DCMedical News: Thursday, July 11, 2019
DCMedical News-DCMN
Washington, D.C.
Thursday, July 11, 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
Health Insurance Coverage for Immigrants
The front page of the Los Angeles Times reports (here) that “Healthcare question may help Trump. Some fear Democrats risk a backlash from voters for promising coverage to migrants.” The story added, “With a sharp left turn, Democrats are risking a backlash on an issue of raw emotional and political sensitivity: providing government healthcare to millions of people in the country illegally.” Reporters noted that “The president would certainly agree. The Democratic contestants hadn’t even left the debate stage when he weighed in. ‘How about taking care of American Citizens first!?’ Trump said on Twitter.” Days later, he elaborated. “We’re going to stop it,” he told reporters of the promise to expand coverage to undocumented migrants, “but we may need an election to stop it.” In response to last October’s proposed “Public Charge” regulations (here), studies showed (e.g., Urban Institute, here) immigrants avoiding public benefit programs, but also resulting in California’s legislature (report in The Hill, here, NPR, here) making it the first state to decide to cover the cost of immigrant health insurance.
Today is World Population Day
The Census Bureau reports (here) that by the time the United Nations declared the first World Population Day, in 1989, the total estimated population for the earth had passed 5 billion people. Today the estimate is 7.58 billion, a 50% increase.
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Inspector General Faults HHS Oversight of Hospices
USA Today reports here and the Washington Post here that “The majority of hospices in the USA have at least one problem with their care and about 20% have had at least one serious deficiency,” according to a report by the Inspector General of HHS (here) and require additional steps outlined in a second IG report (here) to guarantee patient safety. “The report noted problems such as the lack of supervision and proper training for staff and failures to obtain criminal background checks, to monitor medication, to treat severe wounds properly, to stop patients from falling down and to track infections. The number of serious deficiencies nearly quadrupled from 2012 to 2015, then slightly declined the following year.”
CMS Announces Effort to Promote Home-Based Dialysis for End-Stage Renal Disease (ESRD)
CMS announced new measures in radiation oncology and end-stage renal disease to “encourage” risk-based models which are “required” for providers in these areas. The new three-year programs would begin January 1, 2020.
The ESRD announcement (here) and 413-page proposed regulations (here) scheduled to be published in the July 18 Federal Register are characterized as “Specialty Care Models to Improve Quality of Care and Reduce Expenditures.” In summary, “This proposed rule proposes to implement two new mandatory Medicare payment models under section 1115A of the Social Security Act—the Radiation Oncology Model (RO Model) and the End-Stage Renal Disease (ESRD) Treatment Choices Model (ETC Model). The proposed RO Model would promote quality and financial accountability for providers and suppliers of radiotherapy (RT). The RO Model would test whether making prospective episode payments to hospital outpatient departments (HOPD) and freestanding CMS-5527-P 2 radiation therapy centers for RT episodes of care preserves or enhances the quality of care furnished to Medicare beneficiaries while reducing Medicare program spending through enhanced financial accountability for RO Model participants.”
“The proposed ETC Model would be a mandatory payment model focused on encouraging greater use of home dialysis and kidney transplants, in order to preserve or enhance the quality of care furnished to Medicare beneficiaries while reducing Medicare expenditures . . . CMS would assess the performance of participating Managing Clinicians and ESRD facilities on their rates of home dialysis and kidney and kidney-pancreas transplants during each Measurement Year (MY), and would subsequently adjust certain of their Medicare payments upward or downward during the corresponding performance payment adjustment period based on their home dialysis rate and transplant rate.”
The effort is expected to promote peritoneal dialysis, the most common at-home dialysis method, a darling of managed care. Managed Care Magazine writes yesterday “President Trump's executive order today that will revamp kidney care and organ transplantation is expected to include proposals to encourage greater use of at-home dialysis. Our July 2018 issue featured a story [here] . . . about peritoneal dialysis, the method most commonly used in at-home dialysis.” CVS Health, DaVita and Fresenius are all reportedly accelerating efforts to have home dialysis machines approved; DaVita’s 25,000 home dialysis group is growing faster than its center-based dialysis population.
Meanwhile, Liz Seegert publishes (here) in the blog of the Association of Health Care Journalists that “Half of the nation’s 40 million family caregivers are performing complicated medical/nursing tasks for their family members and friends, including giving injections, preparing special diets, managing tube feedings, and handling medical equipment, according to a recent report from AARP [Home Alone, Revisited, here]. Additionally, 70% of these caregivers are dealing with the stress of managing pain relief amid a national opioid crisis.” She adds, “An estimated 20 million family caregivers are performing tasks usually reserved for trained professionals, such as giving injections, managing medications, managing tube feedings and dealing with incontinence issues.”
Further information on the ESRD Treatment Choices (ETC) model can be found at the Center for Medicare and Medicaid Innovation website, here: https://innovation.cms.gov/initiatives/esrd-treatment-choices-model. The effort was accompanied by a White House and HHS statement on Advancing American Kidney Health (here) and a new ASPE 38-page brochure on that subject (here). More information on renal disease from the U.S. Renal Data System, 2018 report here.
DRUGS AND DEVICES
ICER Sets 2020 Review List
The Institute for Clinical and Economic Review—the closest American health care enterprise to cost-effectiveness measurement for drugs—has announced its review list (here) for next year. “The list is drawn from ICER horizon scans of new and emerging therapies, conversations with stakeholders, and suggestions submitted by the public. ICER’s topic selection criteria (here) – including the projected timing and likelihood of FDA approval, and whether a review of the evidence would suggest specific actions for payers, physicians, patients, and policymakers to improve clinical practice – are applied to produce this preliminary list of potential topics.” A recent Managed Care review of ICER’s work is here.
READINGS AND REFERENCES
America’s Health Insurance Plans: Analysis of S.1895, Lower Health Care Costs Act (here), 17 pages.
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: 12, 15, 16, 17, 18, 23, 24, 25, 26
August publications dates: None
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.