DCMedical News: December 18, 2017
DCMedical News
Washington, D.C.
Healthcare, Medical Education
December 18, 2017
Schedule for the Tax Bill
No time for studies, says CBO, in the rush to make taxes great again. CBO Director Hall in a letter (here) to Ways and Means Chairman Brady discusses those “macroeconomic” effects of the “Tax Cuts and Jobs Act,” (you know, the Laffer Curve, lower tax rates=higher tax revenue?). He writes that, regrettably, in the rush “It is not practicable to provide an estimate of the budgetary impact of the bill’s macroeconomic effects at this time.”
Oh, you mean you haven’t read the bill’s 503 pages yet? Well, here you go, plus the 560 page Conference Committee Report, and 10 pages of charts showing the impact of each provision, 2018-2027 (and helpfully labeled “Very Preliminary”).
Specific provisions of interest in the health field:
Elimination of the individual mandate: pg. 153-154 of the Conference Report (all page references here are to that Report.) The text notes that the tax for 2017 and 2018 is $695 (the flat dollar amount) or the “excess income amount,” but is zero after 12-31-2018 (that is, for 2019 ff.)
Medical expenses: out-of-pocket medical expenses for 2017 and 2018 exceeding 7.5% of AGI (vs. 10% currently), pg. 99.
Paid (not off-set) Family and Medical Leave: provides a 12.5% employer tax credit for payment of 50% or more of wages, escalating, but only in 2018 and 2019, pgs. 293-294.
More in tomorrow’s edition.
Where is the “Value” in “VBP”?
A Commonwealth Fund survey of financial managers (the 2017 Virtual Conference of the Healthcare Financial Management Association, broadcast December 14, 2017) focused on “What drives the total cost of care?” and examined 962 population areas, and specifically focused on value-based payment.
After reviewing cost, mortality and patient-specific data, the study found that there was “Nationwide, no association with growth and VBP models and cost growth for Medicare or commercial populations.” Also, “An increase of VBP models within a market did not have a significant impact on quality,” and any correlation of VBP with quality improvement was “likely due to chance as there was no systematic improvement across multiple measures.” You can find the slides here.
So, no correlation of VBP with cost or quality. Four hypotheses were advanced as to why value-based payment models had had no impact. The usual suspects were offered: it’s too early, VBP penetration was broad but not deep, incentives had not aligned, investments are delaying realization of positive return on investment. Unasked was whether “VBP” is a marketing and/or careerist slogan, a relatively unimportant measurement activity, avoiding more difficult measures which might actually affect cost or quality, such as “We need to talk to doctors,” and “We need to talk to patients.”
Budget
Don’t lose sight of HJR 124. See current budget projections (CBO estimates here). Continuing Resolution ends 12-22.
PTAC Meets Today, Tomorrow
PTAC (the Physician-Focused Payment Model Technical Advisory Committee) meets today (the 18th) and tomorrow. PTAC is one of several initiatives underway to promote “innovative” or “value-based” payments for physicians, in lieu of paying retail. Another initiative comes from MedPAC, disillusioned with MIPS, now promoting a voluntary “quality” program, likely to adopt it at their January 11 meeting. You can watch the PTAC part of this story at www.hhs.gov/live. You can find their agenda and original (three day) meeting notice here and the modified (two day) meeting notice here.
Have to Implement It to Find Out What Is In It
The Centers for Medicare and Medicaid Services (CMS) has finalized regulations for Hospital Outpatient Prospective Payment and Ambulatory Surgical Payment Systems and Quality Reporting Programs, (Federal Register on December 14, pgs. 59216-59497, here). Comments can still be submitted until 12-31.
Don’t be disappointed if your “voice” is not heard, however. To implement one of the most controversial rules—cutting the 340B drug payments which support safety net hospitals—CMS has already sent out notices to hospitals (December 13, “Medicare FFS Program, Billing 340B Modifiers under the Hospital Outpatient Prospective Payment System,” here.) As “Lawmakers race to block HHS Medicare cuts to 340B hospitals,” Modern Healthcare, here), it would appear that this race is over. The new system begins January 1.
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com