DCMedical News: Wednesday, June 19, 2019
DCMedical News-DCMN
Washington, D.C.
Wednesday, June 19, 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
2020 Elections, Continued
The Hill (here) reports that most Americans misunderstand the full scope of 'Medicare for All' proposals. Despite statements from the authors of Medicare for All bills (side-by-side comparison, here; H.R.1384, here), a new Kaiser Family Foundation poll (here) found widely varying understanding concerning what would be paid for, what patients would pay and how a single payer system might change the operations of hospitals, doctors and other service providers.
The Kaiser poll found that “Health care is leading the list of possible topics Democrats and Democratic-leaning independents want to hear the 2020 Democratic presidential candidates talk about during their upcoming debates, with nearly nine in ten (87 percent) saying it is very important for candidates to talk about health care. When asked to say in their own words which health care issues they want to hear candidates discuss, affordability emerges as a top issue with nearly three in ten Democrats and Democratic-leaning independents mentioning lowering the amount people pay for health care (28 percent).” However, “when it comes to other key changes that the leading Medicare-for-all bills… would bring, large shares are unaware of how the current health care system may be affected . . . majorities say people with employer-sponsored or self-purchased insurance would be able to keep their plans (55 percent each) under a Medicare-for-all plan.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Senate Committee Hears About Surprise Bills: Moving “Out-of-Network” Physicians “In-Network” is the Chairman’s Solution
Senator Lamar Alexander voiced support for compelling hospitals to require that only physicians who were “in network” care for patients in those hospitals. The comprehensive Lamar-Murray bill (here), which was the subject of a hearing by Senator Lamar’s Health, Education, Labor and Pensions Committee Tuesday, may include such a provision when voted on next week. This “network matching” proposal was described in a Brookings paper by AEI’s Benedic Ippolito (here), and presented in his testimony (here) to the Committee.
Physician specialty groups have favored an alternative arbitration model sponsored by Senators Cassidy (a gastroenterologist) and Hassan; a companion bill in the House is sponsored by Reps. Ruiz (an emergency medicine physician) and Roe (an ob. gyn.)
AHA’s representative (testimony here) said “The AHA believes that hospitals and payers should be left to negotiate reimbursement for out-of-network claims without government interference; however, there may be a role for an alternative dispute resolution process for physician claims. Several states have passed laws to establish such a process to mediate out-of-network claims between physicians and health insurers. Prominent among these processes is ‘baseball-style’ arbitration, and New York is one such state that frequently is referenced as having a successful process.” He made no reference to the current attempts (here) by hospitals and their unions to avoid extension of this model in New York to hospital bills. A third alternative, a “payment benchmark model,” appears to the AHA too much like rate-setting. As if to immediately confirm AHA’s fears, the Pacific Business Group on Health offered testimony (here) in favor of the rate-limit alternative, saying “We strongly recommend setting payments based on the average payment to specialty physicians, e.g., 125% of Medicare payment rates.” Families USA’s testimony is here.
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Readmissions Rates and Numbers Increase and Decrease, but Grow in Expense
AHRQ/H-CUP has published a statistical brief (here), on hospital readmissions numbers, rates and expenses 2010-2016. Depending on class of payer and age, some readmission rates were up, some down; some absolute numbers of readmissions were up, some down. The expense of a hospital readmission, compared to the “index” or original admission to a hospital, showed this: “Compared with the average cost of the index admission, two-thirds of the principal diagnoses had a higher cost of readmission. A total of 12 of the 18 principal diagnosis types had an average readmission cost that was at least 10 percent higher than the average cost of the index admission in 2016. Ear/mastoid process diseases had 90 percent higher readmission costs ($12,900 vs. $6,800 for the index admission), and skin diseases had 63 percent higher readmission costs ($13,200 vs. $8,100 for the index admission). In contrast, only three principal diagnosis types had an average readmission cost that was at least 10 percent lower than the average cost of the index admission. Congenital malformations had 27 percent lower readmission costs ($19,000 vs. $26,100 for the index admission), musculoskeletal system diseases had 15 percent lower readmission costs ($15,000 vs. $17,700 for the index admission), and neoplasms had 13 percent lower readmission costs ($17,900 vs. $20,600 for the index admission).”
READINGS AND REFERENCES
CBO Reports on the Federal Budget in 2018, through infographics: the budget overview, here; discretionary spending, here; mandatory spending, here; and revenues, 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: 20, 21, 24, 25, 26, 27
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.