DCMedical News: January 3, 2018
DCMedical News
Washington, D.C.
Healthcare, Medical Education
January 3, 2018
THE BIG STORY TODAY IN HEALTH CARE
Congress returns (Senate first, this week), begins a scramble to avoid defunding of the federal government, now operating until January 19 under a Continuing Resolution, (25-page House Amendment to the Senate Amendment to H.R. 1370 found here.)
Here are what Commonwealth thinks will fuel the scramble: “Obamacare insurance market bills, Puerto Rico's Medicaid funding, the Children's Health Insurance Program, and the delay of Obamacare taxes.” You might add: budget caps, legislative efforts to fix 340B (below), CMS’s attempts to avoid Essential Health Benefits and also to uncouple FFS standards from “managed” Medicare and Medicaid plans, the medical device tax (that industry will miss Al Franken), and the impact of immigration on the number and quality of health professionals in America (see Tom Brokaw, multiple myeloma patient, on the many nationalities of the professionals caring for him, “You Can Find the Entire World Inside Your Hospital,” NYT 12-31). This time Dems will be needed.
HOSPITALS
Local and State Focus on Health Costs
The costs (read “prices”) of health care may become a still bigger issue at the local and state levels of government.
Example: Ballot initiatives (another face of populism!). SEIU is undertaking local ballot initiatives in five cities in the Bay Area, aimed at Stanford Health Care facilities. The Ballot Initiative can be found here. A companion measure filed against Watsonville Community Hospital has already been approved. Health care facilities would be prohibited from charging patients more than 15% above the actual cost of providing care. This would, if nothing else, force policy types once again to wrestle with the definition of “charges,” to say nothing of parsing the meaning of “cost.”
Example: state Medicaid programs informing safety net hospitals of DSH reductions, sample here.
Example: ProPublica’s December 21 story on the cost of health care as the top financial concern of voters, and examples of what the authors believe to be waste in American health care.
Even Health Affairs is looking at cost, in a multi-year project sponsored by the National Pharmaceutical Council (!).
Measures of “Quality”
No hospital left behind: Becker’s Hospital Review reports “When CMS updated the methodology used in its Overall Hospital Quality Star Rating program in December after a five-month delay, the number of hospitals that received the highest possible overall rating increased from 83 in December 2016 to 337.”
Déjà vu, Gary Becker: the work of behavioral economists continues to undermine common sense in the health field. The New York Times reported January 1 that VA hospital officials in Roseburg, Oregon discovered they can game their “quality” metrics by admitting fewer patients and having fewer surgical operations. The episode recalls the 2014 Phoenix VA Hospital scandal: to achieve bonus payments, Phoenix VA staff electronically discarded appointment request records of veterans who had waited longer than 14 days for a primary care appointment. Discarding the long wait time records artificially improved appointment performance, triggering a management bonus. War hero General Shinseki, then heading the VA, fell on his sword, resigning in 2014. Little if any discussion took place acknowledging that we owed this disgrace to behavioral economics, or, as the late Uwe Reinhardt may have noted, attributing the motivation of doctors and other health professionals to “tips.” So history (“quality metrics” set centrally) repeats.
HEALTH INSURANCE, MEDICARE, MEDICAID, COMMERCIAL
CHIP GETS (SOME) FUNDING - Among provisions in the Continuing Resolution is the CHIP program, with $2.85 billion through March 31. The CR language also allows CMS to use Redistribution Funds to help states dealing with CHIP-related funding shortfalls. Funding community health centers and other health programs was offset by cutting the ACA's Prevention and Public Health Fund by $750 million.
InsideHealthPolicy reported Tuesday on states developing their own individual mandates. One beneficiary would be the federal government. CMS’s release of the Average Advanced Premium Tax Credit by State (found here, December 13, 2017) shows high cost northeast states like Connecticut ($440 per month) and Pennsylvania ($427 per month), but Massachusetts (the only state with an individual mandate) at $177 per month premium subsidy, (exhibit with excerpts for these states found here.)
PHARMA
CMS can cut 340B reimbursement by 40% according to a federal judge who ruled on the matter on the 29th. The judge’s decision can be found here, the original AHA (and other party) Complaint here, the government’s brief here and the AHA-plaintiff brief here.
EVENTS & PUBLICATIONS, MEETINGS AND READINGS
American Enterprise Institute kicks off winter seminar-type events this Thursday at 10:00 a.m., with a traditional Repo focus on “Eliminating the favored tax treatment for employer-paid health insurance premiums, improving the operations of health insurance exchanges, and leveling the playing field for competitive alternatives to Medicare fee for service coverage.” (The Economics of US Health Care Policy, Charles Phelps, Routledge, 2017). Others might observe that a “leveled playing field” for MA plans would remove the only profitable lines of commercial insurance companies. Register here: https://www.aei.org.
Noted: December 20 Modern Healthcare’s Vital Signs Blog on independent physicians—especially in primary care—benefitting from the pass-through income deduction in the Tax Cuts and Jobs Act.
And Tim Jost, we’ll miss your post! The insightful chronicler of and guide to Obamacare for Health Affairs is hanging it up. Maybe Trump did repeal PPACA.
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com