DCMedical News: Wednesday, July 17, 2019
DCMedical News-DCMN
Washington, D.C.
Wednesday, July 17, 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
House to Vote on Eliminating the “Cadillac Tax”
The House will vote today on H.R. 748 (here) to repeal the "Cadillac" tax on high-cost health insurance plans, without offsets for the lost revenue. CQ Health reports that “In May, the Congressional Budget Office (CBO) estimated that, if allowed to go forward, the excise tax would raise $193 billion over the next decade when all the indirect effects of the legislation, such as workers moving to lower-cost plans and receiving more taxable compensation in the form of salaries and wages, are factored in. The CBO estimated the direct revenue loss would be $96 billion over 10 years.” Seeking Alpha reports (here) that the tax “Would place a 40% levy on employer-sponsored healthcare plans that provide excess . . . of $30,150 for families in 2022. Opponents of the tax, including insurance industry advocates and certain think tanks, successfully delayed implementation until 2023, mainly because the thresholds are too low and would make insurance more expensive for older and sicker Americans. Nevertheless, health insurers have been preparing for implementation and have seen higher deductibles on their policies as a result.”
Also approaching: a Senate vote on S. 1895, the “Lower Health Care Costs Act,” 30-page CBO report here.
Summary of that CBO report: The bill aims to “Protect patients from surprise medical billing and reduce payments to some health care providers working in facilities where surprise bills are likely; Allow some generic or biosimilar drugs to enter the market earlier, on average, than under current law; Impose new rules for insurers’ contracts with pharmacy benefit managers and health care providers; Extend funding for community health centers and certain other federal health care programs; Increase access to health, cost, and quality information among patients, providers, and insurers, which would create new administrative responsibilities that increase costs for insurers and pharmacy benefit managers; Impose intergovernmental and private-sector mandates by prohibiting certain medical billing practices, limiting other commercial activities, and prohibit the sale of tobacco products to anyone under the age of 21, among many other duties.” The budget impact would come from “Reduced federal subsidies for health care and health insurance” and “Increased direct spending for community health centers and other federal health programs.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Public Health Professionals Disappearing, Competition with Better-Funded Hospitals and Private Sector
Public health school graduates are being drawn to private sector jobs, says a summary of recent studies reported in “The Nation’s Health,” the official newspaper of the American Public Health Association (here). “Surveys show new public health graduates are generally not ending up at state and local health agencies, traditionally the bedrock of U.S. public health. Instead, graduates are seeking openings in the private sector.” A study published in 2018 in the American Journal of Preventive Medicine notes that 50,000 jobs in local and state public health departments have disappeared since the great recession, reducing the workforce to about 200,000. “In the 1950s and ‘60s, most in the field worked in government and tended to be men with an MD. But today, while the workforce is well educated, only 14% of public health workers have formal training in the field, and women make up 79% of the employees, according to the Public Health Workforce Interests and Needs Survey released in January.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Minnesota BCBS Imposes New Rules, Hospitals Object
The Minneapolis StarTribune reports (here) on new Blue Cross Blue Shield payment limitations imposed on hospital by the Minnesota plan. “First, the hospitals said the insurer is imposing new requirements that patients obtain prior authorization for services, making it more difficult and time-consuming for patients to obtain coverage for more than 250 different services, even though the requests are ultimately approved. The hospital association also said the insurer is declaring some services won't be covered even when provided to an eligible patient at an in-network hospital. For example, endoscopy services including routine colonoscopies to check for colon cancer wouldn't be covered at an in-network community hospital if there's a cheaper ambulatory surgery center within 25 miles, the association said.” The Association’s 27-page letter of objections is here.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Global Payment Promoted in NEJM Study of Mass BCBS Alternative Quality Contract
Song, Chernew and colleagues publish (here) a study of health care spending, utilization and quality, eight years into a “global payment” program offered by the Alternative Quality Contract (AQC) of Blue Cross Blue Shield of Massachusetts. The “population-based payment model” does not appear, however, to have involved either a global budget or a capitated payment; rather, retrospective spending analyses were paired. Not all services were compared, only “sentinel services using an analogous approach.” “Quality” measures were not compared during the study, only “averages in New England and the United States.” Bottom line: spending on claims for the enrollees and organizations that entered the AQC in 2009 was $461 lower per enrollee than spending in the control states, a savings of $57 in lower increases per year, less for AQC enrollees in years subsequent to 2009. These modest savings were achieved in early years of the study “through referring patients to lower priced-providers or places of service,” and in later years through lower utilization, “including use of laboratory testing, certain imaging tests, and emergency department visits.”
Quality Measures in Medicaid and CHIP Programs
2020 Child and Adult Core Set Review Workgroup Draft Report on quality measures to be used FY2020 for Medicaid and CHIP, now available for public comment. It summarizes the review process, discussion, and Workgroup recommendations. The report is available here, comments by August 5.
READINGS AND REFERENCES
Medicare Coverage Databases: A 25-page index (here) to how one might determine what Medicare covers, and how; not including Medicare Advantage.
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: 18, 23, 24, 25, 26
August publications dates: None
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.