Budget Moves Forward: New Spending $3 Trillion, Debt Reduction $3 Trillion, Over the Next Decade
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
The President’s FY 2024 proposed budget moves forward, with some significant health policies (here), some overall savings of $3 trillion (here), and some new spending, both as measured over the coming decade. In the “savings” category, the largest spending reduction over the decade 2023-2033 is projected to be a drop of $227 billion in spending on drugs.
In the spending category, Modern Healthcare (here) has profiled health program plans for FY 2024. The proposals include lowering payments to “managed Medicaid” programs by compelling such programs to have an 85% “medical loss ratio,” the same as that required of “exchange” programs under the Patient Protection and Affordable Care Act.
Additional funds are proposed to be spent for behavioral health access, to boost rural health and to reduce costs for health insurance and prescription drugs. Also, the President would permanently extend enhanced subsidies for health insurance exchange users. The budget calls for “the creation of a federally funded Medicaid-like coverage plan to provide benefits to low-income adults in states that have not expanded Medicaid under the Affordable Care Act.” The plan also would expand home-and community-based services for Medicaid beneficiaries, and double the size of the FQHC program.
The projected drug savings would come from “expanding on the Inflation Reduction Act by allowing the federal government to set prices on a broader array of medicines, cap cost-sharing for some generic pharmaceuticals under Medicare Part D at $2, beef up Medicaid and Children's Health Insurance Program drug rebates, and require drug makers to refund private customers when they increase prices at a rate that exceeds inflation.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
104,000 Patients on Organ Transplant Waiting Lists—Time for a Change, Says the Government
The Washington Post reports (here) that the monopoly of the United Network for Organ Sharing (UNOS), a nonprofit which is the only organization to have run the U.S. organ transplant system, will be broken up. “If successful, the proposal would leave little unaffected in the sprawling, multibillion-dollar network that sends kidneys, livers and other organs from deceased donors to severely ill recipients.”
“That system has long been criticized as inadequate: Nearly 104,000 people are on waiting lists for organs, most of them kidneys; 22 people die each day awaiting transplants, with poor and minority patients generally faring worse than affluent and White people . . . [HRSA] would invite other organizations to take over those areas. They would bid for separate contracts, creating the first competitive environment in the history of the transplant system.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
ECRI Reports Top Ten Patient Safety Issues for 2023
ECRI (formerly the Emergency Care Research Institute), a nonprofit formed in 1968, and its affiliate, the Institute for Safe Medication Practices (ISMP), reports (here) on “serious issues that threaten the safety of patients and healthcare workers when processes and systems are not aligned.” They are:
1. The pediatric mental health crisis
2. Physical and verbal violence against healthcare staff
3. Clinician needs in times of uncertainty surrounding maternal-fetal medicine
4. Impact on clinicians expected to work outside their scope of practice and competencies
5. Delayed identification and treatment of sepsis
6. Consequences of poor care coordination for patients with complex medical conditions
7. Risks of not looking beyond the “five rights” to achieve medication safety
8. Medication errors resulting from inaccurate patient medication lists
9. Accidental administration of neuromuscular blocking agents
10. Preventable harm due to omitted care or treatment
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
MACPAC Reports to Congress, Proposes Specialty Drug Coverage Standardization, Disrespects DSH
The Medicaid and CHIP Payment and Access Commission has sent its March report (here) to Congress. One focus is “Recommendations on ways to improve Medicaid race and ethnicity data collection and reporting. Racial and ethnic health disparities persist throughout the U.S. health care system. These issues are exacerbated by the high rates of missing data on race and ethnicity, which may lead to inaccurate and incomplete understanding of health disparities. High-quality data are needed to understand and address health disparities, but collecting and reporting these data is a challenge.”
Also a focus, “The transparency of Medicaid payments to nursing facilities. Medicaid is the primary payer for most nursing facility residents . . . The Commission has undertaken long-term work to examine the extent to which Medicaid nursing facility payment policies are consistent with the statutory goals of efficiency, economy, quality, and access.”
On drugs, “The Commission makes recommendations that would allow states the option to align drug coverage with Medicare coverage with evidence requirements under a Medicare National Coverage Determination. While Medicaid drug spending is growing overall, it is increasingly being driven by high-cost specialty drugs. From 2010 to 2015, net spending on specialty drugs in Medicaid almost doubled, growing from $4.8 billion to $9.9 billion . . . The Commission’s recommendations would establish Medicare as a standard for acceptable coverage and could also encourage drug manufacturers to develop evidence of a drug’s effectiveness in a timely manner for Medicaid beneficiaries.”
Finally, “As in prior years, the Commission continues to find little meaningful relationship between state DSH allotments and the number of uninsured individuals; the amounts and sources of hospitals’ uncompensated care costs; and the number of hospitals with high levels of uncompensated care that also provide essential community services for low-income and uninsured populations.”
Medicare Advantage Programs Using AI to Cut Off Benefits
STAT reports (here) on “an investigation [which] found [that] artificial intelligence is now driving denials to new heights in Medicare Advantage, the taxpayer-funded alternative to traditional Medicare . . . Behind the scenes, insurers are using unregulated predictive algorithms, under the guise of scientific rigor, to pinpoint the precise moment when they can plausibly cut off payment for an elderly patient’s treatment. The denials that follow are setting off heated disputes between doctors and insurers, often delaying treatment of seriously ill patients who are neither aware of the algorithms, nor able to question their calculations.”
STAT reported “We take patients who are going to die of their diseases within a three-month period of time, and we force them into a denial and appeals process that lasts up to 2.5 years,” Chris Comfort, chief operating officer of Calvary Hospital, a palliative and hospice facility in the Bronx, N.Y., said of Medicare Advantage. “The appeal outlasts the beneficiary.”
“The algorithms sit at the beginning of the process, promising to deliver personalized care and better outcomes. But patient advocates said in many cases they do the exact opposite— spitting out recommendations that fail to adjust for a patient’s individual circumstances and conflict with basic rules on what Medicare plans must cover.”
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Notes to Fred Hyde, MD, JD, MBA, news@dcmedicalnews.org
© 2023 Fred Hyde & Associates, All rights reserved.
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