DCMedical News: January 19, 2018
DCMedical News
Washington, D.C.
Friday, January 19, 2018
THE BIG STORY TODAY IN HEALTH CARE
The House passed (230-197) a short term funding bill (to February 16) for the federal government, but a showdown looms in the Senate on extending government funding beyond midnight tonight. In October, 2013, the federal government shut down for sixteen days. The government continued to pay furloughed employees, and incurred an additional $24 billion in expense. Here is the 2017 HHS contingency plan, showing that HHS would furlough more than 40,000 of its 82,000 employees, not, however, uniformly among its constituent agencies. More than half of FDA employees would continue working, compared to a quarter of those at NIH. FDA is partially funded through fees charged to companies making application for approval of drugs and devices.
The Continuing Resolution which passed is found here, the CBO estimates of the Rules Committee approved rule on the Continuing Resolution is found here, the statutory language is found here. As noted in our Wednesday edition, this proposal (HJR 125) includes a six-year reauthorization of the Children's Health Insurance Program (CHIP), a one-year suspension of the health insurance tax (to 2020), a two-year suspension of the medical device excise tax (to 2020), and a two-year suspension of the Cadillac tax on high-cost employer-sponsored health care plans (to 2022), all three taxes creatures of the Patient Protection and Affordable Care Act (PPACA, “Obamacare,” P.L. 111-148 and 111-152).
Democrats had proposed a separate vote on a bill which would permanently reauthorize CHIP, reauthorize funding for community health centers (CHCs, FQHCs) for two years, permanently repeal therapy caps in Medicare, reauthorize a home visiting program of Medicare for five years and continue the expired Medicare “extenders” (three programs known as special diabetes, teaching health center and National Health Service Corps).
DOCTORS
Hot potato: who is responsible for the spread of opioids? ED physicians (study here, from Annals of Emergency Medicine) have found that “Between 1996 and 2012, opioid prescribing for noncancer patients in the United States significantly increased. The majority of this growth was attributable to office visits and refills of previously prescribed opioids. The relative contribution of EDs to the prescription opioid problem was modest and declining. Thus, further efforts to reduce the quantity of opioids prescribed may have limited effect in the ED and should focus on office-based settings. EDs could instead focus on developing and disseminating tools to help providers identify high-risk individuals and refer them to treatment.”
HEALTH INSURANCE, MEDICARE, MEDICAID, COMMERCIAL
Twenty-nine Senators have contested (letter here) CMS’ ability to compel work from Medicaid recipients through the §1115 waiver process. The waiver process, originally introduced into the Social Security Act in 1962, prior to the passage of Medicaid (in 1965), was an invitation for states to experiment with social insurance. Legislators discovering the breadth of §1115 use by administrative agencies is not, however, new. During the Clinton administration §1115 was used to prop up public hospitals, especially in California, unrelated to any specific Medicaid experiment. Since then, states have widely used §1115 in attempts to increase enrollment of new Medicaid beneficiaries, or, in concert with increasing enrollment, to attempt “delivery system reform.”
MACPAC and MedPAC have jointly published a new study of dual eligibles (beneficiaries of both Medicare and Medicaid), found here. The “2018 Data Book” reports that dually eligible beneficiaries accounted for 15 percent of all Medicaid enrollees but 32 percent of all Medicaid spending. Most were female (61 percent), white (57 percent), living in urban areas (76 percent). In 2013 Medicaid spent $118.9 billion and Medicare spent $193.5 billion on dually eligible beneficiaries. In the years 2009-2013 Medicaid spending on dual eligible patients grew by a total of eight per cent, Medicare by a total of 19.5%. The next meeting of MACPAC is January 25 and 26 (see below, Events & Meetings). A transcript of the last meeting is found here.
HOSPITALS AND HEALTH FACILITIES
CMS Administrator Seema Verma and AHA President Rick Pollack held a joint webinar Wednesday, administered by AHA, to discuss how her agency can lighten the regulatory burden on his member hospitals, lasting 37 minutes. Pollack thanked Verma for making some regulations voluntary rather than mandatory, avoiding premature release of incomplete information, etc. Pollack says the average hospital dedicates 59 FTEs to compliance and spends $760,000 for “Meaningful Use” compliance ($760,000 x 4,950 hospitals = $3.8bn).
Verma said her top priorities were “patients over paperwork,” strengthening the doctor-patient relationship. Verma noted that a tech-savvy population of new Medicare beneficiaries will expect more of an “Amazon” experience. Verma expressed gratitude for the recent care of her husband in the University of Pennsylvania Hospital, but, in the same sentence, noted that the rate of health care expenditure growth is unsustainable. She noted they were looking at ACOs “in a different way” and “that is coming soon.” Verma related an anecdote about an Ohio hospital that had to hire 18 people to manually extract and compile quality related measures for federal reporting, its electronic medical record being unable to do so. You can find the webinar replay here: http://windrosemedia.com/windstream/aha/011718/
A different kind of regulation (and a new meaning for “Civil Rights”) announced today: creation of the Conscience and Religious Freedom Division (CRFD, found here) of the Office of Civil Rights in HHS to guard the interests of health care personnel who object to certain procedures or the treatment of some people in violation of their conscience and beliefs. Jurisdiction of the CRFD will include the provider conscience protections of PPACA, section 1303, which provides that “No individual health care provider or health care facility may be discriminated against because of willingness or unwillingness, if doing so is contrary to the religious or moral beliefs of the provider or facility, to provide, pay for, provide coverage of, or refer for abortions.” California, challenging current federal policy, has drawn attention with the FACT (Freedom, Accountability, Comprehensive Care and Transparency) Act which 144 members of Congress (see amicus brief filed Tuesday, here) believe “violates the First Amendment rights of pro-life pregnancy centers, forcing them to engage in speech that directly contradicts their own message and deeply held beliefs.”
PHARMA
Thought provoking: a GAO report that “Medicare Represented at Least Half of the Market for 22 of the 84 Most Expensive Drugs in 2015,” found here.
EVENTS & MEETINGS
Your January & February Calendar:
January 23: 7:00 p.m. Senator Sanders with “Medicare for All Town Hall Meeting” on digital media outlets
January 25: 8:30 a.m. MACPAC, 1800 M. Street, Suite 650, Washington, D.C., and continuing to Friday, January 26
January 25: 2:00 p.m., Commonwealth Fund media call on Association and Short-Term Health Plans, proposed regulations found here, RSVP at http://events.r20.constantcontact.com/register/event?oeidk=a07ef1kuch778193d5c&llr=drajzjdab
January 29: 8:30 a.m. COGME, at https://hrsa.connectsolutions.com/cogme-council/, also January 30
February 1: 9:00 a.m. Health Affairs, kick-off for cost control series, sponsored by National Pharmaceutical Council
OTHER PUBLICATIONS
A new (January 2018) AHA publication, “State Marketplace Stabilization Strategies,” work by Manatt, found here.
CBO publication on “Insurance Coverage Provisions of the Affordable Care Act—CBO’s March 2015 Baseline,” found here.
NY Governor Cuomo’s Budget Memo found here discusses, among other issues, waiving the corporate practice of medicine prohibition in New York, to allow pharmacies to offer medical care. The Budget memo contends that such clinics could save ten million dollars in two years, by reducing ED visits by Medicaid recipients. However, there is no evidence to support that contention, and some evidence to the contrary (found here), namely that urgent care, walk-in and other “medicine-light” retail providers are “add-ons,” that is, additional expense to the system. From a RAND study in the Annals of Emergency Medicine: “With increased patient demand resulting from the expansion of health insurance coverage, retail clinics may emerge as an important care location, but to date, they have not been associated with a meaningful reduction in low-acuity ED visits.” CVS’ recent decision to keep Aetna’s corporate headquarters in Hartford, CT, rather than relocating to NYC, may affect the enthusiasm with which the Cuomo administration pursues this drug store medicine initiative. The Medical Society of the State of New York is conducting a survey of its members, to see what they think.
DCMN: DC Medical News publishes every day that either the House or the Senate of the U.S. Congress is in session. Publication dates for the remainder of January: 22, 23, 24, 25, 26, 29, 30, 31
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Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com