Weekend update

David Ermer–Uncategorized–

Both Houses of Congress are out of town this coming week, although the Senate will be back here for the week of August 13. Before leaving town, the Senate passed 92-6 its amended version of the interior department minibus appropriations bill (HR 6147) which includes OPM and FEHBP appropriations.  The two Houses of Congress now must establish a conference committee to resolve differences between their respective versions of HR 6147.

One difference between the bills, as the Federal Times reports, is that the Senate version includes a 1.9% pay increase for federal employees for 2019 (1.4% base page and 0.5% locality pay just like this year.)  The White House issued a statement of administration policy expressing concerns about the Senate version which is accessible here. 
Last week, the Centers for Medicare and Medicaid Services finalized the FY 2019 inpatient prospective payment rule for Medicare Part A. As the CMS press release discloses, CMS finalized a passel of Medicare Part A facility payment rules for FY 2019 last week, including this one which is most relevant to the FEHBP (as the FEHBP enrollment includes a large cadre of annuitants with primary Medicare Part A coverage).  The accompanying CMS fact sheet explains that 

The increase in operating payment rates for general acute care hospitals paid under the IPPS that successfully participate in the Hospital Inpatient Quality Reporting (IQR) Program and are meaningful electronic health record (EHR) users is approximately 1.85 percent. This reflects the projected hospital market basket update of 2.9 percent reduced by a 0.8 percentage point productivity adjustment. This also reflects a +0.5 percentage point adjustment required by legislation, and the -0.75 percentage point adjustment to the update required by the Affordable Care Act.

CMS projects that the rate increase, together with other changes to IPPS payment policies, will increase Medicare spending on inpatient hospital services in FY 2019 by approximately $4.8 billion, including an increase in new technology add-on payments of $0.2 billion. Other additional payment adjustments will include continued penalties for excess readmissions, a continued 1 percent penalty for hospitals in the worst performing quartile under the Hospital Acquired Condition Reduction Program, and continued upward and downward adjustments under the Hospital Value-Based Purchasing Program.

Also, here’s Healthcare Dive’s take on the CMS rule.

Following up on a couple of recent posts —

  • Here’s a link to a Healthcare Dive article including an interview with Express Scripts CEO Tim Wentworth. In particular

Wentworth * * * cited the company’s participation in dialogue around the Trump administration’s Drug Pricing Blueprint and noted that, if Medicare Part D rebates were phased out, it would not have a “material impact” on earnings — but list prices of brand drugs would need to be lowered to offset the value of rebates “no longer going back to members and clients.”  “We are ready for the challenge,” Wentworth continued, “should the Administration reform Medicare Part B to either provide an alternative to buy-and-bill or implement proven PBM tools.”

  • Here’s Forbes Apothecary piece with a good overview of the HSA bills that the House of Representatives recently passed and is now pending Senate consideration.