Washington Update: Monday, January 30, 2023
Three alternatives — FFS, VBP, MA — are models for Medicare’s future.
We share the attached deck with Congressional staffs who ask for our perspective on the evolution of Medicare, starting with a look at the continuum of care and Medicare post-acute spending. The 2010 Affordable Care Act put great faith and resources into “value-based purchasing” (VBP) and “alternative payment models” (APMs). But we show how Medicare FFS remains the reliable old workhorse that, despite its weaknesses, delivers care to the sickest patients.
Republican control of US House came down to 6,670 votes in five districts.
A new analysis of the 2022 elections results shows how close the US House race was. In an election cycle where 107 million Americans voted, Democrats would have kept control of the House if they had won 6,671 additional votes in just five districts. That is a 0.006% difference. The closest race was Rep. Lauren Boebert (R-CO) who won by 554 votes. The Republicans needed a net gain of five seats to win back the House majority and ended up with a net nine seats.
OIG launches “collaborative” IRF audits, ahead of broader “RCD.”
HHS-OIG has long telegraphed its plan to conduct more IRF audits, saying medical record documentation for many IRF stays do not meet Medicare requirements to support IRF-level of care. OIG is now working with IRF trade associations to move ahead with a set of “collaborative” audits. These audits are separate from a broader CMS “Review Choice Demonstration” (RCD) initiative that is expected to be launched later this year.
UnitedHealth & LHC still await FTC approval for merger.
Almost a year after it was announced, UnitedHealth and LHC still await approval of their proposed merger by the Federal Trade Commission (FTC). The deal’s timing agreement is set to expire in mid-February. In March 2022, LHC agreed to be acquired by UnitedHealth for $5.4 billion. The FTC is now subjecting deals to greater scrutiny, especially those deals led by large Medicare Advantage plans. The FTC is using “vertical harm” analysis to further scrutinize the merger.
Elevance (formerly Anthem) plans to acquire Louisiana Blues Plan
Elevance Health, formerly known as Anthem, has signed a deal to acquire Blue Cross and Blue Shield of Louisiana. The deal will add nearly two million people to Elevance’s total insured population of 47 million. Elevance will now operate Blue Cross Blue Shield plans in 15 states if the deal closes. Elevance and the Louisiana Blues have been working together the past several years in a joint venture for dual eligible patients.
U.S. Supreme Court may dial-back authority of regulatory agencies.
This year, the Supreme Court may change the “Chevron deference” doctrine. In 1984, the Supreme Court issued the Chevron decision, saying courts and states must generally defer to regulatory agencies. Conservatives have long sought to dial this back and give less authority to regulators. Liberals say curtailing agencies would mean shifting more responsibilities to Congress which has not shown great skill in accomplishing core functions, let alone more detailed regulatory policy.
Chicago Mayor Lori Lightfoot (D) seeks reelection on February 28.
Mayor Lightfoot faces a tough re-election on February 28 when she faces eight challengers, including Rep. Chuy Garcia (D-IL) and former schools chief Paul Vallas. Polls show a tight race. If no candidate finishes with a majority of the votes, a runoff election will be held on April 4. In 2019, Mayor Lightfoot became the first African American woman and first openly gay person to lead Chicago. She is the first big city mayor to stand for reelection since the end of the pandemic.