Effect.” The logo will appear under “Disclosures” in the academic health policy literature.
HOSPITALS AND OTHER HEALTH CARE FACILITIES
Premier Says “Hospital-Associated” Sepsis Incidence Down, Costs Up:
The hospital group purchasing outfit, applying ICD-10-CM coding retroactively to 2015, reports (here) that the incidence of “hospital-associated” (as opposed to “community-acquired” and therefore “present on admission”) sepsis was down 15%, but that the cost per case is up. “Premier’s findings show that the average cost per case for hospital-associated sepsis jumped more than 20 percent from approximately $58,000 in October 2015 to just over $70,000 in September 2018. This indicates that in 2018, hospitals in aggregate were spending an additional $1.5 billion to treat patients with hospital-associated sepsis compared to just three years prior.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
MedPAC Meets April 4-5:
The Medicare Payment Advisory Commission meets this Thursday and Friday to discuss expanding the use of “value-based payment in Medicare; the performance of the Medicare Shared Savings Program; redesigning the Medicare Advantage (MA) quality bonus program; increasing the accuracy and completeness of MA encounter data; options for slowing the growth of Medicare fee-for-service spending for emergency department care; and, on Friday, options to increase the affordability of specialty drugs and biologics in Medicare part D; and improving payment for low-volume and isolated outpatient dialysis facilities.” Details in tomorrow’s DCMN.
READINGS AND REFERENCES
This Week is National Public Health Week (in the U.S.)
More Opioid Scandal:
New York Attorney General Letitia James has sued the Purdue company and owner Sackler family members for, among other things, deceptive marketing and advertising of opioids that helped fuel the opioid overdose epidemic, 269-page complaint 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
April publication dates: 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
Don’t be fooled today.
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.