DCMedical News: Wednesday, September 25, 2019
DCMedical News-DCMN
Washington, D.C.
Wednesday, September 25, 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
DSH Disappearance, $4 Billion Payment Cut Required
Publication of the “Final Rule” for reduction in Disproportionate Share Hospital (DSH) payments takes place in today’s Federal Register (here). CMS notes in the rule that it has no authority to delay or reduce the payment cuts, beginning at $4 billion in FY2020 and increasing to $8 billion each year for the fiscal years 2021 to 2025. The continuing resolution passed in the House (House bill here) would continue the current level of DSH payments through November 21 (section 1303). A bill (H.R. 3022, here) from Representative Eliot Engel would permanently repeal all cuts to the program.
“Safety Net” Strain to Increase
Strain on the safety net will increase with two million more people uninsured in 2018 compared to 2017 (8.5% in 2018 vs. 7.9% in 2017), according to the Census Bureau’s study (here) of health insurance in 2018. The Census Bureau noted that the increase in the uninsured was “particularly remarkable” given the falling unemployment rate, since most Americans obtain health insurance coverage through work. The Census Bureau study indicates that this is the first meaningful increase in the number of people without health coverage since 2009.
Reports released by CMS August 12 (here, table with enrollment and premiums here) show that people who do not qualify for subsidies continue to be priced out of the market. “Following a decline of 1.3 million unsubsidized people in 2017, another 1.2 million unsubsidized people left the market in 2018. These enrollment declines among unsubsidized enrollees coincided with increases in average monthly premiums of 21 percent in 2017 and 26 percent in 2018. The decline began in 2016, as 23 states saw decreases from 2015 to 2016 among unsubsidized enrollees. Forty-three states saw decreases in unsubsidized enrollment from 2016 to 2017, and 47 states saw a decline from 2017 to 2018. During this most recent year, nine states including, Iowa, Georgia, Nebraska, Tennessee, Virginia, Kentucky, Missouri, Kansas and West Virginia, lost more than 40 percent of their unsubsidized enrollment.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Walmart-for-All
Walmart has begun offering a health field education benefit for its employees. Becker’s reports that “Beginning Sept. 24, Walmart's 1.5 million workers in the U.S. can apply for one of seven bachelor's degrees and two career diplomas in health-related fields through Live Better U, Walmart's education benefit program. Employees pay only $1 a day for the duration of their college or career programs.
The seven bachelor's degrees, which include health science and healthcare management, are offered through Purdue University Global, Southern New Hampshire University, Bellevue University and Wilmington University. The career diploma programs for pharmacy technicians and opticians are offered through Penn Foster. The new programs will help train employees to fill healthcare jobs across Walmart and Sam's Club, which include more than 5,000 retail pharmacies, 3,000 vision centers, 400 hearing centers and Walmart Health, a standalone health clinic in Dallas, Ga., that opened earlier this month.” An extensive profile of Walmart health plans in Business Insider (here) notes that the chain also plans to offer home health services and mobile units that offer specialty services, such as dermatology or women's health.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
HHS Secretary Azar (here) and CMS (here) announce that Medicare Advantage and Part D premiums will both decline this year, by 23% from 2018, while 1,200 more Medicare Advantage plans will be offered in 2020, compared to 2018. The CMS announcement indicates that the average monthly plan premium will decrease 14%, $26.87 in 2019 to an estimated $23 per month in 2020. Of the (approximately) 60 million people currently enrolled in Medicare, a projected 24.4 million will be in Medicare Advantage programs in 2020. CMS claims that the average monthly premium for a Medicare Advantage plan is the lowest that it has been since 2007, and that the basic Part D premium of $30 in 2020 is the lowest Part D basic premium since 2013. Open enrollment begins October 15th and ends December 7th.
AHRQ Notes Twenty Years
AHRQ (the Agency for Healthcare Research and Quality) has noted (here) the 20th anniversary of To Err is Human, the Institute of Medicine report which concluded that “somewhere between” 44,000 and 98,000 patients die every year in American hospitals from preventable medical errors. AHRQ’s current director (Gopal Khanna) noted the various successes of AHRQ during those two decades, especially the Pronovost Comprehensive Unit-based Safety Program, leading to a 91% decline in central line bloodstream infections nationwide between 2010 and 2015. Khanna noted that remaining major challenges include diagnostic error, writing that “an estimated 12 million people per year are affected by diagnostic errors, including 4 million suffering serious harm. Research suggests the cost to the U.S. healthcare system exceeds $100 billion annually,” with the three largest areas of diagnostic error being cancer, vascular conditions and infections.
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: 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.