DCMedical News: Monday, September 23, 2019
DCMedical News-DCMN
Washington, D.C.
Monday, September 23, 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 Begins Final Legislative Week in FY 2019 Today
Senate action is needed on a “stop gap” spending bill (House bill here, CBO report here) to continue government funding from October 1 until November 21. Congress adjourns this Friday, reconvening October 15th.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Does Value-Based Pay Have a Future?
A review in Medical Economics (here) notes that “pretty much everyone in healthcare likes the idea of paying for outcomes, but no one is sure how to fairly implement it.” Problems include definition of quality, definition of value, and in fact the conflation of value-based care generally with MACRA (the Medicare Access and CHIP Reauthorization Act of 2015) and MIPS (Merit-based Incentive Payment System).
A higher toned (and better organized) review is undertaken by Casalino (here) in JAMA. He writes, “Physician professionalism can be conceived as the intrinsic motivation to become a better physician and to place patients’ interests above the physician’s own interests. If a VBP [Value-Based Payment] program weakens professionalism, it may improve performance in the areas it measures but have the unintended consequences of worsening performance in unmeasured areas and of incentivizing physicians to avoid patients who may lower their scores in measured areas.” He cites the British pay-for-performance program in primary care and its short-term improvements but long-term quality decline, lessons apparently unnoted at the time “VBP” was introduced more widely in the U.S.
GoFundMe Not Just for Cancer Care Anymore (See DCMN 9/10/19, “Crowdfunding for Cancer Care”)
Physicians opposed to the American Board of Internal Medicine’s (ABIM) maintenance of certification (MOC) program have donated $290,000 to a GoFundMe campaign sponsored by Practicing Physicians of America. The money will support federal class action lawsuits seeking an end to MOC, and filed against defendants ABIM, the American Board of Radiology, and the American Board of Psychiatry and Neurology. The basic claim is that the Boards tie initial certification to its maintenance of certification process, limiting growth and competition, but alleging also “racketeering and unjust enrichment claims,” according to Medical Economics (here). ABIM has made changes in MOC in response to controversy, including alternatives to the traditional ten-year exam known as the “Knowledge Check-In” (KCI), a shorter, every other year, online assessment available to internists and nephrologists in 2018, with eight more specialties added in 2019. MOC, while voluntary, is increasingly linked to hospital privileges and third party (health insurer) network participation (“credentialing”). Seven states have passed legislation to prevent hospitals, licensing boards and insurance companies from requiring MOC, including Georgia, Maryland, Missouri, North Carolina, Oklahoma, Tennessee and Texas.
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Survivors Carve Up Hahnemann, Feds Dispute Salability of Residence Programs
Tower Health and Drexel University have agreed to pay $50 million in bankruptcy for Hahnemann’s St. Christopher’s Hospital for Children (story here). Proceeds from the dissolution of Hahnemann, controlled in recent years by a California investment broker, will yield (1) this sale, (2) real estate, estimated to be worth more than Hahnemann as a going concern, and (3) a stand-off between the bankruptcy court which “sold” the Hahnemann residency programs, and CMS, which does not believe CMS-funded residency positions are available to be transferred from one hospital to another. Lawyers from the Department of Justice requested a stay on the bankruptcy court sale of the residency programs, which was granted September 16th, (story here). The residency programs were thought to be worth $55 million to the prospective purchasers (six health systems, including Jefferson, Einstein, Temple, Mainline in Bryn Mawr, Cooper University in Camden, New Jersey, and Christiana in Wilmington, Delaware).
Dueling Philosophies of Hospital Consolidation Meet Today in San Francisco
Jury selection begins today in San Francisco in two suits with antitrust allegations against Sutter Health. The first suit (filed in 2014, the UFCW Complaint, here) and the second (the Attorney General of California filed suit in 2018, here) have the potential for national import. Sutter is a 24 hospital, 36 ambulatory surgery center, 12,000 physician and 53,000 employee system located in 19 counties in northern California, with $13 billion in revenue in 2018. Under California’s antitrust law, treble damages and attorneys’ fees are available if the UFCW and the State win. UFCW, a union trust fund, represents a class of California employers who self-insure their health care costs, while the remedies sought by the Attorney General are to stop the alleged practices.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Air Ambulances WAY Out of Network
CQ Magazine in today’s edition (here) features the connection between air ambulance services and “surprise” billing issues. Two-thirds of the rides (when studied for 2017 in a report issued by the GAO in March of this year, here) were out-of-network, with a median price of $36,400. Various proposals would prohibit air ambulance companies from balance billing (S. 1895 before the Senate H.E.L.P. Committee) or would require provision of cost data in claims (HR. 2328 in the Energy & Commerce Committee). A particular controversy is the backing of air ambulance companies by private equity firms (see Washington Post here, Health Affairs here), a sore point to some in Congress given the extensive advertising by private equity companies against surprise billing legislation during the August congressional recess.
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: 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.