DCMedical News: Monday, April 29, 2019
DCMedical News-DCMN
Washington, D.C.
Monday, April 29, 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
Congress is back in session today. A proposed rule for Inpatient Prospective Payment Rates for hospitals for FY20 is published (see below). CMS proposes (again) new (and untested) experiments for primary care payment.
Appropriations: The House Appropriations Subcommittee on Labor-HHS-Education will mark up its bill for FY20 tomorrow, April 30, in anticipation of the full Committee acting May 8. The administration budget is here, “analytical perspectives” from OMB here, HHS budget here, Education Department budget here, Labor Department budget here, FDA here, “major savings and reforms” in the budget summarized here.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Should Surgeons Be Paid Like Lawyers?
A Stanford group has published a study (here) of the amount of time surgical specialists devote to operations, and compared the results (2005 to 2015) to pay scales based on relative values adopted by the AMA’s Relative Value Scale Update Committee. The result? No collusion! “We analyzed the accuracy of valuations of 293 common surgical procedures from 2005 through 2015. We compared the RUC’s estimates of procedure time with “benchmark” times for the same procedures derived from the clinical registry maintained by the American College of Surgeons National Surgical Quality Improvement Program (NSQIP). . . [W]e found substantial absolute discrepancies between intraoperative times as estimated by the RUC and the times recorded for the same procedures in a surgical registry, but the RUC did not systematically overestimate or underestimate times.”
AAMC Publishes Projection of Physician Supply and Demand
The Association of American Medical Colleges published its findings through 2032 (here). In summary, “We continue to project that physician demand will grow faster than supply, leading to a projected total physician shortfall of between 46,900 and 121,900 physicians by 2032. This projected shortfall range reflects updates to model inputs including updated population projections, revised starting demand and supply projections, updated estimates of physician specialty choice, larger starting-year shortfall estimates based on recently revised federal health professional shortage area (HPSA) designations for primary care and mental health, and lower projections of future insurance coverage expansion. The projected range is similar to the previous (2018) study’s projected shortfall range for 2030 of between 42,600 and 121,300 physicians. A primary care physician shortage of 21,100 to 55,200 physicians is projected by 2032. The shortfall range reflects the projected rapid growth in the supply of APRNs and PAs and their role in care delivery.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Proposed FY20 Rule for Inpatient Hospital Prospective Payment Published
The proposed rule (in 1824 pages) for the hospital Inpatient Prospective Payment System was published (here, CMS summary here). From the pre-publication (Federal Register publication planned for May 3): “We are proposing to revise the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems for FY 2020 and to implement certain recent legislation. We also are proposing to make changes relating to Medicare graduate medical education (GME) for teaching hospitals and payments to critical access hospital (CAHs). In addition, we are proposing to provide the market basket update that would apply to the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis, subject to these limits for FY 2020. We are proposing to update the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) for FY 2020. In this proposed rule, we are including proposals to address wage index disparities between high and low wage index hospitals; to provide for an alternative IPPS new technology add-on payment pathway for certain transformative new devices; and to revise the calculation of the IPPS new technology add-on payment. In addition, we are requesting public comments on the substantial clinical improvement criterion used for evaluating applications for both the IPPS new technology add-on payment and the OPPS transitional pass-through payment for devices, and we discuss potential revisions that we are considering adopting as final policies related to the substantial clinical improvement criterion for applications received beginning in FY 2020 for IPPS (that is, for FY 2021 and later new technology add-on payments) and beginning in CY 2020 for the OPPS. We are proposing to establish new requirements or revise existing requirements for quality reporting by specific Medicare providers (acute care hospitals, PPS-exempt cancer hospitals, and LTCHs). We also are proposing to establish new requirements and revise existing requirements for eligible hospitals and critical access hospitals (CAHs) participating in the Medicare and Medicaid Promoting Interoperability Programs. We are proposing to update policies for the Hospital Value-Based Purchasing (VBP) Program, the Hospital Readmissions Reduction Program, and the Hospital-Acquired Condition (HAC) Reduction Program.” Comments are due June 24. DCMN will publish section-by-section summaries and analysis through May.
Also published: The proposed FY20 Inpatient Rehabilitation Facility payment rule (here); the proposed payment rule for Skilled Nursing Facilities (here); and the proposed payment rule for Hospice (here).
FTC to Examine COPAs, Impact on Hospital Competition
The Federal Trade Commission will hold a workshop (announcement here, background paper here) on Certificates of Public Advantage. The issue: “State governments are increasingly using COPAs, which are regulatory regimes intended to displace competition among healthcare providers. COPAs may preclude antitrust scrutiny of mergers and collaborations, including hospital mergers, that otherwise would be likely to raise antitrust concerns. States have enacted COPAs with the assumption that regulatory oversight can mitigate the effects of lost competition and may allow hospitals to achieve certain efficiencies. The Commission is interested in empirical research on the actual benefits and harms associated with COPAs.” Open to the public, comments due 7-31.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Prices? Your Fault!
Modern Healthcare publishes an essay on fault-finding for high health care prices (here). Hospital Pricing Specialists publishes a list of prices you might pay for an EKG (here, sorted by State, also sorted by Price), from $8 at several Texas public hospitals to $1,635 at Western Arizona Regional Medical Center in Bullhead City. Princeton University Press publishes a gem by the late Uwe Reinhardt (“Priced Out: The Economic and Ethical Costs of American Health Care”); https://www.amazon.com/s?k=uwe+reinhardt+priced+out&crid=137KFHO2M3G9Y&sprefix=uwe+%2Caps%2C141&ref=nb_sb_ss_i_3_4. Princeton charges $28, but the price is $19 at Amazon.
READINGS AND REFERENCES
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: 30
May publication dates: 1, 2, 7, 8, 9, 10, 14 15, 16, 17, 20, 21, 22, 23
June publication dates: 5, 6, 7, 8, 11, 12, 13, 14, 25, 26, 27, 28
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.