DCMedical News: Friday, July 12, 2019
DCMedical News-DCMN
Washington, D.C.
Friday, July 12, 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
PPACA Future: Alarmed Opinion
Near-universal alarm is expressed by health policy commentators in the aftermath of oral argument before the Fifth Circuit Court of Appeals Tuesday in New Orleans, concerning the fate of the Patient Protection and Affordable Care Act. Examples include USA Today (“Republicans will kill your health care and, indirectly, maybe even you,” here, also including comments from Ezra Klein); “Obamacare’s Precarious Fate” in the New York Times, here, from that paper’s editorial board; from Timothy Jost, writing for the Commonwealth Fund (here); and from Bloomberg (“Winning the Obamacare Suit Would Be a Disaster for Republicans”), here.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
No Surprises Act
The House is moving forward with a bill (H.R. 3630, here) in the Energy and Commerce Committee on a bill to eliminate “surprise” out-of-network financial shocks for patients. The bill, approved by the E&C health subcommittee Thursday, would require physicians to accept payment for out-of-network services based on what local insurers pay in-network doctors. Also moving forward: renewed authorization for Community Health Centers (§330 centers); a two-year “kick-the-can” deferral of Disproportionate Hospital Share cuts; and removal of the cap on the federal portion of Medicaid spending in U.S. territories, such as Puerto Rico, so that the territories will have their expenditures matched in proportion as the states do, and no longer be capped at 55%.
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Medicare Home Health Care Pay Bump, Rules Change
The Centers for Medicare & Medicaid Services (CMS) will propose (in the July 18 Federal Register, announcement here; pre-publication Federal Register text here; “Fact Sheet,” here; Medical Learning Network summary, here) significant changes to the Medicare Home Health Prospective Payment System (Home Health PPS). The proposal would update payments for home health agencies by 1.3 percent ($250 million).
Under the proposal the temporary program to pay for home infusion therapies (e.g., chemotherapy) would be made permanent, beginning in FY2021. But another Medicare policy taking effect this year (allowing payment for home infusion only when a nurse or another health professional is present in the patient’s home during treatment) is projected to reduce such services significantly; the National Home Infusion Association has sued CMS to un-do that new payment policy.
HAC Penalties? Modest Hit to Safety-Net Hospitals, But of No Clinical Import
A study in the British Medical Journal (here) notes that Medicare’s “Hospital Acquired Conditions” (HAC) program which set financial penalties for poor performing hospitals in fact had no positive impact on the institutions or their patients. There were no changes in rates of hospital-acquired conditions, 30-day readmission or 30-day mortality. Over the study period (mid-2014 to late-2016) researchers reviewed HAC scores for 3,238 acute care hospitals, including 708 of the 724 hospitals penalized in FY 2015. Penalized institutions were more likely to be large teaching institutions and to have a greater share of patients with lower socioeconomic status. “No clear patterns of clinical improvement were observed across hospital characteristics.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Pulling Back
The Administration pulled back on two initiatives, the first (here) was designed to require states to document whether Medicaid fee-for-service networks are sufficiently robust to enlist enough providers to assure beneficiary access, and to guard against arbitrary reductions in provider payments. The Obama administration’s proposed Access Monitoring Review Plan regulations sought to satisfy the Social Security Act, §1902(a)(30)(A), which requires the states to assure that payments are consistent with efficiency, economy and quality, and that they are also sufficient to “enlist enough providers so that care and services are available under the plan at least to the extent that such care and services are available to the general population in the region.”
The Obama network and payment-adequacy regulations were published November 2, 2015, and required the states to develop and submit to CMS an access monitoring plan, to be updated at least every three years, covering primary care, physician specialty services, behavioral health, obstetrics services, home health and any other type of services for which payment reductions have been proposed or for which a high volume and demand exists. CMS accompanied the pull-back Thursday with a memorandum (here) advertising development of a new “Comprehensive Strategy for Monitoring Access in Medicaid,” which appears to involve the convening of new work groups and possibly state-level experiments. The pull-back on monitoring access and the new memo combine either to “ease administrative burdens for the states” or to “make it easier for states to cut health care services under Medicaid,” or both.
Then the administration reversed course (STAT report, here) on one of its own proposals, a January plan to end rebates that drug manufacturers pay to pharmacy benefit managers. The proposed rule would have eliminated a “safe harbor” that exempts drug rebates from the Anti-Kickback Statute (prohibition on payments to induce the use of products or services covered by Medicaid or Medicaid). A major factor in this reversal was said to be the Congressional Budget Office’s estimate (here) of a $177 billion cost to the government for the change over a decade. According to The Hill, “The rebate plan was a centerpiece of the administration's 2018 drug pricing blueprint and had been touted by Health and Human Services Secretary Alex Azar as one of the best ways to bring drug costs down. According to HHS, the proposal would have lowered prescription drug prices and out-of-pocket costs by encouraging manufacturers to pass discounts directly on to patients at the point of sale. HHS said prescription drug rebates amount to 26 to 30 percent of a drug's list price on average.”
DRUGS & DEVICES
Danish Medicines Agency Strengthens Conflict of Interest Policy
Staff members of the Danish Medicines Agency will not be allowed to own shares in pharmaceutical or medical device companies, and the current staff will be compelled to divest such shares within two years. Inherited shares must also be divested. The Agency’s new policy (here) notes that “Several drug regulatory authorities around the world publish their executives’ and inspectors’ declarations of interest forms on their websites as does the Danish Medicines Agency as part of its policy of openness.”
READINGS AND REFERENCES
President’s Executive Order of July 10th on “Advancing American Kidney Health,” here. A statement of policy concerning payment for treatment of kidney disease, to accompany proposed regulations and new models for reimbursement, see DCMN 7-11-19.
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: 15, 16, 17, 18, 23, 24, 25, 26
August publications dates: None
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.