DCMedical News: Tuesday, May 7, 2019
DCMedical News-DCMN
Washington, D.C.
Tuesday, May 7, 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
House on Fire, Senate Warming Up
CQ reports that the House of Representatives is preparing to pass a variety of health measures. First, a bill that would require the Trump administration to rescind an October guidance that loosens the §1332 requirements of PPACA, to allow states to offer health insurance without essential health benefits, coverage for pre-existent conditions or other otherwise non-compliant plans. The Congressional Budget Office reported (here) that the measure would have no effect on federal spending “because no states have submitted a waiver application under the guidance that would [be] eliminated by this legislation.” The CMS “RFI” seeking §1332 proposals is here, responses due in two months.
The Energy and Commerce Health Subcommittee will hold a hearing on the drug supply chain, while an Oversight Committee panel will discuss national drug policy. The House Ways and Means Committee will hold a hearing on the “Medicare for All” (MFA) bill, but the Energy and Commerce Committee will not. Tomorrow the full Appropriations Committee will take up the FY 2020 spending bills for the Departments of Labor, Education and Health and Human Services. Get your side-by-side comparison of MFA and other public option plans here, from the Kaiser Family Foundation.
The Senate Health, Education, Labor and Pensions (HELP) Committee will hold a hearing today on electronic health records; the Senate Judiciary Committee will discuss intellectual property and prescription drug prices tomorrow; and, also tomorrow, the Senate Finance Committee will hold an oversight hearing on physician payment “reform” and the implementation of MACRA and will hear from four representatives of physician societies and one Brookings scholar.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Medical Economics Focuses on Ancillary Services in a “Value-Based” Payment Environment
The practical journal discusses the conundrum (here) of where to put the ancillaries: “Under a value-based system . . . with its focus on cost of care and outcomes, the financial return for adding a service is harder to calculate . . . [there is] the example of whether to provide pulmonary function testing for patients with COPD. Not only does the practice have to decide if it can provide the service for less than a pulmonologist, it has to weigh whether in-house testing will reduce the number of its patients requiring trips to the emergency department or hospitalization, which would drive up the overall cost of caring for that patient.” And more.
What’s New in Medicine?
A study in the April 19 JAMA reports (here) that 92% of popular mental and behavioral health “apps” are sharing user data with outside collectors of such data; another JAMA piece (here, May 6) reports that academic medical faculty are feeling disrespected and unappreciated; and a third JAMA piece (here, also May 6) reports that CMS’ “physician quality” reports are incomplete and probably misleading.
MEDICARE, MEDICAID, COMMERCIAL HEALTH INSURANCE
2019-2029 CBO Health Subsidy Projections
The Congressional Budget Office has estimated (here) the total (and components) of federal subsidies for health insurance through 2029. The bottom line: Medicaid and CHIP take about 40-45% of the total federal subsidies, as do subsidies in the form of tax benefits for work-related insurance. Medicare is about 10%, and the remainder of the PPACA subsidies (exchanges, Basic health Program) another 10%. Says the report, “In an average month for each year during that period, between 240 million and 242 million such people are projected to have health insurance, mostly from employment-based plans. But the number of people without health insurance is projected to rise from 30 million in 2019 to 35 million in 2029. Net federal subsidies for insured people will total $737 billion in 2019, according to estimates by CBO and the staff of the Joint Committee on Taxation (JCT). That annual sum is projected to reach $1.3 trillion in 2029.” But this L.A. Times story and survey (with the Kaiser Health Network) shows how all is not well in work-related health insurance, especially for older adults.
$ocial Determinants of Health:
A 3-M data blogger (here) describes the March ICD-10 Coordination and Maintenance meeting. The agenda was “written proposals for ICD-10 codes describing SDOH (Social Determinants of Health), socioeconomic risk factors such as inability to pay for prescriptions or for transportation to medical appointments . . . As often happens in this and other discussions of healthcare data, it was hard to ignore what was not discussed at this meeting—the M-word—money! The topic of money, the importance of money, the effect of money, was tiptoed around in the usual way . . . United Health Care, the main driver behind the request for new ICD-10 SDOH codes, phrased their request in the accepted style . . . ‘UHC believes utilizing the ICD-10-CM codes is a logical choice, as it is the standard language between care providers and payers.’ No one can come out and say, ‘ICD-10 codes are the logical choice because providers must assign them to get paid.’ Creating specific SDOH codes in ICD-10 where they are more likely to be assigned is the best chance we have of eliminating some of the more pointlessly wasted money in the healthcare industry.”
More up-coding controversy may be coming for United: “UnitedHealth Group Inc.’s top executives have been hit with claims that they hurt the company’s finances and reputation through a ‘years-long scheme’ to overbill the government for Medicare Advantage services,” says Bloomberg Law, here.
STLDI: Another Problem
The Commonwealth Fund reports (here) on another problem with short term, limited duration health insurance plans, namely that every bill is a potential surprise, in the absence of contracts with provider networks. “In the case of short-term plans, every medical bill has the potential to become a balance bill. Because most short-term plan insurers have no established contract rates for health care services, they apply an ‘allowable charge calculation’ to every claim, not just out-of-network claims as in the case of insurers with contracted provider networks.” Commonwealth has also published a more general piece (here) on how states are protecting consumers against STLDI plans.
READINGS AND REFERENCES
Patient Engagement? Big Data? Transformation?
Lawton Burns and Mark Pauly of Wharton turn their humorous weapons on B.S. in health care, here in STAT this week, and in previous “top-10” B.S. offerings, here and here. Their point? “At a minimum, unqualified acceptance of such ideas, even (and especially) by apparently qualified people, will waste resources that could have been used to make the best of what we currently have, and will lead to enormous frustration for the audience of politicians and outraged critics of the current system who want answers and want them now.”
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
May publication dates: 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.