DCMedical News: Thursday, September 19, 2019
DCMedical News-DCMN
Washington, D.C.
Thursday, September 19, 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
“Stop Gap” Funding Moves Forward
A bill has been proposed (here) through the Chair of the House Appropriations Committee to fund federal agencies through November 21. A vote on the measure is expected in the House today.
Congress adjourns September 27 and does not reconvene until October 15, two weeks after the beginning of the federal fiscal year. Congress adjourns again (after 20 working days) on November 21, and does not reconvene until December 3. Provisions concerning extension of health programs begin on pg. 26 of the bill (Community Health Centers, National Health Service Corps, Teaching Health Centers that Operate Graduate Medical Education Programs, Diabetes Programs, Indian Health). Medicaid program extensions, beginning on pg. 33, include Community Mental Health Center demonstrations, FMAP calculations for Territories and avoidance of reductions in Disproportionate Share Hospital (DSH) payments. Medicare program extensions, beginning on pg. 35, include “quality” endorsement programs, outreach and assistance for low-income programs, Area Agency on Aging and Aging and Disability centers funding and extension of the termination date for the Patient Centered Outcomes Research Trust Fund.
Drug Price Plan Also on for Today
A drug price negotiating plan (here) which would give private insurers the benefit of governmental drug price negotiation will be unveiled today and will be the subject of a hearing next Wednesday by the House Energy and Commerce Committee.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Medicare (Payments) for All
Seven physician groups (and Premier) but no hospital organizations have petitioned CMS (letter here) to make payment on “innovative” and “alternative” reimbursement schemes from 2017. They note, “Under the 2015 Medicare Access and CHIP Reauthorization Act (MACRA), this bonus was expected to be distributed in calendar year (CY) 2019. After nearly two years, the delay in payment of the bonus remains both unexpected and unexplained. MACRA passed with a large bipartisan, bicameral majority in Congress and is best known for repealing the flawed sustainable growth rate formula. Importantly, MACRA also created the Quality Payment Program (QPP) for traditional Medicare, which was intended to accelerate the transition of traditional Medicare away from its reliance on a flawed, fee-for-service payment system in part by providing incentives for physicians and other clinicians to move into Advanced APMs.” The “flawed sustainable growth rate (SGR) formula” intended to make Medicare expenditures “sustainable” for the government operated to (in theory) reduce physician payment increases from 1997 to 2015. The actual implementation of a physician fee reduction took place only in 2002, however. By 2015 the accumulated reduction would have been a 30% drop in Medicare reimbursement for physicians. A hasty, Sunday Rose Garden MACRA signing ceremony took place, one day before the proposed drop threatened to propel participating physicians out of the Medicare program.
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Public Reporting of PCI Mortality Rates Worthless for Prediction
A Stanford group reports (here) in JAMA Cardiology that public reporting of percutaneous coronary intervention mortality is worthless to patients and hospitals, alike. “We evaluated publicly reported PCI performance statistics among New York hospitals between 1998 and 2016 and found that a hospital’s risk-adjusted mortality rate was only weakly associated with its future mortality. At hospitals with high PCI-related mortality, PCI volume was not substantially reduced and patient severity in the following year did not change. However, these hospitals experienced substantial decreases in observed and risk-adjusted mortality . . [and] low-mortality hospitals experienced analogous increases in mortality.” The report concludes “It is unlikely the reduction in mortality between consecutive years represents report-driven practice improvement. Our results suggest that the annual variation in hospital differences in risk-adjusted mortality was associated with random variation and temporal trends that likely represent regression to the mean.”
A Minute in the Operating Room
A study of California hospital operating room (OR) expenses (here) finds that “From FY2005 to FY2014, expenses in the OR have increased faster than the consumer price index and medical consumer price index. Teaching hospitals had slower growth in costs than nonteaching hospitals. Over time, the proportion of expenses dedicated to indirect costs has increased, while the proportion attributable to salary and supplies has decreased.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
High Cost Medicaid Beneficiary Report
The GAO reported to Republican Congressional leaders (here) that “care management” was the primary tool available to states in controlling expenditures on the health of the five per cent of beneficiaries who account for more than half of Medicaid expenditures for all beneficiaries. The states reported “providing various types of assistance such as coordinating care across different providers to manage physical and mental health conditions more effectively—for beneficiaries in their fee-for-service delivery systems. Five of the states also contracted with managed care organizations (MCO) to deliver services for a fixed payment and required the MCOs to ensure the provision of care management services to high-expenditure beneficiaries. Some of the seven selected states used additional strategies to manage care for high-expenditure beneficiaries. For example, Indiana [reflecting the work of CMS Administrator Seema Verma, then a consultant to then-Governor Mike Pence] officials described a program to restrict, or ‘lock in,’ a beneficiary who has demonstrated a pattern of high utilization to a single primary care provider, hospital, and pharmacy, if other efforts to change the beneficiary’s high utilization were unsuccessful.”
$1.3 Billion in Medical Loss Ratio Rebates in 2019
The Kaiser Family Foundation reports (here, infographic) that commercial insurers will rebate $1.3 billion this year because their medical expenses (as a percentage of premium, medical loss ratio or MLR) fell below the 85% required (80% in smaller states) for health insurance exchange plans under the Patient Protection and Affordable Care Act. Half of the money will go to individual policy holders, the remainder divided evenly between small and large group employers.
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: 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.