DCMedical News: Tuesday, June 4, 2019
DCMedical News-DCMN
Washington, D.C.
Tuesday, June 4, 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 Returns:
The House and Senate are both in session today. Today is the 100th anniversary of the passage of the 19th amendment (women’s vote), historical documents found at https://www.archives.gov/historical-docs/19th-amendment
Hospitals Win DSH Debate in Supreme Court
In a 7–1 decision (here) the Supreme Court sided with hospitals that had sued HHS over a 2014 DSH calculation change made by the Obama administration and defended by the Trump administration. The justices affirmed a 2017 ruling by the D.C. Circuit Court, which found HHS made changes in the reimbursement formula for disproportionate share hospital (DSH) payments to hospitals without going through the notice and comment rulemaking procedure of the Uniform Administrative Procedures Act. The amici curiae brief of the American Hospital Association, Federation of American Hospitals and Association of American Medical Colleges is here; of fourteen state and regional hospital associations, here; of Catholic Health and others, here. Justice Gorsuch wrote the opinion, Justice Kavanaugh (who had written the D.C. Circuit opinion) abstained, Justice Breyer (who thought it might be a matter of interpretation, rather than policy) voted “no.” The rule, which was written by HHS to be retroactive to 2004, involves funds primarily intended to support safety net hospitals, with as much as $4 billion at stake.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Looking for Trouble:
“Care Cascades” (falling into the medical-industrial vortex) are described (here) in this week’s JAMA Internal Medicine. “Low-value medical services may have sizable downstream consequences in the form of further tests, treatments, office visits, hospitalizations, and new diagnoses prompted by findings of the initial tests. Regional studies and clinical experience suggest that these care cascades after low-value services can present patient, physician, and societal harms such as wasted resources and procedural complications.” This study found that “16% of those who received a preoperative electrocardiogram before cataract surgery experienced a potential cascade event; this was more likely among older, sicker individuals who lived in cardiologist-dense areas or had a cardiac specialist perform the electrocardiogram. There were 5 to 11 cascade events per 100 beneficiaries, costing up to $565 per beneficiary or $35 million nationally in addition to $3.3 million for the initial electrocardiograms.” The study concludes, “Care cascades after preoperative EKG for cataract surgery are infrequent but costly. Policy and practice interventions to reduce low-value services and the cascades that follow could yield substantial savings.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Joint Bundle Experiment “Saves” Medicare Money, but Not from Lower Payments to Hospitals, Doctors or for Devices:
“Over 2 years, the Comprehensive Care for Joint Replacement model was associated with reduced Medicare Part A spending driven by post-acute savings, without changes in volume, quality, or patient selection.” Sending the patient home is less costly than sending the patient to a post-acute care facility, as detailed in JAMA Internal Medicine this week (here). “Savings” to the Medicare program apparently disappear, however, when program experiment costs and “reconciliation” payments to hospitals are included: “Nevertheless, this crude comparison cautions that savings on claims, while consistent with changes in clinician or hospital behavior, may not have exceeded the reconciliation payments from the CMS in the first 2 years.”
VA Hospital Star Ratings
Modern Healthcare reports (here) on “star” and related ratings of Veterans Health Administration medical centers. “The Veterans Affairs Department is slated to consolidate community care programs this week and roll out key provisions of the Mission Act, expanding private healthcare choices for veterans.” See also http://vhahospitalqualitystudy.org/, id & pw=Legion.
MEDICARE, MEDICAID, COMMERCIAL HEALTH INSURANCE
Inslee-Care, Continued:
Washington is moving forward with rule-making (announcement here) for its prohibition on surprise bills—the State of Washington, that is, Jay Inslee, Governor.
United HealthCare Network Bulletin:
Prior authorization schema, coverage decisions, MA benefits and more, June bulletin here.
Social Determinants in the NHS:
“An analysis of data, published on Tuesday by the Institute for Fiscal Studies [IFS; report here in the Financial Times], a think-tank, found strong evidence that access to a Sure Start centre reduced the probability of hospital admission among children of primary school age. The benefits were clearest for children living in the poorest 30 per cent of neighbourhoods and they increased as children grew older. Greater Sure Start access cut the probability of hospital admission in these areas by 19 per cent at the age of 11, the IFS said, while in the richest 30 per cent of areas there was almost no impact. Across all areas, the programme’s effect was equivalent to averting 5,500 hospitalisations of 11-year-olds each year.”
DRUGS AND DEVICES
Opioid Litigation
Oklahoma State Courts Network documents involving litigation against opioid manufacturers, Complaint here, court documents here: http://www.oscn.net/dockets/GetCaseInformation.aspx?db=cleveland&cmid=2266216, focus primarily on deceptive marketing. The National Prescription Opiate Litigation, U.S. District Court, Northern District of Ohio at https://www.ohnd.uscourts.gov/mdl-2804 is concentrating on allegations that the “manufacturers of prescription opioids grossly misrepresented the risks of long-term use of those drugs for persons with chronic pain, and distributors failed to properly monitor suspicious orders of those prescription drugs--all of which contributed to the current opioid epidemic.”
Opioid HCUP Fast Stats:
The Agency for Healthcare Research and Quality has released interactive maps showing for 2016 the incidence of opioid-related emergency department visits (national average 296.9 per 100,000 population, Massachusetts highest at 452.5) and inpatient stays for opioid addiction (national average 243.5 per 100,000 population, Ohio highest at 479.2), both at https://www.hcup-us.ahrq.gov/faststats/OpioidUseMap?setting=IP.
READINGS AND REFERENCES
More History: Bill Moyers discusses LBJ and the passage of Medicare, in an essay entitled “Everyone Should be Entitled to Medicare,” at the LBJ library, at http://www.lbjlibrary.org/press/lbj-in-the-news/bill-moyers-essay-everyone-should-be-entitled-to-medicare.
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
June publication dates: 5, 6, 7, 8, 11, 12, 13, 14, 25, 26, 27, 28
July publication dates: 9, 10, 11, 12, 15, 16, 17, 18, 23, 24, 25, 26
August publications dates: None
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.