DCMedical News: Tuesday, July 16, 2019
DCMedical News-DCMN
Washington, D.C.
Tuesday, July 16, 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
Joe Biden Unveils Biden-Care, Building on Obamacare, a Contrast to “Medicare-for-All”
Democratic Presidential candidate and former Vice President Joseph Biden unveiled his proposal for health insurance and health care (here), calling on the nation to build on the Patient Protection and Affordable Care Act. CQ Health reports that “Biden proposed setting up a voluntary public option based on Medicare's framework, an idea which did not make it into the 2010 law. He also proposed expanding the law's premium tax credit subsidies that help people afford their insurance by proposing to eliminate a cap that limits subsidies to people with household incomes of up to 400 percent of the federal poverty level. . . Biden proposed allowing low-income people who make up to 138 percent of the federal poverty level but live in states that did not expand Medicaid eligibility to get the public option plan without paying a premium. States that expanded Medicaid would have the option to switch those people to the premium-free public option plan.” Becker’s (here) lists “Eight Takeaways” characterizing the plan.
Rep. Debbie Dingell, a supporter of Medicare-for-All, laments in Healthcare Financial Management (here) the difficulties she faced dealing with current Medicare policies and bureaucracy during the illness and after the death of her husband, Rep. John Dingell.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
ABMS Sends Obituary for Maintenance of Certification
The American Board of Medical Specialties sent a note June 5th (here) to chief executives and chief medical officers of hospitals, announcing replacement for the controversial “Maintenance of Certification” program. By the end of the year, according to ABMS - - which represents the 24 “mainstream” member boards - - each of those boards will have “established or will be implementing continuing certification programs that base decisions on frequent, formative, and practice-relevant assessments that promote recent advances in the specialty,” rather than on the difficult, infrequent and reportedly clinically irrelevant “Maintenance of Certification” examination.
Bariatric Surgery Standards, Credentialing and Accreditation Updated
The American College of Surgeons publishes an update on standards for metabolic and bariatric surgery (96-page standards manual here, news release here), reviewing designations, volume criteria, program responsibilities, facilities and equipment, data surveillance, and accreditation process review.
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Six Hospital Organizations Weigh in on S. 1895, the Lower Health Care Act
The American Hospital Association, America’s Essential Hospitals, American Association of Medical Colleges, Catholic Health Association, Children’s Hospital Association and Federation of American Hospitals wrote to Senators Alexander and Murray (here) indicating their “full commitment to help the committee address the issue of health care affordability,” but opposing the bill crafted to accomplish that aim. The main problem: “a benchmark rate in statute for the out-of-network payments”; many of the hospital members of these organizations and their physicians profit from such payments. The model they promote is New York State’s dispute resolution, in place since 2015, which uses, however, benchmark payments as measured by FAIR Health.
EMTALA and Psychiatric Hospitals
CMS has sent a note to state survey agency directors (here) clarifying that Medicare participating psychiatric hospitals are required to comply with EMTALA (Emergency Medical Treatment and Active Labor Act) requirements. This would include having qualified staff to perform a Medical Screening Exam, stabilization within the capabilities of the institution, and performing ongoing assessments. CMS makes clear that it does not expect psychiatric institutions to provide full clinical services, analogizing the psychiatric to the “small rural hospital that needs to send a patient to another hospital to complete the medical screening exam to determine if there is an emergency medical condition.”
Home Infusion Accreditation
CMS publishes today (here) a Federal Register notice that The Joint Commission has applied to accredit home infusion services, and spells out the process for approving accrediting organizations for the Medicare home infusion benefit.
Closing of Hahnemann Hospital
A prominent and historic safety-net hospital in Philadelphia will fall victim to private equity (here), in the culmination of a campaign to “strip the assets” and sell the real estate.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
News from the States
Governing.com profiles efforts in California (here) to renew the individual mandate and to expand subsidized coverage. “The estimated cost over three years is around $1.5 billion. The state plans to pay for the expanded access using general fund money in the first year, and with revenue from the reinstated tax penalty in the remaining two years.”
A new issue brief from the Commonwealth Fund (here) reports that the three-year rolling average rule for the medical loss ratio (MLR) enabled insurers to “recoup a portion of their losses from earlier years” under exchange policies of the Patient Protection and Affordable Care Act. The report notes that the “MLR rule dampens the severity of these cycles, thus protecting insurers as well as consumers.” The report also indicates that commercial insurers’ financial results improved dramatically, primarily by increasing premiums by 11% more than the increase in claims, with profit margins improving from -7.4 to 3.3%, but with rebates still remaining lower than in PPACA’s earlier years.
DRUGS AND DEVICES
No Hard Cap on Part D Out-of-Pocket Drug Spending
The Kaiser Family Foundation reports (here) on Medicare Part D enrollees with high out-of-pocket drug costs in 2017. The report notes that “Part D enrollees can face relatively high out-of-pocket costs because the Part D benefit does not have a hard cap on out-of-pocket spending.” KFF says “1 million Medicare Part D enrollees had out-of-pocket spending above the catastrophic threshold, with average annual out-of-pocket costs exceeding $3,200.” Most frequent were drugs for autoimmune diseases, hepatitis C and various cancers, with out-of-pocket spending for each of top ten medications above $5,000.
READINGS AND REFERENCES
Medicare Risk Adjustment Made Easy: An essay from 3-M Health Systems, here, complete with examples, HCCs and a conclusion—that Medicare risk adjustment appears not to adjust for as much as 90% of cost differences.
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: 17, 18, 23, 24, 25, 26
August publications dates: None
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.