DCMedical News: Wednesday, April 10, 2019
DCMedical News-DCMN
Washington, D.C.
Wednesday, April 10, 2019
DCMedical News is published every day both the House and the Senate are in session. Subscription information below.
HOSPITALS, NURSING HOMES AND OTHER HEALTH FACILITIES
Is Transparency Helpful?
A feature in The New York Times (here) about fungal resistance, hospital rooms infected and difficult to clean, and the potential for impaired hospital reputations, raises issues of a “Culture of Secrecy.” On the matter of identifying hospitals with resistant infections, “The C.D.C. declined to comment, but in the past officials have said their approach to confidentiality is necessary to encourage the cooperation of hospitals and nursing homes, which might otherwise seek to conceal infectious outbreaks.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
MACPAC to Meet, Discuss DSH and UPL Supplemental Payments to Hospitals:
The Medicaid and CHIP Payment and Access Commission will meet tomorrow and Friday (agenda here). MACPAC’s March 2019 Report to Congress on Medicaid and CHIP (here) addresses DSH funds (Disproportionate Share Hospital, $12 billion per year) and UPL funds (Upper Payment Limits, $13 billion per year), two forms of supplemental payments for hospitals with significant volume of Medicaid patients.
With regard to DSH, currently facing an annual $4 billion (and increasing in later years) reduction October 1, MACPAC wrote “If Congress chooses to go ahead with DSH reductions, the Commission offers a plan to mitigate their impact and improve the relationship between state allotment amounts and uncompensated care costs. Specifically, we recommend... changing the methodology to reduce allotments in a way that gradually improves the relationship between DSH allotments and the number of non-elderly low-income individuals in a state.” (House Speaker Nancy Pelosi appeared at the American Hospital Association gathering in Washington Tuesday and said – as reported in Modern Healthcare, here – there would be no change in the DSH formula this year, as well as more deferral of the beginning of DSH cuts. Political leaders in states which did not expand Medicaid under PPACA – the Patient Protection and Affordable Care Act – have sought to redirect DSH funds in order to help hospitals in their states.)
On UPL, MACPAC wrote “Our review of data submitted by states to the Centers for Medicare & Medicaid Services (CMS) to demonstrate their compliance with upper payment limits, found large discrepancies between UPL spending reported by states and actual spending claimed for federal matching funds.”
In general, MACPAC found “although charity care and bad debt are declining, Medicaid shortfall (the difference between a hospital’s Medicaid payments and its costs of providing services to Medicaid-enrolled patients) is growing. Medicaid shortfall, in fact, outpaced the decline in unpaid costs of care for uninsured patients in state plan rate years 2013 and 2014 for DSH hospitals.” A MACPAC tutorial on Medicaid supplemental payments to hospitals is here.
Miscellaneous Modest Medicaid Proposals Pass the Senate, are Sent to the President:
The proposals, collected in the Medicaid Services Investment and Accountability Act of 2019 (here) would “[A]mend title XIX to extend protection for Medicaid recipients of home and community-based services against spousal impoverishment, establish a State Medicaid option to provide coordinated care to children with complex medical conditions through health homes [and] prevent the misclassification of drugs for purposes of the Medicaid drug rebate program.”
Urban Institute Paper on Consequences of the Repeal of PPACA:
The paper (here) projects that the nation’s uninsured would increase by 20 million (roughly the same number brought from uninsured to insured through Medicaid expansion and exchange plans offered through PPACA); that federal healthcare spending would go down by 35%; that state health spending on Medicaid and CHIP would decrease 6%; and that demand for uncompensated care would increase by 82%.
DRUGS AND DEVICES
STAT reports (here) that after three years the Centers for Disease Control and Prevention (CDC) has given some additional explanation of its March 2016 opioid prescribing guidelines (here) which had targeted primary care physicians, the doctors who write the great majority of prescriptions for opioids. The original guidelines advised doctors to prescribe opioids only after other therapies had failed, and to use the lowest possible doses. Now CDC has sent a letter (here) in which CDC’s chief medical officer says that the guidelines should not be used to deny relief to patients with chronic pain.
READINGS AND REFERENCES
U.S. Census Bureau, Small Area Health Insurance Estimates (here): One third of the nation’s counties had “un-insurance rates” under 10%. At the other end, counties with more than 25%, a majority are in Texas.
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: 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.