Washington Update: Monday, March 6, 2023
MedPAC Acknowledges PAC-PPS Model May Not Be Worth Pursuing
MedPAC met last week and continued its debate about a proposal to unify or merge all four post-acute payment systems. For almost ten years, MedPAC has argued a combined PAC-PPS could be used to both reduce Medicare post-acute spending and improve patient outcomes. Last week, MedPAC finally acknowledged the many difficulties in synchronizing – across four post-acute settings – all the many aspects of provider rules and patient care.
Instead… MedPAC now recommends site-neutral policies to address issues.
MedPAC also discussed how CMS policy changes over the past decade make a unified PAC-PPS far less compelling. These changes include LTCH criteria, IRF 60% rule, and new payment systems for SNFs and HHAs. MedPAC staff now recommend policymakers consider more targeted site-neutral payment policies that would be simpler to implement than adopting a mammoth new PAC-PPS. In June, MedPAC is expected to submit to Congress its final report on the issue.
CMS may expand IRF transfer policy to include transfers to home health.
This month, CMS is expected to release its annual IRF rule, and it may use the rule to expand its IRF transfer policy to include home health agencies (HHAs). The IRF transfer policy reduces payments for IRF stays shorter than the average length of stay (ALOS) for the patient’s assigned IRF-CMG. The current policy only applies when an IRF patient is transferred to a general hospital, another IRF, an LTCH or a SNF. CMS is now considering expanding the policy to include transfers to home health. The HHS-OIG recommended expanding the policy to home health in 2021.
Issue of physician-owned hospitals is once again revived in Washington.
Sen. James Lankford (R-OK) and Sen. Bill Cassidy (R-LA) recently introduced legislation which would allow physicians to once again bill Medicare for services in hospitals where the physicians have an ownership interest. The Affordable Care Act (ACA) – aka ObamaCare – restricted physicians’ ownership. Republicans have generally supported the idea of doc-owned hospitals, while Democrats have generally opposed. The AHA and the Federation are also expected to oppose.
Fortune 500 reflects influence of healthcare sector – and MA insurers.
The importance of the healthcare sector is evident in this year’s list of Fortune 500 companies: Four of the top 10 companies are healthcare companies, including CVS/Aetna (#4), United Health (#5), McKesson (#9) and AmerisourceBergen (#10). Then there are the companies which are increasingly trying to move into healthcare, including Walmart (#1), Amazon (#2), Apple (#3) and Alphabet (#8).
Apple’s CEO says health will be Apple’s “greatest contribution to mankind.”
In one year, we may know whether Donald Trump will be GOP nominee.
“Super Tuesday” – the primary election day when 13 large states go to the polls to vote for a Republican nominee – is one year from this week. The party nominees are usually settled on or before Super Tuesday every four years. That means we will likely know one year from now if Donald Trump will again win the Republican nomination for Republican. The betting markets still predict he is the odds-on favorite to win the nomination.
Penn Medicine residents make bid to unionize in closely watched case.
More than 1,400 residents and fellows at Penn Medicine – one of the nation’s most prestigious medical schools – became the first of their kind in Pennsylvania to recently pursue unionizing. They are among a growing number of medical residents exploring labor organizing nationwide. The American Medical Association, which supports rights to collective bargaining, reported only 7% of practicing physicians are in a union, and many of them are government employees.
Pennsylvania Gov. Shapiro will present his budget tomorrow in Harrisburg.
Gov. Josh Shapiro (D-PA) will deliver his first budget address and outline his priorities. His predecessor — Gov. Tom Wolf (D) — and Republican state lawmakers clashed, and it took nine months to pass a budget in Wolf’s first year in office. Similar dynamics are expected this year. Democrats narrowly control the state House 102-100 and Republicans control the state Senate by 28-22. With his big electoral wins, national Democrats are watching Shapiro’s leadership potential.
Pennsylvania has a new House Speaker: First African-American Woman
Pennsylvania State Rep. Joanna McClinton (D., Philly) was elected speaker of the state House, becoming the first African-American woman to hold the gavel and run the legislative chamber. Her ascension came after State Rep. Mark Rozzi (D) stepped down as speaker after a rocky two-months period. Since the November elections, the state House membership was somewhat uncertain and Rozzi tried to present himself as an independent who could lead. But McClinton had long been in contention for the position and claimed it when the elections were resolved.