DCMedical News: Monday, October 21, 2019
DCMedical News-DCMN
Washington, D.C.
Monday, October 21, 2019
DCMedical News is published every day both the House and the Senate are in session. Subscription information below.
THE BIG STORY IN HEALTH CARE
Opioid Trial Begins in Ohio
Save for a last-minute settlement, six companies will be on trial beginning today, defending against 2,000+ suits claiming that the companies played a role in creating and exacerbating the opioid crisis (addiction, destitution, 70,000 overdose deaths in 2017, and of course shortages and disruption for some patients in pain). Leading the plaintiff charge is Mark Lanier, who, according to Bloomberg, recently had his third multi-billion-dollar award in winning a case against Johnson & Johnson concerning talc, baby powder and cancer. An ordained Baptist minister and former professional chess player, Lanier will face a field of defendants reduced by settlements or dismissals. Left in the defense: McKesson, Teva, Cardinal, AmerisourceBergen, Henry Schein and Walgreen Boots Alliance.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
In an ASC You May Be on Your Own
CMS’s 2020 ambulatory surgery center (ASC) rules loosen safety requirements for ASCs (final rule in Federal Register of September 30 here, news here). Written transfer agreement for ASC patients who need to be transferred to a hospital are no longer required; histories and physicals will only be required now for some ASC patients, criteria to be determined; and emergency preparedness plans will have to be reviewed by ASCs only every two years, not annually, and without the inconvenience of consulting local emergency preparedness authorities. UnitedHealth (Modern Healthcare report here) begins November 1 to force outpatient surgery to ASCs. But how about safety inspections? OIG reports (here) that “In FY 2017, not quite half of States (22 of 50 States) met CMS’s requirement to ensure that no more than 6 years elapse between surveys for an individual ASC.”
Long Term Care, Pharma, Physician Practices and IT Most Active Health Areas for Mergers & Acquisitions
Epstein, Becker & Greene and ECG Management Consultants report in Bloomberg (chart here) on 2019 activity.
Variation in High Statin Use
A study in JAMA Cardiology (here) indicates that high statin use varies with factors mostly unrelated to patient care. “Hospital size of at least 500 beds, medical school affiliation, male sex, and patient receipt of a stent were associated with greater high-intensity statin use. For-profit hospital ownership, patient age older than 75 years, prior coronary disease, and other comorbidities were associated with lower use.” But statins for lower risk patients, and especially for primary prevention, may be “low value care,” says a study (here) in BMJ, a consequence of the commercial success of statin promotion.
More than 80% of Electronic Medical Record Content is Repetition
That number (cut and paste!) and more in an article (here) focusing on “workarounds” in electronic medical records in this week’s Modern Healthcare.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Take Advantage
One week into the annual “open enrollment” period (attempts by insurers to attract traditional Medicare beneficiaries to their “Medicare Advantage” plans) Bloomberg (here) takes a look at a big business. “Health insurers across the U.S. will race to enroll more seniors in lucrative government-backed Medicare plans this month, even as a roiling debate over the role of private companies in health coverage shapes the presidential race . . . Selling them has become a crucial profit center for the insurance industry.” How big is the business? “In 2019, about 22 million people, or roughly a third of all Medicare enrollees, got their Medicare coverage through the private plans. For each person who signs up, the insurers collect a fee from the government. It was $11,545 on average this year, which adds up to about $254 billion.” And this: “Medicare products are the biggest business at the biggest health insurance company, UnitedHealth Group Inc.’s insurance unit.”
Medicaid in State Budgets
Kaiser Family Foundation reports (here) an increase of 6.2% in 2020 in State budgets for Medicaid, despite flat enrollment.
Got Spare Time? Advise Medicare!
A notice in today’s Federal Register (here) invites nominations to the Medicare Evidence Development & Coverage Advisory Committee (originally, in 1998, the Medicare Coverage Advisory Committee). How does it work? “The MEDCAC consists of a pool of 100 appointed members including: 90 at-large standing members (10 of whom are patient advocates), and 10 representatives of industry interests. Members generally are recognized authorities in clinical medicine including subspecialties, administrative medicine, public health, biological and physical sciences, epidemiology and biostatistics, clinical trial design, health care data management and analysis, patient advocacy, health care economics, medical ethics or other relevant professions. The MEDCAC works from an agenda provided by the Designated Federal Official. The MEDCAC reviews and evaluates medical literature and technology assessments, and hears public testimony on the evidence available to address the impact of medical items and services on health outcomes of Medicare beneficiaries.” The notice indicates that “As of June 2020, there will be 25 membership terms expiring. Of the 25 memberships expiring, 2 are industry representatives, 5 are patient advocates and the remaining 18 membership openings are for the at-large standing MEDCAC membership.” Deadline for your nomination is November 18.
DRUGS AND DEVICES
Medicare Part D Drug Price Increases
A new Kaiser Family Foundation study (here). The bad news: price increases nine times inflation for the 20 most popular drugs. The good news: legislation to cap price inflation will yield savings to the Medicare program.
“Pelosi Drug Bill” Advances
Joining the Education & Labor Committee in the House, the Energy & Commerce Committee voted Friday (also along party lines) to advance H.R. 3 (here). The bill would compel CMS to negotiate prices of the most expensive drugs that have few or no competitors, capping them relative to the prices paid in six other countries. Bloomberg notes this provision added to the bill in Energy & Commerce: the list of drugs requiring negotiated prices would include any new ones with a wholesale acquisition cost equal to the median national household income, now about $62,000.
READINGS AND REFERENCES
U.S. House of Representatives:
Members at https://www.house.gov/representatives
Committees and Members at https://www.house.gov/committees
U. S. Senate:
Members at https://www.senate.gov/general/contact_information/senators_cfm.
Committees and Members at https://www.senate.gov/committees
House and Senate 2019 Calendar of Regularly Scheduled Sessions, here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
October publication dates: 22, 23, 24, 28, 29, 30, 31
November publication dates: 12, 13, 14, 15, 18, 19, 20, 21
December 3, 4, 5, 6, 9, 10, 11, 12
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.