DCMedical News: Wednesday, October 23, 2019
DCMedical News-DCMN
Washington, D.C.
Wednesday, October 23, 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
Antitrust Lives
The Federal Trade Commission in a 5-0 vote ordered Aetna Inc., Anthem Inc., BlueCross BlueShield of Tennessee, Cigna and United Healthcare to submit data regarding patient billing, employee wage data, and other information to assist in a study of hospital mergers, with special focus on government sanctioned hospital mergers called certificates of public advantage (COPA). Bloomberg reports that “COPAs are used by state regulators to permit hospital mergers that lead to a monopoly in a specific region. Regulators typically oversee such mergers to ensure consumers still receive high-quality health care for a low cost after the deal’s completion . . . Health systems Ballard Health and Cabell Huntington Hospital, Inc., which were both recently formed through COPAs, were also a part of the order request . . . FTC regulators are also interested in how hospital mergers impact employees’ wages.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Focus on GME Spending
A study in JAMA Internal Medicine (here) puts a spotlight on funding for graduate medical education. “Graduate medical education (GME), the training of resident physicians, is funded by GME payments to hospitals and health systems, largely from Medicare and Medicaid. The number, specialty, and practice locations of future physicians is heavily dependent on how GME positions are determined and placed. In 2015, Medicare alone provided $12.5 billion in GME payments to teaching hospitals. Yet, shortages persist in select specialties, such as primary care, and in rural and underserved areas.” Influential study groups have weighed in: “The Medicare Payment Advisory Commission found only 40% to 45% of the indirect payment was empirically justified and recommended reallocating payments more than the justified amount to new GME programs. The Institute of Medicine recommended consolidating Medicare GME payments into a single payment and redirecting 30% to a transformation fund.” And this suggested cap: “If Medicare GME were capped at the $150,000 [per resident] rate of the Teaching Health Centers program, $1.28 billion would have been available for redistribution to address other US health workforce needs.”
Surgeons Choose Wisely for Low Value Services of Other Specialties
How do physicians implement the American Board of Internal Medicine’s recommendations concerning elimination of “low value” services? A study in JAMA Surgery (here) finds that surgeons recommend limiting radiologist studies and some peri-operative preparations. “This focus on deimplementation of radiological imaging and preoperative workups largely misses an opportunity for surgical societies to identify low-value operations for deimplementation.” Studies of other physician specialties have had similar results, namely, recommendations which would change the practices of specialists other than those being surveyed.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
For the Second Straight Year, Exchange Premiums Drop, Despite Predictions to the Contrary
CMS announced (here) that “Benchmark” monthly exchange plan premiums under the Patient Protection and Affordable Care Act will drop 4% next year, the second straight year for declines, notwithstanding premium increase forecasts early in October. There will be 20 new health insurers, for a total of 175, compared to 132 last year. Some 27 of the 38 states offering the exchange policies will have decreases in the Benchmark premium, the second lowest silver tier plan for a 27-year-old, $388 per month in 2020, or, for a family of four, $1,520. (Both figures are without subsidies in the form of premium tax credits based on the second-lowest silver tier plan, the “Benchmarks.”)
The exchanges are used primarily for individuals without access to employer-sponsored group health insurance coverage. A large majority of consumers receive premium tax credit subsidies; others receive support for out-of-pocket expenses. Bloomberg reports that in 2019 87% of consumers and states using the federal exchange received premium tax credits, paying an average premium of $87 a month after application of the tax credit amount. Out-of-pocket payments are subsidized for 71% of the enrollees in the federal exchanges, for those earning between 100 and 250% (250%=$30,350 for an individual and $62,750 for a family of four) of the federal poverty level. Open enrollment for the federal exchanges begins November 1 and ends December 15. Enrollment in the current year is approximately 10.6 million.
Commonwealth Fund Surveys Voters About Health Insurance
The survey (press release here; report here; charts here) shows just over a quarter of U.S. adults favoring “Medicare-for-all,” but many more needing additional information; strong support for Medicaid expansion in states which have not done so; and that a majority of insured adults are satisfied with their coverage.
Inslee Care, Continued: Washington Tackles Long Term Care Insurance with New State Program
Governing.com reports (here) that “The state of Washington passed legislation that will go further than any other state in closing [long term] coverage gaps for a large proportion of its residents. The program will be funded by a wage tax of about 0.6 percent, which kicks in in 2022. Beginning in 2025, the state will offer a maximum lifetime benefit of $36,500 for a person to use for long-term care needs, with the benefit indexed to rise annually with inflation. The coverage isn’t universal: To use the money -- up to $100 a day -- a resident will need to have worked and paid into the program for at least three years in the past six or for a total of 10 years with five years of uninterrupted work. In addition to the standard stay in a nursing home, the benefit will cover items such as installing wheelchair ramps at home and providing services such as those offered at an assisted living facility or by in-home care.”
DRUGS AND DEVICES
How Good are FDA Databases for Determining Death in Post-Market Surveillance?
Not very. A study in JAMA Internal Medicine (here) notes that “As the US Food and Drug Administration (FDA) moves to hasten approval of medical devices, data from post-marketing studies and registries are increasingly relied on to inform decision-making.” But “We found a substantial misclassification of patient deaths in the FDA’s MAUDE database for the Sapien 3 and MitraClip devices, which resulted in the underreporting of deaths. Our findings raise concerns about the accuracy of adverse-event reports for high-risk devices . . . Both the miscategorization of deaths in FDA adverse-event reporting and hidden adverse-events reports can lead to inaccurate public and physician perception of the safety of medical devices and can compromise informed decision-making.”
READINGS AND REFERENCES
Eight Ways to Address the Uninsured
The Urban Institute and the Commonwealth Fund undertake a comprehensive look at eight alternatives for expansion of health insurance to universal (or near universal) coverage, here.
IPPS and LTCH Final Rule
HFMA publishes a 149-page summary (here) of the Fiscal Year 2020 Medicare Hospital Inpatient Prospective Payment System and Long- Term Care Hospital Prospective Payment System Final Rule.
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: 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.