DCMedical News: Friday, April 12, 2019
DCMedical News-DCMN
Washington, D.C.
Friday, April 12, 2019
DCMedical News is published every day both the House and the Senate are in session. The next edition (following the Congressional recess) will be April 29. Subscription information below.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
InsideHealthPolicy reports on a push to add 15,000 resident physician positions under the Medicare Graduate Medical Education (GME) program. Sixty-five health organizations (led by the American Hospital Association, but not including the American Medical Association or the American Academy of Family Practice) have signed on. Reports IHP, “The Resident Physician Shortage Reduction Act would authorize 15,000 new Medicare-supported residency positions, specifically through increased payments for direct GME, between 2021 and 2025. The bill would authorize 3,000 spots per year, set out to hospitals in the following priority order: first, hospitals in states with new medical schools or new branch campuses, then those training more residents than are supported by their current GME cap, followed by hospitals affiliated with Veterans Affairs medical centers, hospitals that emphasize training in a community-based setting or in outpatient departments, those not located in a rural area but which operate an approved rural track program and lastly all other hospitals. Hospitals could receive up to 75 new training positions a year, and would be required to make sure at least 50 percent of the new GME-supported spots are used for a shortage specialty residency program.” Each new residency position is estimated to cost Medicare $100,000 per year, depending on hospital location and cost history, and not including Indirect Medical Education support.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Around the World With “Universal Coverage”:
Sherry Glied and colleagues check in (here) for the Commonwealth Fund with lessons concerning universal coverage health systems in other countries, finding considerable variation and important differences between those systems and “single payer” health insurance proposals by Presidential candidates (and others) in the U.S. The authors find that a high degree of centralization is not a feature of the plans of a dozen commonly cited countries with universal health coverage. Other universal health coverage systems also differ considerably in benefit design and patient cost-sharing, while private insurance has a highly variable role in different country plans, from significant to none.
MACPAC: When is a Medicaid Shortfall Not?:
The Medicaid and CHIP Payment and Access Commission voted to include in its June report to Congress a change in the definition of the Medicaid shortfall in order to re-impose stricter limits on the amount of supplemental payments that Disproportionate-Share Hospitals (DSH) can receive. The Medicaid shortfall is the amount or difference between the costs of providing care to Medicaid patients and the direct payments received by a hospital for that care. A 2018 District Court ruling allowed hospitals to receive DSH funds to reimburse costs that had already been paid by private insurers or Medicare. Oral argument on the appeal at the U.S. Court of Appeals for the D.C. Circuit took place Tuesday. Likely winners in this approximately $4 billion (over 10 years) contest would be hospitals with big safety net populations; likely losers would be children’s hospitals. Another MACPAC recommendation would affect how quickly states add new FDA-approved drugs for individual state Medicaid program coverage: states could wait for 180 days, while currently, Medicaid covers drugs as soon as they are approved. Another recommendation concerning drug coverage was to eliminate the cap on rebates from manufacturers seeking to have their drugs covered by Medicaid programs, reportedly a $15-20 billion (over 10 years) matter. CQ reports on the “Red Queen” nature of this change: “Removing the rebate cap could result in savings and allow states to provide the same amount of coverage at a lower cost to them, but if drug makers pay higher rebates, they would be likely to eventually raise their list prices to compensate for lost revenues.”
Catching Up with MedPAC:
Last week’s meeting of the Medicare Payment Advisory Commission produced a recommendation (here) to drop the $1 billion or so in annual penalties associated with Medicare “quality” programs. The IQRP (Hospital Inpatient Quality Reporting Program), HRRP (Hospital Readmissions Reduction Program), HAC (Hospital-Acquired Condition—formerly HAI, for those Hospital-Acquired Infections—Reduction Program) and VBP (the Hospital Value-Based Purchasing Program) would all be dropped, in favor of a new (also untested, unproven) program, HVI, the Hospital Value Incentive Program. In the rest of the news, MedPAC reports every March on the Medicare fee for service program, the Medicare Advantage program and the Medicare prescription drug program (Part D), Executive Summary here, Fact Sheet here, Full Report (531 pages) here, and Press Release here.
DRUGS AND DEVICES
Maryland Drug Price Cap:
STAT reports (here) that Maryland has passed the “first-of-its kind law to create a state board that could cap payments for ultra-expensive prescription drugs.”
READINGS AND REFERENCES
Secretary Azar, Remarks to the National Business Group on Health (here): Surprise bills, drug prices, rebates and more.
Congressional Budget Office Working Paper: “Prices for and Spending on Specialty Drugs in Medicare Part D and Medicaid: An In-Depth Analysis,” March 2019, here.
Save this One for 2020: “Trump Is Being Vague About What He Wants to Replace Obamacare. But There Are Clues,” Margot Sanger-Katz (here), The New York Times, April 5, 2019.
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: 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.