DCMedical News: Tuesday, October 22, 2019
DCMedical News-DCMN
Washington, D.C.
Tuesday, October 22, 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
Settlements
Opioid litigation in Ohio saw plaintiffs settle with two counties before the trial began. Distributors McKesson Corp., Cardinal Health Inc., and AmerisourceBergen Corp., will pay a combined $215 million. The Hill reports that “Manufacturer Teva Pharmaceutical Industries will pay $20 million cash between the end of this year and 2021 and provide $25 million worth of the anti-overdose drug Suboxone.” An estimated 2500 suits remain.
Sutter Health settled antitrust claims brought against it by the Attorney General and numerous employers in California, also before trial began. Terms of the settlement will not be known until, possibly, next year.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
MedPAC Stops Counting Hospitalists as Primary Care Physicians
At its October 3rd meeting, MedPAC announced (here) that it would no longer be counting hospitalists as primary care physicians in its evaluation of the adequacy of primary care availability for Medicare beneficiaries. MedPAC staff explained, “Nearly all hospitalists have been included in our count of PCPs because they self-designated as internal medicine.”
Primary care, with internal medicine, family practice, geriatrics and pediatrics counted by CMS, would appear to be the exact opposite (continuity, focus on a limited panel of patients over time) of hospitalist (shift work) services. MedPAC points to the large growth in the number of hospitalists (from 32,427 based on claims data in 2010 to 48,407 in 2017). CMS, counting the hospitalists, had 186,193 physicians available for primary care; now, without the hospitalists, that number is 140,290. Without a proffer of evidence, the slides presented to the MedPAC meeting indicate that “Revised counts of PCPs do not change the conclusion that beneficiary access to care has remained adequate.” MedPAC’s previous analysis of the growth rate for primary care physicians (2.5% in 2011, .7% in 2016), turns negative (-.6% in 2017) without the hospitalists. In analyzing the number of encounters per beneficiary, MedPAC reports that primary care physicians went down from 4.1 in 2013 to 3.7 in 2017; specialist physicians went up from 12.3 to 12.4, but MedPAC staff are now counting hospitalists in the specialist physician category. APRNs and PAs went from 1.1 to 1.8 encounters, the most dramatic increase. MedPAC staff is seeking feedback from the members about these “methodological changes,” and will present same together with projection of future supply numbers at the next MedPAC meeting, November 7th & 8th.
MD Ranger Reports on Physician Payments from Hospitals
MD Ranger’s 2019 report on hospital expenses for physician coverage is here. More than half of the total spending was for hospital-based physicians (hospitalists, intensivists, emergency, pathology, radiology, neonatology, etc.), the fastest growing physician cost in the MD Ranger survey. Emergency department call coverage payments are also significant, ahead of “directorship” and administrative contracts. Median total hospital spending for hospitals under 100 beds was $2 million +, hospitals 100 – 300 beds $8 million, hospitals over 300 beds $12 million and up. The median for all facilities was $8 million.
Incidentalomas Studied for Effect on Patients and Physicians
A report in JAMA Network (here) says “Incidental findings on screening and diagnostic tests are common and may trigger cascades of further testing and treatment that are of uncertain value. By some estimates, up to 52% of radiology and laboratory tests produce incidental findings, and these rates are likely to increase with gains in technology. In some cases, further evaluation of these findings may reveal a clinically important and intervenable discovery, such as an early-stage cancer first detected on chest radiography that would have caused death if left untreated. More often, subsequent evaluations may find nothing significant . . . Such cascades of care come with substantial potential for harms. Patients may experience anxiety and additional treatment risks in addition to monetary costs and inconvenience, and physicians may be distressed, conflicted, or burdened by additional work.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
The “Avoidable” ER Visit, Possible Role for Telehealth
3M’s Director of Analytics, Populations and Payment Solutions opines (here) that telehealth may be an answer to the “avoidable” ER visit. How many visits is that? Steve Delaronde notes different studies showing avoidable ER visits at 3.3%, 30% and two-thirds of the total. He attributes the growth in ER visits to insurers underpaying primary care physicians, leading to narrow networks; limits on transportation; and limits on continuous insurance coverage. An expanded vision of telehealth is found in China, in this week’s Bloomberg (here), a picture of industrial telehealth-based medicine.
Can we fix those “surprises” from ER bills? New York has a model (since 2015, here), now extended (beginning January 1) from physician charges to include hospital ER bills. The extension (signed by New York’s Governor Cuomo October 17) includes caps on hospital charges and arbitration, combining the two competing solutions vying for attention in Congress. The updated New York statute provides that health insurance enrollees won’t have to pay more in out-of-pocket charges than they would pay for in-network treatments at hospitals. Hospital charges would be limited to 125% of previously contracted rates, increased by the “medical consumer price index” for contracts expiring more than 12 months prior to the claim. The New York State law applies only to underwritten coverage, not to beneficiaries of self-insured employers. The latter can still take disputes to arbitration. MedPAC staff took a crack at the question of avoidable hospitalization and emergency department visits at the group’s meeting October 3rd (here).
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
“Price Transparency” and “Skin in the Game” - - Economists with No Clothes
Massachusetts’ Attorney General issued a report (here) indicating that “price transparency websites” created by Massachusetts health insurers don’t help consumers shop for care, or lower their health care expenses. A seven-year-old Massachusetts law requires insurers to provide consumers price estimates for medical services. However, the report finds that “Patient expenditures at lower-priced hospitals have decreased over time,” that “Online cost estimators have had a limited impact on patient selection of high-value care,” that “Very few consumers who use cost estimators seek to hold their payers to the cost estimates they receive,” and that “The amount of a consumer’s deductible has a limited impact on selection of lower-price, high-value care.” The front page of Monday’s Los Angeles Times (here) has consumer/patient stories, confirming the relative uselessness of price transparency tools, as opposed to, for example, regulation.
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: 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.