DCMedical News: Tuesday, July 9, 2019
DCMedical News-DCMN
Washington, D.C.
Tuesday, July 9, 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
The 5th Circuit Court of Appeals in New Orleans will hear oral argument today in the case of State of Texas, et al v. USA, et al (No. 19-10011), beginning at 1:00 p.m. The Court has indicated that by 4:30p.m. EST it would post video on its website (http://www.ca5.uscourts.gov/home?utm_source=&utm_medium=email&utm_campaign=23423). The District Court ruling on the Complaint (here) from 20 states by Judge Reed O’Connor (here) had declared the entire Patient Protection and Affordable Care Act unconstitutional. The Kaiser Family Foundation summarizes the issues in a brief, here.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Uh-Oh
The Guardian reports (here) that British oncologists are being offered shares in private hospital companies that compete with hospitals of the National Health Service for patients.
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
More Competition
Florida’s Governor has signed legislation (here) allowing patients to stay up to 24 hours in ambulatory surgery centers, dramatically increasing the type of complexity of patients who may have operations in such centers.
Cochrane Review of Pay-for-Performance Reimbursement Experiments: In a Word, “Meh”
“The review [here] authors found 27 relevant studies that compared six different P-4-P programs. Twenty‐four were from the USA, two from the UK and one was from France. All studies compared pay for performance (through the use of rewards or penalties or both) with no pay for performance, i.e. a basic payment scheme without a component that incentivizes quality of care. The studies were either funded by government agencies or received no funding.’
“There was no improvement of patient outcomes (mortality, adverse clinical events) or the improvement was at most very small. Consequently, we are uncertain whether P4P has a positive impact on patient outcomes because the certainty of the evidence was very low. There was a slightly larger improvement in quality of care. Non‐payments ('sticks') seem to be a little bit more effective than additional payments ('carrots'). The impact of Pay‐for‐Performance on equity is unclear. We found no data on utilization (resource use), health care provider outcomes (quality of care) and adverse effects.
Specifics by P-4-P program:
“Premier Hospital Quality Incentive Demonstration Program: It is uncertain whether this program, which used rewards for some hospitals and penalties for others, has an impact on mortality, adverse clinical events, quality of care, equity or resource use as the certainty of the evidence was very low.”
“Value‐Based Purchasing Program: It is uncertain whether this program, which used rewards for some hospitals and penalties for others, has an impact on mortality, adverse clinical events or quality of care as the certainty of the evidence was very low. Equity and resource use outcomes were not reported in the studies, which evaluated this program.”
“Non‐payment for Hospital‐Acquired Conditions Program: It is uncertain whether this penalty‐based program has an impact on adverse clinical events as the certainty of the evidence was very low. Mortality, quality of care, equity and resource use outcomes were not reported in the studies, which evaluated this program.”
“Hospital Readmissions Reduction Program: None of the studies that examined this penalty‐based program reported mortality, adverse clinical events, quality of care (process quality score), equity or resource use outcomes.”
More Inslee-Care
Gov. Jay Inslee visited the University of Washington Medical Center in Seattle last Monday to discuss how new state funding will be used to train additional psychiatric and behavioral health providers and to develop the “nation’s first behavioral health teaching hospital,” a pipeline for psychiatrists and other mental health professionals.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Waivers Promote Medicaid Payment for Institutions for Mental Disorder
CMS announced that Minnesota (here) and Nebraska (here) have become the 23rd and 24th states who have received approval under the Trump Administration for demonstration projects that increase access to treatment for opioid use disorder and other substance use disorders (SUDs). “Under the section 1115 demonstrations, Minnesota and Nebraska are approved [for the five-year waiver period from July 1] to receive Medicaid matching funds for treatment in facilities that meet the definition of an institution for mental diseases (IMD). “Whereas only a handful of states were approved for these demonstrations before 2017, our approach has allowed us to approve nearly 20 more demonstrations in just 18 months,” according to CMS Administrator Seema Verma.
“Under the Minnesota demonstration, Medicaid eligible individuals will receive enhanced mental health services through Minnesota’s Certified Community Behavioral Health Clinics (CCBHCs). Temporary expenditure authority will allow CCBHCs to integrate community health care providers to increase rates of identification, initiation, and engagement in treatment for SUD. CMS expects the Nebraska demonstration will enhance existing substance abuse related services and offer those services to beneficiaries in more appropriate treatment locations, including residential facilities.”
DRUGS AND DEVICES
TV Won’t Advertise Drug Prices Any Time Soon
In ruling on Merck v. HHS a federal judge (opinion here) voided the Administration rule (here, Secretary Azar’s remarks at the time of publication of the rule, here) which would have required drug companies to include “list prices” for drugs in their television ads. Judge Amit Mehta wrote that Congress had not given the Administration the authority to compel such drug price advertising.
CMS Reports to Congress on “Open Payments”
The Centers for Medicare and Medicaid Services made its April report to Congress (here) public June 28. Drug and medical device makers paid a record $9.35 billion to doctors and hospitals, $5 billion for research, $3 billion for “general purposes,” and almost $1.4 billion to physicians with ownership interests. Analysis of the six-year history of Open Payment reports from Rockpointe’s Policy & Medicine is here. Detail also at https://openpaymentsdata.cms.gov/summary
READINGS AND REFERENCES
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
July publication dates: 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.