DCMedical News: Wednesday, September 11, 2019
DCMedical News-DCMN
Washington, D.C.
Wednesday, September 11, 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
Eleven Legislative Days Remain Until the Beginning of FY2020. October 1 Looms as Funding Deadline for Health (and many other) Programs
Fiscal Year 2020, which begins October 1, will need new appropriations and authorization legislation, both stalled in the returning Congress. Community Health Centers are once again at risk, as are proposals to defer reductions in Disproportionate Share Hospital (DSH) supplemental Medicaid payments. A variety of “extenders” in health care need re-authorization, including “Money Follows the Person” out of the nursing home and into the home; renewal of Obamacare’s Patient-Centered Outcomes Research Institute; and diabetes prevention and research, among others.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Surprise Bill Strategy Changes
Bloomberg reports that doctors are pushing for “reasonable” payments, rather than payments based on list prices (charges), as part of the negotiation over legislation to end surprise medical bills. A letter from physician and medical specialty groups proposing arbitration is found here, making no reference to billed charges. Insurers and employers had expressed opposition to arbitration as a method for resolving billing disputes, concerned that physician groups would succeed in using billed charges or otherwise very high out-of-network payments to boost payment for services, beyond any multiple of Medicare rates.
State insurance commissioners from 32 states also sent a letter (here) to the Senate HELP Committee, supporting the bill that the panel proposed, also not including arbitration, instead setting payments based on median network rates for the areas in which the services had taken place. Also at issue: air ambulance charges, frequently boosted at the behest of private equity owners of such companies. Bloomberg reports that “The biggest impact on reducing payments for out-of-network doctors would likely be on private equity companies that provide staffing for emergency room doctors.” Those companies have been active in advertising during the August Congressional recess. The result has been slowing of momentum which had been building behind surprise bill legislation in July, according to CQ and others.
New Codes, New Bills, New Revenue
The American Medical Association (AMA) has released 400 new codes for use in the Current Procedural Terminology (CPT) code set, (announcement here), effective January 1, 2020, a “return to an older view on medical care” in which “many patients are realizing the best access point for physician care is once again their home." The 2020 CPT update includes six new codes for reporting online digital evaluation services, or e-visits, including patient-initiated digital communications with a physician or other qualified healthcare professional (99421, 99422, 99423) or a nonphysician healthcare professional (98970, 98971, 98972). Also included: CPT codes (99473, 99474) for reporting self-measured blood pressure monitoring. “In addition, 2020 changes include new codes for health and behavior assessment and intervention services (96156, 96158, 96164, 96167, 96170 and add-on codes 96159, 96165, 96168, 96171),” replacing older codes "to more accurately reflect current clinical practice that increasingly emphasizes interdisciplinary care coordination and teamwork with physicians in primary care and specialty settings." The CPT was begun by the AMA in 1966, one year following the passage of Medicare and Medicaid.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Census Bureau Reports on Health Insurance in the U.S. Population in 2018
The Census Bureau has issued a report (here) on health insurance coverage of Americans in 2018. Highlights: “In 2018, 8.5 percent of people, or 27.5 million, did not have health insurance at any point during the year. The uninsured rate and number of uninsured increased from 2017 (7.9 percent or 25.6 million). The percentage of people with health insurance coverage for all or part of 2018 was 91.5 percent, lower than the rate in 2017 (92.1 percent). In 2018, private health insurance coverage continued to be more prevalent than public coverage, covering 67.3 percent of the population and 34.4 percent of the population, respectively. Of the subtypes of health insurance coverage, employer-based insurance remained the most common, covering 55.1 percent of the population for all or part of the calendar year. Between 2017 and 2018, the percentage of people with public coverage decreased 0.4 percentage points. The percentage of people covered by Medicaid decreased by 0.7 percentage points to 17.9 percent. The rate of Medicare coverage increased by 0.4 percentage points to 17.8 percent.”
MedPAC Considers Change in Post-Acute Care, Diabetes, Durable Medical Equipment, but not in the Readmission Reduction Program
At its September meeting the Medicare Payment Advisory Commission considered (further) changes in diabetes and DME coverage (here); the impact of Medicare Advantage programs on Medicare Fee-for-Service (here); “value” in Post-Acute Care payments (here); and defended the Hospital Readmission Reduction Program (here).
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: 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.