DCMedical News: Thursday, October 17, 2019
DCMedical News-DCMN
Washington, D.C.
Thursday, October 17, 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
Hot! Hot! Hot!
The Hill (here) reports that Senate Minority Leader Schumer will focus on health legislation “amid impeachment fever.” The effort will take the form of bolstering the Patient Protection and Affordable Care Act (ObamaCare), which “was by and large unpopular until the GOP nearly eradicated it during the last Congress.”
Democratic candidates for the Presidency debating Tuesday night spent considerable time on “Medicare for All,” with significant questions about funding, the merits of different approaches to health care, Medicare for All vs. Medicare for All Who Want It, etc. The NY Times report is here.
The Commonwealth Fund and the Urban Institute jointly released a new report (here, with exhibits) on comparison of health insurance “reform” options, from “Building on the ACA to Single Payer.” The paper analyzes eight proposals and the potential effects on coverage, cost and spending by government, consumers and employers. The report finds that “Universal coverage of all Americans and improved affordability is attainable by building on the ACA,” that a “single-payer approach would leave no one uninsured and largely eliminate consumers’ out-of-pocket medical costs,” but that “it would require much greater federal spending to finance,” and that single-payer “lite” “can be constructed with lower federal spending and systemwide costs.”
One respected observer (J.B. Silvers, here) checked in, also via The New York Times, to indicate that the most realistic path to Medicare for All is “similar to how we got to Medicare in the first place: the failure of private insurance.” Professor Silvers notes that the most likely ending in the current reform cycle is the failure of the private health insurance system, with arrival at Medicare for All by inadvertence. His bottom line on Medicare: “It has been a tremendous, albeit expensive success. For the most part, people on Medicare like it a lot. This is the reason such a disruptive change is even a political possibility.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Robotic Colectomy, Minimal Benefit, Greater Cost
A study in JAMA Surgery (here) notes that the use of robotic surgery for common operations like colectomy is increasing rapidly, “but evidence for its effectiveness is limited and may not reflect real world practice.” The study notes that “Robotic colectomy was associated with minimal safety benefit over open colectomy and had comparable outcomes with laparoscopic colectomy,” and that it “replaced a greater proportion of laparoscopic rather than open colectomy, especially in hospitals with the highest adoption of robotics.”
An editorial (“Robotics Against the Evidence,” here) which accompanies the new study says “The use of robotic surgery for common operations, such as colectomy, but also for even simple procedures, such as inguinal and ventral hernia surgery, is increasing rapidly . . .The duration of surgery was longer in the robotic group, and overall hospital costs were also significantly higher . . . Importantly, there are no differences whatsoever in complications between laparoscopic and robotic colectomies; yet the use of robotic colectomy increased more than 10-fold between 2010 and 2016 as a replacement of laparoscopic colectomy rather than open colectomy.”
Congressional Budget Office (CBO) Reports on Workforce Legislation
The Congressional Budget Office has issued a report (here) on H.R. 2781 “Educating Medical Professionals and Optimizing Workforce Efficiency and Readiness for Health Act of 2019,” favorably reported by the House Committee on Energy and Commerce September 24th. The bill would reauthorize grant programs, for which $280 million was appropriated in 2019, now proposed at $359 million for those programs for each year between 2020 and 2024. Authorization includes “training for diversity,” grants for programs that enhance the geriatric workforce, and loan repayment assistance for individuals entering pediatric specialties.
Also issued by CBO is a report on H.R. 728, Title VIII Nursing Workforce Reauthorization of 2019 (here), which would authorize and amend the program which appropriated $221 million in 2019, to now include $78 million for advanced education nursing grants, $18 million for workforce diversity grants, $44 million for nurse education, practice and quality programs, and $91 million for loan repayment and scholarship, a total of $970 million over the period 2020-2024. This bill was also reported favorably by the House Committee.
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Hospital groups “Cry Foul Over CMS’s Surgical Coverage Proposal.”
MedPage Today (here) notes that hospital lobbies are objecting to expansion of the list of surgical procedures that Medicare will reimburse at independent ambulatory surgery centers (ASCs), claiming that they will have “devastating life-threatening” results for patients. The AHA’s 66-page letter (here) is a response to the Outpatient Prospective Payment System and ASC payment system changes proposed August 8 (here) for 2020. AHA objects to other CMS proposals, including transparency; reductions in the OPPS reimbursement to hospital provider-based departments so that they would be equivalent to the physician fee schedule, roughly 40% of the OPPS rate; proposed continuation of the current policy to pay 340B drug savings at a rate of average sales price minus 22.5%; and implementation of a CMS-proposed prior authorization process. AHA writes, “We remind CMS that the agency was recently found by the courts to have exceeded its statutory authority when it cut the payment rate for clinic services at excepted off-campus PBDs [provider-based departments].” They also indicate that “There is no basis for paying hospitals less than the statutory ASP [average sales price] plus 6%” under the 340B program. On ASCs, the hospital group opposes the removal of total hip arthroplasty from the “inpatient only” list, opposes the addition of coronary intervention procedures to the list of ASC-covered procedures, and provides a list of other recommendations concerning additions or subtractions to the proposed regulations, for which the comment period has ended.
Payment Reductions to Hospitals 2010-2029
Separately, the AHA joined the Federation of American Hospitals in submitting a report developed by the firm Dobson │DaVanzo (here) on twelve legislative acts and associated CMS regulations “that are estimated to reduce federal payments to hospitals by $252.6 billion” over the 2010-2029 period. Most of the payment reduction is in sequestration ($85.8 billion) and MS-DRG documentation and coding ($85.7 billion), with another $26 billion in Medicaid DSH, $23.7 billion in the aforementioned off-campus provider-based departments (above), and miscellaneous losses for long-term acute care and hospice facilities.
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: 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.