DCMedical News: Thursday, September 12, 2019
DCMedical News-DCMN
Washington, D.C.
Thursday, September 12, 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
Will Work Make Medicaid Beneficiaries Healthier? And How is that Medicaid Expansion Working?
A study in this week’s New England Journal of Medicine (here) evaluates the work-for-Medicaid program in Arkansas, at one year the oldest of several efforts to link Medicaid eligibility to work or community service requirements. Arkansas and eight other states have received federal approval to implement work requirements for Medicaid, with six other state applications pending. Because the Medicaid statute was intended by Congress to improve the health of beneficiaries, the work requirements must promote better health and help beneficiaries escape poverty. A federal judge, skeptical of the health benefits claim, halted the program. This paper finds that implementation of the policy in 2018 was “associated with significant losses in health insurance coverage in the initial six months of the policy but no significant change in employment.” Moreover, “more than 95% of persons who were targeted by the policy already met the requirement or should have been exempt,” which “suggests that bureaucratic obstacles played a large role in coverage losses under the policy.”
Meanwhile, Harvard’s Benjamin Sommers publishes (here) in JAMA a summary of research on Medicaid and health improvement, concluding that “An increasing number of studies have provided rigorous evidence that Medicaid expansion, which has increased the number of Medicaid recipients by more than 10 million since 2013, has been associated with improved health of low-income US residents in various ways, including self-reported health, acute and chronic disease outcomes, and mortality reductions.” And a multi-author group publishes in Brookings Papers (here) an analysis of the geography and distribution of Medicaid funded services in the five years of Medicaid expansion under PPACA. They note, “Across all the states in our sample, we find that the ACA Medicaid expansion resulted in an increase in the use of hospital services. In a number of states, however, the estimated effect is small and statistically indistinguishable from zero. We also examine heterogeneity in the target efficiency of the expansions, finding that the degree to which the expansions could target those with the greatest need for medical services varied meaningfully across states.”
Appropriations Skidding Toward October 1
The process of appropriations for the fiscal year beginning October 1 skidded again, as bills for funding the Departments of Labor, Health and Human Services, and Education were “pulled” from the mark-up agenda previously scheduled for this morning’s Senate Appropriations Committee. The hold up: abortion, family planning and Title X funding issues. The Labor-HHS-Education bill was scheduled for action in a Subcommittee of Appropriations Tuesday, but was also put off at that time.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Slowing Progress in Heart Disease
A study (here) in JAMA shows declining progress in age-adjusted mortality rates (AAMR) in heart (and other) disease. “These findings demonstrate a continued but slower decline in AAMR for heart disease, a plateau in mortality rates from stroke and diabetes, and an increasing AAMR for hypertension (although hypertension as underlying cause of death remained relatively infrequent) between 2010 and 2017. Racial disparities in cardiometabolic causes of death persisted.”
Chronic Care Management Copays Would Disappear Under Bill Approved by House Ways and Means Committee
A Congressional Budget Office report (here) notes that “in 2015, Medicare began to pay for CCM services for beneficiaries who have two or more chronic conditions that are expected to last at least 12 months or until the death of the patient. CCM services are electronic and provided remotely. Examples of such services include developing comprehensive care plans and management, providing access to around-the-clock care and transitional care management, and coordinating home- and community-based care. Medicare patients must consent to receiving the services and acknowledge their cost-sharing responsibilities. Under its fee-for-service program, Medicare typically pays 80 percent of the physician fee schedule amount, and beneficiaries pay the remaining 20 percent. In 2018, about 4 million CCM services were provided to Medicare beneficiaries and, on average, patient’s monthly cost sharing totaled about $11 per service.” This bill would eliminate cost sharing, increasing the number of beneficiaries served by approximately 200,000 (a five percent increase) in 2020, increasing to about 1 million additional services (a 25 percent increase) by 2029, at a cost of $790 million over the 2019-2029 period.
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
More Coordination
The Office of the National Coordinator for Health Information Technology (ONC) announced (here) that The Sequoia Project has been named to serve as the Recognized Coordinating Entity (RCE). “The RCE will be responsible for developing, updating, implementing, and maintaining the Common Agreement component of the Trusted Exchange Framework and Common Agreement (TEFCA). The Common Agreement will create the baseline technical and legal requirements for health information networks to share electronic health information and is part of ONC’s implementation of the 21st Century Cures Act.”
READINGS AND REFERENCES
The Journal of the AMA publishes (annually) results of the questionnaire of the Liaison Committee on Medical Education, the Annual Medical School Questionnaire. Results profiling medical schools in the United States, 2018 -2019, can be found here.
The Journal of the AMA publishes the results of the National GME Census, a database of information on training program accredited by the Accreditation Council for Graduate Medical Education, summarizing the residents and fellows in those programs, found here.
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: 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.