DCMedical News: January 31, 2018
DCMedical News
Washington, D.C.
Wednesday, January 31, 2018
To our new readers: This is an independent newsletter, published every day that one or another House of Congress is in session. Subscription information will be found at the bottom of these pages.
THE BIG STORY TODAY IN HEALTH CARE
The President and the State of the Union: health care issues addressed included Veterans Choice (easing the availability of access by veterans to civilian physicians and hospitals); de-regulation and its impact on the number of drug and device approvals by the Food and Drug Administration; “Right to Try” legislation (easing access to non-conventional or unapproved drugs by terminally ill patients); attention to opioid addiction treatment; and lowering the price of prescription drugs, characterized by the President as one of the top priorities for the coming year. Full text here.
DOCTORS
Poll for Thought: Brace yourself, most physicians don’t think value-based payment models work. That, at least, was the headline for an article in Modern Healthcare, found here. The MH story, in turn, was a report on Leavitt Partners’ new poll on “The State of Health Care Today,” involving more than 5,000 consumers, 621 physicians and 538 employers, found here.
The poll has many more interesting observations, but doesn’t really support the MH headline. The closest that the Leavitt report comes to the MH conclusion is “physicians are skeptical that value-based reforms have a positive impact on patient health outcomes,” (pg. 8 of 12). “Value-based payment,” (VBP) however, is rarely extolled for its potential to have a positive impact on patient health outcomes, as opposed to having a/n (supposedly downward) impact on expenditures. As a slogan, VBP is almost entirely unrecognized by consumers (pg. 10, Leavitt report). Also unrecognized is the rest of the lexicon of current health policy (MCOs, IDNs, PCMHs, ACOs and bundled payments).
Overall view of the American health system: works pretty well but fundamental changes needed (75% of physicians, 50% of employers, 44% of consumers agreed). Responsibility for problems with the American health system: physicians blame insurance companies (52%), employers blame insurance companies and government (31%, 32%), consumers blame government (47%). A majority (that is, more than 50%, at least of these samples) of both physicians and employers can be found to support these efforts to contain cost: cost transparency, wellness and prevention (attention Aaron Carroll, M.D., here), management of heavy users and management of mental health issues.
Other observations: 60% of physicians have never heard of or are not familiar with the requirements of MACRA (the Medicare Access and CHIP Reauthorization Act of 2015). See previous editions of January 16 and 24 on bundles, January 9, 11, 17 and 23 on MIPS and MACRA. Past issues of DCMedical News may be accessed as follows: at the top of this e-mail, click on “View this email in your browser,” then click on “Past Issues.”
HOSPITALS AND HEALTH CARE FACILITIES
The cost of dying: Going up or down? A Dartmouth team examines the question in this week’s JAMA Internal Medicine, abstract here. Excerpts from the paper:
Previous work by others had shown: “Health care expenditures continue to increase in the United States. Historically, end-of-life expenditures have been a consistent contributor to that growth.1Recent studies of end-of-life practice patterns suggest that increased use of hospice care costs more than it saves,2 end-of-life care intensity is increasing,3 and end-of-life intensive care unit use and care transitions are increasing,4 raising concerns that end-of-life care costs might be accelerating.”
This work shows: “Contrary to other studies, we found that per-capita end-of-life spending is decreasing and appreciably contributing to overall per-capita Medicare spending growth moderation. End-of-life spending reductions were driven by substantially lower inpatient care expenditures (and modestly lower physician and home health expenditures) without commensurate increases in other care segments. Potential explanations include both changes in supply (physician efforts may have been redistributed to the newly insured following implementation of the Affordable Care Act) and demand (normalization of more conservative end-of-life preferences, or even financial constraints imposed by the Great Recession6).”
Another data point: H-CUP (the Healthcare Cost and Utilization Project) reports on “Trends in Hospital Inpatient Stays by Age and Payer, 2000-1015,” found here. The direction is down, with a 25% decrease among patients 65 years and over.
HEALTH INSURANCE, MEDICARE, MEDICAID, COMMERCIAL
The tapeworm in the American body politic: Warren Buffett’s characterization of the cost of health care and its impact on American business. Now his company, Amazon and J.P. Morgan Chase will become the odd trio that attempts another deconstruction, with emphasis on tech and direct contracting (for “sensible” services) for their combined 1.1 million employees, perhaps later for others. In response, the stocks of insurance companies sank. Story here.
PHARMA
Who benefits from the new CMS rules on section 340B drugs? A study by Avalere (found here) says, don’t worry, be happy. (In the 340 discount drug program hospitals are reimbursed at list price by CMS, but pay only a discounted price, using funds generated by the price difference for other purposes, in theory for other services used by uninsured patients. For background see our edition of January 3 and links in that edition to a judge’s decision that CMS can cut 340B reimbursement by 40%.)
The Avalere study notes that the funds otherwise spent by CMS to support the purchase price of drugs for safety net hospitals will be redistributed, a net increase for more than half of all hospitals. The problem, of course, is that the increase comes at the expense of genuine safety net hospitals. Support for the current program comes from Senator Hatch, who is retiring, while movement to reform comes from Rep. Walden, Chair of the House Energy and Commerce Committee. Mr. Hatch emphasized the importance of the program during confirmation hearings for newly installed Secretary of HHS Alex Azar. (Mr. Azar has a lot on his desk, including a letter found here on overdue responses from HHS to the House Committee on Oversight.)
EVENTS & MEETINGS
Your January & February Calendar:
January 31:
10:00 a.m. to 11:30, Bipartisan Policy Center https://bipartisanpolicy.org/events/, Policy Roadmap for Individuals With Complex Care Needs (stars, including Burke, Feder, Mann).
February 1:
9:00 a.m. Health Affairs, kick-off of cost control program series.
February 5:
8:30 a.m., Academy Health holds its National Health Policy Conference at the Marriott Marquis, Washington, D.C. See web site (https://academyhealth.confex.com). Continues through February 6. Cost to attend $1,315.
February 6:
3:00 p.m., Full Ways and Means Committee in the House, hearing on the Opioid Crisis and “barriers” in the Medicare program to prevention and treatment of opioid abuse and dependence.
February 13:
12:30 to 5:00, the ONC and the ASPE present a webinar on “Blockchain in Healthcare,” agenda and registration page here.
March 1:
MedPAC, Ronald Reagan Building, Horizon Ballroom, 1300 Pennsylvania Ave, continuing March 2.
OTHER PUBLICATIONS
“Medicare Beneficiaries’ Out-of-Pocket Health Care Spending as a Share of Income Now and Projections for the Future,” Kaiser Family Foundation, here. Excerpt: “One-fourth of traditional Medicare beneficiaries spent nearly 30 percent or more of their total income on out-of-pocket costs in 2013, while 10 percent of beneficiaries in traditional Medicare spent nearly 60 percent or more,” pg. 6.
For reference:
Members of the Senate (here) and Members of Senate Committees (here), Senate Calendar (here).
Members of the House with their House Committees (here), House Calendar (here).
DCMN: February publication dates: 5, 6, 7, 8, 9, 12, 13, 14, 15, 16, 26, 27, 28.
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com