DCMedical News: Friday, September 27, 2019
DCMedical News-DCMN
Washington, D.C.
Friday, September 27, 2019
DCMedical News is published every day both the House and the Senate are in session. The House and Senate adjourn their regularly scheduled sessions today. The next day on which both the House and the Senate are in session is October 15, when DCMN will resume publication. Subscription information below.
THE BIG STORY IN HEALTH CARE
Senate Passes Continuing Resolution to Fund Government Agencies Until November 21
CQ reports that “The Senate on Thursday cleared legislation [82-15] to fund federal agencies through Nov. 21, giving lawmakers and the White House more time to reach agreement on the annual appropriations process . . . President Donald Trump is expected to sign the continuing resolution (HR 4378, here), holding off another partial government shutdown for at least 51 more days. But this could be the first of several stopgap bills amid tense debates about abortion policy and the border wall.” The stopgap spending bill also extends several health care programs [see pg. 16 of the bill for Community Health Centers and the National Health Service Corps; pg. 17 for Teaching Health Centers that operate GME Programs; pg. 21 for delay in reductions to the Medicaid DSH allotments; pgs. 22-25 for other health measures.]
Continuing Challenges for Disproportionate Hospital Share Funds
Notwithstanding the Continuing Resolution, CMS has presented another challenge to safety net hospitals dependent on DSH money, as reported (here) in Modern Healthcare. In calculating the DSH supplemental payments for FY2020, CMS is using as a base year 2015. That was a year with significantly reduced bad debt, secondary to coverage expansion through Medicaid and exchange insurance plans; lower bad debt calculations will lower DSH payments. An interactive chart developed by MH shows ten states with median bad debt per adjusted discharge increasing more than 22% from 2017 to 2018, including 30% in Connecticut and 69% in Rhode Island. (Other states included New York 7%, New Jersey 9%.)
More on Appropriations for FY 2020
CQ continued in its report, “The Senate vote on the CR followed the House, which passed the measure 301-123 last week. Votes from 76 Republicans helped Democrats to establish a veto-proof majority in that chamber . . . Lawmakers from both parties have expressed hope that this will be the only continuing resolution needed for fiscal 2020, which begins Oct. 1, but ongoing disputes could lead to several more stopgap measures.” Also, for the full fiscal year 2020, “The House has passed 10 spending bills, while the remaining two were reported out of committee but haven't reached the floor. The Senate Appropriations Committee has approved 10 bills, but two have been stymied for lack of bipartisan support — Labor-HHS-Education and Military Construction-VA.” CBO staff present (here) a summary of Congressional Proposals “Related to a Lapse in Appropriations.”
What Happened to the Surprise Bill Legislation?
Families USA is leading a coalition of 14 consumer groups to advertise in favor of legislative remedies for “surprise” (out-of-network) bills. CQ reports (here) that “Revelations that private equity firms were behind a wave of television advertisements and mailers urging lawmakers to oppose the benchmarking payment mechanism for out-of-network services may have actually led lawmakers to be skeptical of those arguments, some members said.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
This is What Pilot Programs Look Like
Walmart, CVS Health, Kroger, Amazon, Walgreen’s and Best Buy are all promoting health services (Business Insider, here). Walmart’s Sam’s Club is piloting “bundles” of health care services, and Amazon has started a virtual health care service for workers in Seattle, an “online” primary care clinic that offers in-home nurse visits and prescription delivery.
AHA Checks in on the Physician Fee Schedule Rules for Calendar Year 2020
The American Hospital Association has sent comments to CMS on the proposed physician fee schedule rules for next year, on behalf of its member hospitals and “more than 270,000 affiliated physicians.” The paper (here) applauds CMS’ pull back on sudden changes in physician fees, laments other fee reductions, urges CMS to let beneficiaries know about screening co-pays (rather than relying on patients’ physicians to do so), deplores the loss of the 6% add-on to the average sales price for Part B injectable and implantable drugs, debates the calculation of therapy assistant time, urges leniency in the timing of Stark Law and Anti-Kickback Statute sanctions, discusses at length Accountable Care Organization quality measure changes and in general supports the desirability of holding off on major MIPS changes, such as implementation of MIPS Value Pathways (MVPs).
What Happens in the EHR and What Actually Happens in the Physician’s Examination of the Patient
Researchers publishing in JAMA Network (here) examined the accuracy of physician documentation in electronic medical records of the physicians’ review of systems and the physical examination. They found: “In this case series of 9 licensed emergency physician trainees and 12 observers of 180 patient encounters, 38.5% of the review of systems groups and 53.2% of the physical examination systems documented in the electronic health record were corroborated by direct audiovisual or reviewed audio observation.” In other words, only 4 in 10 system reviews and 5 in 10 physical exams looked the same to reviewers as they appeared in the electronic record.
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Paperwork Reduction, Program Efficiency, Transparency, Flexibility and Innovation
In 393 pages CMS puts forward a final rule (here, for publication in the September 30 Federal Register) which “[R]eforms Medicare regulations that are identified as unnecessary, obsolete, or excessively burdensome on health care providers and suppliers. This final rule also increases the ability of health care professionals to devote resources to improving patient care by eliminating or reducing requirements that impede quality patient care or that divert resources away from furnishing high quality patient care.” Oh, and the rule also has new requirements for hospital Conditions of Participation.
DRUGS AND DEVICES
The House Energy & Commerce Committee Republican Leaders Denounce Democratic Drug Price Proposals, here.
Foundations Funding a Nonprofit Generic Start Up (Civica Rx) discuss their “Civic Duty to Improve Access to Generic Pharmaceuticals,” in a Health Affairs blog, here.
Kaiser Health News starts a new newsletter (here) on the pharmaceutical and medical technology industries.
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
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.