DCMedical News: Wednesday, June 5, 2019
DCMedical News-DCMN
Washington, D.C.
Wednesday, June 5, 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
Sharing Expertise in Cost Effective Health Services Across the Pond
The Financial Times reported (here) that President Trump is insisting on expanded opportunities for American health companies to sell services to England’s National Health Service as part of any U.S.-U.K. trade arrangement. Later, Bloomberg News reported that “U.K. Health Secretary Matt Hancock said in a tweet that ‘the NHS isn’t on the table in trade talks. Not on my watch,’” and also reported that “Trump walked back his suggestion in the [television] interview.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Veterans’ Care by Non-VA Professionals, In Non-VA Institutions
New rules for the “Mission Act” will be published in today’s Federal Register, and will be effective tomorrow, June 6.
The first rule (here) implements authority for covered veterans to receive hospital care, medical services, and extended care services from non-VA entities or community providers. Under this rule, veterans can access non-VA providers if their drive time to a VA facility exceeds 30 minutes for primary care, mental health or home health services, and 60 minutes for specialty care, consistent, according to the regulation narrative, with TRICARE, Medicaid plans which the VA evaluated, and existing VA rules. VA patients will also be able to see private providers if appointment wait times exceed 20 days for primary care, mental health or home health, and 28 days for specialty care.
Responding to comments and questions (among the 24,000 received) concerning the impact of the program on civilian resources, the regulation narrative reads “We do not believe our actions in implementing the VCCP will have that significant of an effect on the health care industry. According to the National Health Expenditure Data set, the United States spent $3.5 trillion on health care in 2017. By comparison, VA obligated $12.9 billion for community care in FY 2017 or 17.8 percent of total VA Medical Care spending.”
With regard to payment rates, “VA has typically paid at applicable Medicare rates under the Veterans Choice Program, to avoid the scenario raised by comments where non-VA providers are discouraged from participating in VA community care programs. With regard to the specific concerns in paying IME or DME billing for academic hospitals, we also do not make changes to § 17.4035(a) as proposed but do clarify that VA does pay adjustments to Medicare costing as applicable and appropriate.”
The second rule (here) allows veteran access to civilian urgent care centers, with copayment of $30, and coverage for prescribed drugs.
VA Secretary Wilkie announces and discusses the new rules, here.
More to Offer the English:
AHRQ summarizes (here) a study of dentist prescription of opioids in the U.S. and in England. “In 2016, the proportion of prescriptions written by US dentists that were for opioids was 37 times greater than the proportion written by English dentists. In all, 22.3% of US dental prescriptions were opioids (11.4 million prescriptions) compared with 0.6% of English dental prescriptions.”
Meeting This Week:
AcademyHealth (Washington), AMA House of Delegates (Chicago).
MEDICARE, MEDICAID, COMMERCIAL HEALTH INSURANCE
Medicaid Enrollees Face Employment Barriers
The Urban Institute reports (here) that the very people who would be compelled to work under “Work-for-Health-Insurance” Medicaid schemes face the highest barriers to finding and keeping work. “Medicaid enrollees who would potentially be subject to work requirements disproportionately face employment barriers, such as lack of a high school degree, health problems, limited transportation and internet access, criminal records, and residence in high-unemployment neighborhoods.”
Is PCORI Worth $500 Million Per Year?
The Patient-Centered Outcomes Research Institute, established in the Patient Protection and Affordable Care Act, is up for renewal. Research funded by PCORI (2017 annual report here) is meant to compare the relative effectiveness of alternative treatment options, and is explicitly forbidden by PPACA from having any binding influence on decisions for public insurance programs. PCORI has also attracted skepticism concerning the applicability of its work to medical practice, since part of its mission is helping guide practitioners to the most effective treatments; PCORI has apparently never had a physician in private practice on its board, but did have a leader in chiropractic. Rep. Michael Burgess, an Ob-Gyn from Texas, asked recently “what the return on investment has been and what we have learned from the comparative clinical effectiveness research.”
Health Issues of Import to the Public:
Washington (state) posts draft notice for text prohibiting balance billing (surprise bills), in line with recently passed legislation, here. The Hill reports (here) that “About 17 percent of Americans said health care was their most significant financial issue, followed by 11 percent citing lack of money or low wages, 8 percent saying college expenses, 8 percent saying the cost of owning or renting a home and 8 percent saying taxes.” Robert Blendon, our premiere health field pollster, reports in NEJM (here) that “Although the United States spends 18% of its gross domestic product on health — more than any other industrialized country — that is not the focus of the public’s concerns. In fact, 69% of the public believes that the United States is spending too little on health (only 10% believes we’re spending too much) . . . Instead, the driving force for concern is the belief that health care services are unreasonably priced and that what people pay for care harms their household’s financial situation.”
READINGS AND REFERENCES
Victor Fuchs, Social Theorist or Socialist?
The distinguished economist explains (here) in JAMA Network why U.S. employer-based health insurance distorts markets in favor of higher income, well employed people. In U.S. health care, as a result of favorable tax treatment of employer based health insurance, “Emphasis is on specialty and subspecialty care, expensive technology, extra capacity to facilitate access (US hospitals have an average occupancy rate of 65% compared with an average of 76% according to the Organisation for Economic Co-operation and Development), and more and better-quality amenities, including space and privacy in the hospital. Architects who build in many countries suggest that design for US hospitals must also include better space for visitors and professional staff. This more costly product mix (specialty care and hospital amenities) is appreciated by patients at all income levels, but higher-income patients would and sometimes do pay extra for them. Many low- and middle-income households would be better off if medical care was less costly, and they had more money for other public and private goods and services.”
APA v. Medicare Act, Notice and Comment Provisions, discussed in SCOTUSBlog (here), from Azar v. Allina Health Services
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: 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.