DCMedical News: Friday, June 7, 2019
DCMedical News-DCMN
Washington, D.C.
Friday, June 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
Senate “Omni-Health” Bill Hearing Planned
Senators Lamar Alexander and Patty Murray have indicated that the sprawling omni-bill in health they offered May 23 (the “Lower Health Care Costs Act,” 165 pgs., here, nine page summary here, Modern Healthcare summary here) will have a hearing in June before the Health, Education, Labor and Pensions Committee they lead.
This year’s Alexander-Murray bill will include provisions intended to lower prescription drug costs, end surprise medical bills and increase transparency for patients. The alternative track, that of the Senate Finance Committee, is expected to focus more narrowly on drug prices.
Still Looking for This One:
The Wall Street Journal reported May 24 (here) that “President Trump is expected to release an executive order as early as next week to mandate the disclosure of prices in the health-care industry, according to people familiar with the discussion. The order could direct federal agencies to pursue actions to force a host of players in the industry to divulge cost data, the people said. The administration is also looking at using agencies such as the Justice Department to tackle regional monopolies of hospitals and health-insurance plans over concerns they are driving up the cost of care, according to two people familiar with the discussions.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Older, Sicker, Poorer, With Challenging Patient Mix, Workforce Shortages
That’s rural healthcare, in a new AHA report, here. Solutions not a strong chapter, however: payment for converting from inpatient to outpatient, allied health in lieu of doctors, telehealth in lieu of either. Useful summary of Medicare’s various designations for rural hospitals (pg. 19-20), bibliography.
MEDICARE, MEDICAID, COMMERCIAL HEALTH INSURANCE
Congressional Budget Office (CBO) Estimates
Heavyweights Sherry Glied and Thomas Lee weigh in (here, in the New England Journal of Medicine) on this question, “Is CBO Forecasting Good Enough for Government Work?” They note the recent history: “In 2017, the CBO modeled the effects of Senate Republicans' proposed legislation to repeal the Affordable Care Act and projected that it would leave 22 million additional Americans without health insurance over the next decade. The White House responded with a statement saying, ‘The CBO has consistently proven it cannot accurately predict how healthcare legislation will impact insurance coverage.’”
Glied and Lee note, “When predicting the effects of the ACA itself, the CBO was directionally correct on most key issues. The agency more accurately predicted the costs associated with the legislation and the number of people affected by it, especially in the short run, than other forecasters did . . . the CBO's forecasts of the number of people who would remain uninsured after implementation of the ACA tracked well with reality, as did its projections regarding the costs of subsidies.
But the CBO's record is hardly perfect. It predicted, for example, that the ACA’s reductions in payments to Medicare Advantage plans would lead to a 30% decrease in enrollment in such plans; the opposite pattern was observed (a nearly 80% increase in enrollment over this period), in part because implementation of the cuts happened differently than the CBO expected.”
Other authors have noted that this result (increased, rather than decreased MA enrollment) may be the result of the extraordinary profitability of MA plans for commercial health insurers, due to (a) historical subsidies of MA (over fee-for-service Medicare), (b) marketing of MA plans to younger and healthier seniors, (c) profit from systematic upcoding in MA plans and, in general, a (d) lack of claims information from MA plans for analysis by Medicare, Med-PAC or policy students.
DRUGS AND DEVICES
“Office of the National Coordinator”
Six former occupants of this imperial-sounding position endorse (here) CMS’ proposed interoperability rules, raising the complexity level and penalties for non-compliance, but with no mention of the past decade’s literature on the role of health care IT in creating patient safety challenges, and imposing costs on all actors in the system without evidence of commensurate benefit (see, for example, here, here, here, here and here.) OIG evaluated health IT systems in Medicare Accountable Care Organizations (here), and found “the promise of seamless integration and coordination across providers and care settings has not yet been realized” and that “ACOs also faced challenges from physician burnout due to the workload of managing EHRs.”
READINGS AND REFERENCES
“Medicare physician payment reform after two years: Examining MACRA implementation and the road ahead,” by the Medicare Payment Advisory Commission, May 8, 2019, here.
Kaiser Family Foundation, “Making Sense of Medicare-for-All and Other Proposals to Expand Public Coverage,” May 21, 2019, here.
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: 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.