DCMedical News: Monday, October 25, 2021
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY Monday, October 25, 2021
“Delta+”: SARS Co-V 2 Variants
Becker’s reports that “A sub lineage of the delta variant that has gained some traction in the U.K. has been detected in the U.S., the CDC said Oct. 21. AY.4.2, a descendant of the highly transmissible delta variant, is on an ‘increasing trajectory’ in the U.K., according to a recent update [here, entitled SARS-CoV-2 variants of concern and variants under investigation in England] from the U.K. Health Security Agency. It accounted for 6 percent of all samples sequenced in the country for the week beginning Sept. 27, the most recent week with complete sequencing data. The strain is rare in the U.S. and accounts for ‘well below 0.05 percent’ of cases sequenced, the CDC told Becker's in an Oct. 21 statement.”
Medicare Reductions in Physician Pay, a Top Story in Congress
Reps. Ami Bera (D, a general practitioner) and Larry Buchson (R, a cardiothoracic surgeon) have gathered 245 (letter here, AAMC press release here) House member signatures protesting an aggregate 9% reduction in physician fees under the Medicare program, scheduled to go into effect January 1, 2022.
Meanwhile, efforts to expand Medicare to cover hearing, dental and vision benefits have faltered, and CQ reports (here) that “Democrats are considering payment reductions for private Medicare Advantage plans to help offset the cost of a multi-trillion dollar budget bill, according to three sources with knowledge of the talks, triggering a lobbying fight from the insurers. The insurance industry is closely watching lawmakers' search to pay for a sweeping job and social spending bill expected to cost around $2 trillion over a decade.”
In their letter, Reps. Bera and Buchson write “As Congress begins the complex process of identifying and considering potential long-term reforms, we must also create stability by addressing the immediate payment cuts facing health care professionals.”
DOCTORS, NURSES AND OTHER HEALTH CARE PROFESSIONALS
Cleveland Yankee in King Arthur’s Hospital Court
The Cleveland Clinic, opening a 184-bed private hospital in London, is bringing its American model for physician compensation, upping the stakes for recruitment of specialists and creating an incentive for their hospital to keep beds and operating rooms full, according to a report (here) in The Financial Times. “A healthcare company planning to open a new private hospital in London has started a recruitment war for top medical staff by offering them high fixed salaries.”
The FT reports that private hospitals typically employ doctors who work for the national health for spare time fee-for-service work. The Cleveland Clinic is offering fixed payment of £300,000-£350,000 for two days’ work per week to top specialists. The resulting competition resembles “the Premier League on deadline transfer day.”
Administrative Simplification! Why Didn’t We Think of That?
David Cutler and two McKinsey partners examine “Administrative simplification and the potential for saving a quarter trillion dollars in health care” in JAMA (here). They write, “Nearly every industry in the US has experienced substantial improvements in productivity over the last 50 years, with 1 major exception: health care. In 2019, the US spent an estimated $3.8 trillion on health care, including an estimated $950 billion on nonclinical, administrative functions, and that number has increased despite major technological enhancements.”
One remedy? Seismic interventions: “A set of ‘seismic’ interventions were identified that require broad, structural collaboration across the health care industry. These include new technology platforms such as the use of a centralized, automated claims clearinghouse; operational alignment such as standardizing medical policies across payers, for example, requiring the same set of diagnostics and clinical data before agreeing to cover a more complicated procedure or drug therapy; and payment design such as globally capitated payment models for segments of the care delivery system.”
HOSPITALS AND OTHER HEALTH CARE FACILITIES
COVID Hospital Cost Sharing
A study in JAMA (here) analyzes cost sharing for COVID-19 services for patients covered by public (Medicare Advantage) and private health insurance. The challenge: “Many insurers waived cost sharing for COVID-19 hospitalizations during 2020. Nonetheless, patients may have been billed if their plans did not implement waivers or if waivers did not capture all hospitalization-related care.” The finding: “Many patients were billed for professional and ancillary services, suggesting that insurer cost-sharing waivers may not have covered all hospitalization-related care. High cost-sharing for patients who were billed by facility services suggests that out-of-pocket spending may be substantial for patients whose insurers have allowed waivers to expire.”
HCA Reports $2.3 Billion Third Quarter Profit
The hospital company reported (here) “Revenues in the third quarter of 2021 increased to $15.276 billion, compared to $13.311 billion in the third quarter of 2020 . . . Adjusted EBITDA totaled $3.224 billion, compared to $2.053 billion in the third quarter of 2020.” Becker’s CFO reports (here) that “HCA's net income totaled $2.3 billion in the third quarter of 2021, more than triple the $688 million recorded in the third quarter last year,” and that “For the nine months ending Sept. 30, HCA recorded a net income of $5.1 billion on $43.6 billion in revenue. In the same nine-month period in 2020, HCA saw a net income of $2.3 billion on $37.2 billion in revenue.”
DRUGS & DEVICES
Accelerated Spending
A study in JAMA Internal Medicine (here) of FDA “Accelerated Approvals” (AA) for cancer drugs, and the impact of those drugs in Overall Survival (OS), details “Medicare spending on the 10 AA cancer drug indications reevaluated by the FDA in 2021, all of which have a confirmed lack of OS benefit.” The study reports that “Between 2017 and 2019, Medicare Parts B and D cumulatively spent at least $569 million on the 10 cancer drug indications with a confirmed lack of OS benefit after AA,” not counting spending on these drugs in the Medicaid programs, other public health programs or private health insurance. The authors conclude, “The magnitude of spending estimated in our study highlights the need for the FDA to withdraw approvals for drug indications with a confirmed lack of clinical benefit in a timely manner.”
The FDA and Approval of AI Devices
A report in Nature Medicine (here) on “How medical AI devices are evaluated: limitations and recommendations from an analysis of FDA approvals . . . sheds new light on limitations of the evaluation process that can mask vulnerabilities of devices when they are deployed on patients.”
Device Manufacturer Payments to Physicians Exceeds Payments From Pharma Manufacturers
A report in Health Affairs (here) finds “Medical Device Firm Payments To Physicians Exceed What Drug Companies Pay Physicians, Target Surgical Specialists.”
List Prices, Net Prices and Discounts in Prescription Drugs
A study in JAMA (here) of drug price changes 2007-2018 found that “From 2007 to 2018, list prices increased by 159%, or 9.1% per year, while net prices increased by 60%, or 4.5% per year, with stable net prices between 2015 and 2018. Discounts increased from 40% to 76% in Medicaid and from 23% to 51% for other payers. Increases in discounts offset 62% of list price increases.”
READINGS AND REFERENCES
Select Coronavirus Public Health Resources and References may be found here.
2021 CQ Congressional Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
October 26, 27, 28
November 1, 2, 3, 4, 5, 15, 16, 17, 18, 30
December 1, 2, 3, 6, 7, 8, 9, 10
Notes to Fred Hyde, MD, JD, MBA, news@dcmedicalnews.org