DCMedical News: Monday, September 9, 2019
DCMedical News-DCMN
Washington, D.C.
Monday, September 9, 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
Congress Returns (as does DCMedical News)
Both Houses of Congress return to session today. The schedule for Congress for the remainder of 2019 can be found here.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Brexit Doctor Blues
Statista (here) has analyzed the dependence of European countries on foreign-trained physicians. The highest percentage dependency is Ireland, almost 40%, with many countries much lower (France and Germany both 10%, Italy, .8%).
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Indirect Medical Education (IME) Funding May be due for Change
Wide-ranging change in graduate medical education (GME) funding for hospital residency training programs may be coming, presaged in discussion during the most recent meeting of the Congressionally chartered Medicare Payment Advisory Commission (MedPAC), held September 5 and 6 in Washington.
GME training program funding comes in two categories, Indirect Medical Education (IME) and Direct Graduate Medical Education (DGME or DME). IME, $9.3 billion per year, supports teaching hospitals’ higher cost of patient care not otherwise accounted for in the Inpatient Prospective Payment System (IPPS), and included as an adjustment of the IPPS. DGME, $3.7 billion per year, supports direct medical education costs, such as the “stipends” paid to residents; payment is made outside of the IPPS rates.
A staff presentation to MedPAC (here) highlights the concentration of funds at the “top.” The one hundred teaching hospitals with the largest IME payments accounted for 47% of the residents and 51% of the IME payments. The staff and the Commission have taken issue with the amount of the payments (“above justified level”), and also that the payments are only made for inpatient training and services, at a time of increased clinical work (and training) on the outpatient services. A proposal discussed at the meeting would (a) make the payments available for both inpatient and outpatient training, (b) “justify” the payment levels in each area, (c) introduce “performance-based” teaching payments and (d) make consistent Medicare payments under both the fee-for-service and the Medicare-Advantage programs. All of this while maintaining the current level (“aggregate”) of IME payments.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
MedPAC Meeting September 5-6
Also on the Medicare Payment Advisory Commission agenda: an overview (“Context for Medicare Payment Policy,” here) of the Medicare programs, bringing beneficiary, provider and program data together.
Highlights: growth in per beneficiary spending differing in the major components, fee-for-service (FFS), Medicare Advantage and Part D, with FFS growth slowing 2009-2013, then increasing 2013-2018, especially in the hospital outpatient, laboratory and hospice settings. Both the program’s Trustees and the Congressional Budget Office expect Medicare annual expenditures to double in the next decade, from today’s $700 billion plus to 2028’s $1.4 trillion.
Enrollment, at approximately 20 million in 1970, is approaching 60 million, with active workers (paying into the fund) at 4.5 per Medicare enrollee in 1970, but now at 2.5 active workers per health insurance enrollee. The Hospital Insurance Trust Fund, for part A benefits and post-acute care, 41% of the total Medicare program expenditures, is financed by payroll taxes from those active workers, and is anticipated to be insolvent by 2026. The Supplementary Medical Insurance Trust Fund, for part B (physician, outpatient) and part D (drugs) expenditures, accounts for 59% of the total expenditures, and is “solvent only because general tax revenue transfers and premiums are increased each year to cover spending.”
Statista updates with 2018 numbers (here) 15 OECD country health care expenditures per person.
Medicaid Enrollment Report
The Centers for Medicare and Medicaid services report that 73 million people are enrolled in the Medicaid and CHIP programs (May 2019 enrollment). Approximately half of the total enrollment consisted of children in the Medicaid and CHIP programs, 35 million individuals.
READINGS AND REFERENCES
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.
Committees and Members at https://www.senate.gov/committees
House and Senate 2019 Calendar of Regularly Scheduled Sessions, here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
September publication dates: 10, 11, 12, 17, 18, 19, 20, 23, 24, 25, 26, 27
October publication dates: 15, 16, 17, 18, 21, 22, 23, 24, 28, 29, 30, 31
November publication dates: 12, 13, 14, 15, 18, 19, 20, 21
December 3, 4, 5, 6, 9, 10, 11, 12
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.