DCMedical News: Friday, April 16, 2021
DCMedical News-DCMN
Washington, D.C.
Friday, April 16, 2021
DCMedical News is published every day both the House and the Senate are scheduled to be in session. Subscription information and archives here.
THE BIG STORY IN HEALTH CARE
The Pre-Existing Condition Fight, Again: Patient Advocacy and Voluntary Health Groups Take Aim at Skinny Health Plans
A group of 30 patient advocacy and voluntary health groups have taken aim at short-term, limited duration insurance, health care sharing ministries, farm bureau plans, association health plans, grandfathered and other forms of insurance they regard as incompatible with the goals of the Patient Protection and Affordable Care Act. They protest that rules enacted under the last Administration “have allowed issuers across markets to discriminate against people with pre-existing conditions as they did prior to the passage of the ACA”; that proliferation of “these non-ACA-compliant plans has weakened the overall effectiveness of the ACA by exposing consumers, particularly those with pre-existing conditions, to significant financial risk, segmenting the individual market risk pool and unnecessarily inflating insurance premiums for people who rely on comprehensive coverage provided through the ACA marketplaces”; and conclude that “non-compliant plans utterly fail to provide the same degree of certainty and security for patients and consumers.”
A report from the group (here) “endeavors to compile what is known about the most common kinds of non-compliant plans and make recommendations for Congress, the administration and state leaders. These actions, if implemented, would significantly improve patient protections for millions of people in the United States living with serious and chronic health conditions.” Led by the Leukemia and Lymphoma Society, the group reports on plans like those of the Data Mining Partnership, where unrelated individuals download tracking software and are thereafter considered ‘working owners’ of the DMP (non-ACA-compliant) health plan. The DMP plan was upheld in the U.S. District Court for Northern Texas, by Judge Reed O’Connor, noted for other (unrelated) rulings against PPACA (ACA).
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
GAO Profiles Graduate Medical Education (GME) Programs After Integration of ACGME and AOA Accreditation
The General Accountability Office has taken stock of the nation’s GME programs (one page summary here, 39-page report here) following the integration of the Accreditation Council for Graduate Medical Education and the American Osteopathic Association’s programs. The bottom line: the number of programs has increased; geographic and specialty distribution were largely unchanged.
The report is a useful highlight of the programs themselves: funded largely by Medicare ($15 billion in 2018), GME programs must be accredited to be eligible. During the transition period to combined accreditation (2014-2020), “The number of GME programs increased by 14 percent, from 10,608 to 12,117. Most (73 percent) of the 1,032 programs solely accredited by the American Osteopathic Association (AOA) in 2014-2015 applied for, and of these almost all were accredited, by ACGME in 2019-2020; the remaining AOA-accredited programs chose to close. Overall, the number of residents training in GME programs increased by 13 percent.”
In analyzing residency program specialization and geographic distribution, the GAO found “Of the residents in a specialty program, nearly half trained in a primary care specialty (i.e., internal medicine, family medicine, or pediatrics). The remaining residents trained in a subspecialty, such as cardiovascular disease. The geographic distribution of programs and residents was largely unchanged between 2014-2015 and 2019-2020. In both years, most (about 60 percent) programs and residents were located in the South and Northeast, and nearly all (98 percent) programs and residents trained in urban areas. Of the 3,142 counties in the U.S., GME programs in 2014-2015 were located in 467 counties. By 2019-2020, the number of counties with programs increased to 525. While there was growth in the number of programs and residents in rural areas, growth in urban areas was greater.” One-quarter of the medical students in the U.S. are in training to become osteopathic physicians.
UnitedHealth Group and Optum in the Money, and in the News
At the first quarter investor briefing (transcript from Seeking Alpha, here) almost all of the executive focus was on Optum Health, the data and services giant within United, where “OptumInsight revenues increased 14% and operating income increased 45% compared to the year ago period.” The growth is coming, according to some physician groups, at the expense of business practices (New York Times report here) which, those groups contend, stifle competition, for example the “multistate group of anesthesiologists [which] filed cases in Texas and Colorado, accusing the insurance giant of squeezing them like a ‘boa constrictor.’” A pension fund, unhappy with United’s proposed acquisition of data giant Change (Blackstone, formerly McKesson), filed a suit which Bloomberg reports “accuses the board and Blackstone of favoring the underpriced deal because it would end a series of ‘tax receivable agreements’ on terms requiring huge lump sum payments to early investors in Change, which spun off from McKesson Corp. before going public in 2019.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
MACPAC Meets, Discusses, Recommends
MACPAC, the Medicaid and CHIP Payment and Access Commission, the Congressionally chartered advisory body for the 50-state program with more than 75 million enrollees, met April 8 and 9 in Washington, agenda here. Subject matter presentations to the group by staff are, in general, more substantial than those in the MedPAC meetings, with extensive background, and detail on recommendations in the final pages of each “chapter.” They discussed:
Access to Behavioral Health Services for Children and Youth, here; Access to Mental Health Services for Adults, here; High Cost Specialty Drugs, here; a Congressionally mandated report on None-Emergency Medical Transport, here; Promoting Behavioral and Clinical Physical Integration Through EHRs, here; Strategies for State Contracts With Dual Eligible Special Needs Plans, here; Ensuring Quality in Medicaid and CHIP, here; Progress on Rebalancing, Lessons From States, here; Update on Transformed Medicaid Statistical Information Systems, here; and What States Are Learning From Expanded Telehealth, here.
Bonus reading: the March report of MACPAC to Congress (report here, press release here); the Congressional Research Service on the (presumed) end to litigation over Medicaid mandatory work programs, here.
Skilled Nursing Facility Medicare Program Rates for FY 2022
The SNF proposed rule (here), in the April 15 Federal Register, comments by June 7, would “Update the payment rates used under the prospective payment system (PPS) for skilled nursing facilities (SNFs) for fiscal year (FY) 2022. In addition, the proposed rule includes a proposed forecast error adjustment for FY 2022, proposes updates to the diagnosis code mappings used under the Patient Driven Payment Model (PDPM), proposes to rebase and revise the SNF market basket, proposes to implement a recently enacted SNF consolidated billing exclusion along with the required proportional reduction in the SNF PPS base rates, and includes a discussion of a methodology to recalibrate the PDPM parity adjustment,” in 69 pages.
Inpatient Psychiatric Facilities Prospective Payment System and Quality Reporting Updates
A 22-page “summary” of the proposed FY 2022 payment rule under Medicare, from the Healthcare Financial Management Association, here.
FY 2022 Hospice Wage Index and Payment Rate Update, Hospice Conditions of Participation Updates, Hospice and Home Health Quality Reporting Program Requirements
A 75-page proposed rule for the hospice program, here, from the April 14 Federal Register, comments due June 7. A 37-page summary of the proposed rule is here, from the Healthcare Financial Management Association.
READINGS & REFERENCES
Select Coronavirus Public Health Resources and References (alphabetical) may be found here.
2021 CQ Congressional Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
April 19, 20, 21, 22
May 11, 12, 13, 14, 17, 18, 19, 20
June 14, 15, 16, 17, 22, 23, 24, 25
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.