DCMedical News: Thursday, May 19, 2022
DCMedical News is published every day both the House and the Senate are scheduled to be in session. Publication will resume June 7.
THE BIG STORY Thursday, May 19, 2022
Congress in recess, both the House and Senate return June 7.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Telehealth, Beyond Pandemic Proclamations
Becker's (here) reports that "The governor of Mississippi recently signed into law a bill [here] that requires insurers to cover telehealth services on par with in-person care."
Analysis of Post-COVID-19 Hospitalizations
Fair Health has published a "white paper" (here) on "Patients Diagnosed with Post-COVID Conditions, An Analysis of Private Healthcare Claims Using the Official ICD-10 Diagnostic Code," finding, among other conclusions, that "The majority (75.8 percent) of patients diagnosed with a post-COVID condition had never been hospitalized for COVID-19 . . . The study was among the first to use the official ICD-10 diagnostic code (U09.9) for post-COVID conditions that became effective October 1, 2021 . . . Analyzing private claims data from 78,252 patients diagnosed with the U09.9 code from October 1, 2021, to January 31, 2022."
CPC+ and –
Mathematica (here) reports on the fourth of five years' evaluation of Comprehensive Primary Care Plus (CPC+), "a national multipayer primary care improvement model developed by the Centers for Medicare & Medicaid Services (CMS)," and "the largest and most ambitious primary care and delivery reform ever tested in the United States. CMS launched CPC+ in 2017 and it ran through December 2021, supporting 3,070 primary care practices’ efforts to improve the care they provide to over 17 million patients."
"The latest results from Mathematica’s evaluation of Comprehensive Primary Care Plus (CPC+) show reductions in emergency department (ED) visits, acute hospitalizations, and acute hospitalization expenditures and improvement in some quality-of-care measures, though overall savings to Medicare were offset by increases in expenditures on other services."
Vertical Integration (Physician Practice Acquisition by Hospitals and Health Systems) Leads to Physician Price Hikes
Harvard researchers publishing in Health Affairs (here) studied vertical integration in Massachusetts. They found "Vertical integration and joint contracting with small and medium health systems rose from 19.5 percent in 2013 to 32.8 percent in 2017 for primary care physicians and from 26.1 percent to 37.8 percent for specialists . . . vertical integration and joint contracting led to price increases from 2013 to 2017, from 2.1 percent to 12.0 percent for primary care physicians and from 0.7 percent to 6.0 percent for specialists, with the greatest increases seen in large health systems."
HOSPITALS AND OTHER HEALTH CARE FACILITIES
Insurers Ask Congress and the Administration to Put a Lid on Private Equity Acquisitions in Health Care
"The health insurance industry wants policymakers to require more transparency of private equity healthcare deals and increase oversight of health system consolidation, the trade group AHIP wrote in letters to President Joe Biden and congressional leaders Monday," according to Modern Healthcare (here).
"In too many segments of our healthcare system, competition has been stymied by powerful healthcare providers and drug manufacturers gaming the rules to their advantage and inadequate laws and enforcement to protect competitive markets," AHIP wrote. "Increasing transparency into private equity acquisitions and how they affect quality is a step toward improving the system."
Modern Healthcare had previously reported that "The value of private equity deals in healthcare nearly tripled between 2010 and 2019, reaching almost $120 billion. Private equity-backed hospitals charge higher prices than non-acquired hospitals and have lower staffing ratios."
Colorado Supreme Court Nixes Hospital Attempt to Use Its Chargemaster to Determine Patient Bills
From the Opinion (here) "In this case, the supreme court considers whether a hospital's chargemaster, a database that lists rates for specific medical services and supplies, was incorporated by reference into hospital services agreements that a patient had signed. The court now concludes that because the patient neither had knowledge of nor assented to the chargemaster . . . the chargemaster was not incorporated by reference into the hospital services agreements." For the patient at Century/CHI, "Centura advised her that she would personally be responsible for $1,336.90 of the amounts to be billed. After the surgery, however, Centura determined that it had misread French’s insurance card and that she was, in fact, an out-of-network patient. Centura then billed French $229,112.13 and ultimately sued her to collect."
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Medicaid Managed Care Physician Networks: Broad, But Not Deep
Researchers at Yale publishing in Health Affairs (here) note that "States have increasingly outsourced the provision of Medicaid services to private managed care plans . . . many states set network adequacy standards that require plans to contract with a minimum number of physicians. In this study we used data from the period 2015–17 for four states to assess the level of Medicaid participation among physicians listed in the provider network directories of each managed care plan. We found that about one-third of outpatient primary care and specialist physicians contracted with Medicaid managed care plans in our sample saw fewer than ten Medicaid beneficiaries in a year . . . 25 percent of primary care physicians provided 86 percent of the care, and 25 percent of specialists, on average, provided 75 percent of the care. Our findings suggest that current network adequacy standards might not reflect actual access."
Unwinding PHE-Related Medicaid Enrollment
CMS has sent a note (here) to stakeholders for a May 25 call (sign up information for Zoom briefing on linked invitation): "You are invited to . . . the first of a monthly partner education series on Medicaid and CHIP Continuous Enrollment Unwinding. Over the COVID-19 public health emergency, the federal government eased rules in order to prevent people with Medicaid and CHIP from losing their health coverage during the pandemic. However, at some point soon states will be required to restart Medicaid and CHIP eligibility reviews meaning that millions of people could lose their health coverage due to procedural reasons."
DRUGS & DEVICES
Federal Judge Says "No" to HHS Position on Coupons
STAT+ reports (here) that a D.C. federal judge has ruled (Opinion here) for summary judgment in favor of Pharma, and against HHS, in voiding a rule which "would have required drugmakers to pay higher rebates to Medicaid for providing financial assistance to patients." The question is whether copay coupons and discount cards should be included when calculating the so-called best price that drugmakers must offer the government to participate in the Medicaid program."
The importance of discounts and rebates in prescription drug pricing is noted in Drug Channels (here). The editor writes, "When rebates and discounts were factored in, brand-name drug prices declined—or grew slowly—in 2021. Consistent with our previous analyses, rebates and discounts reduced the selling prices of brand-name drugs to less than half of their list prices. What's more, average net drug prices have declined for the past five years."
READINGS & REFERENCES
Select Coronavirus Public Health Resources and References may be found here.
The JAMA Patient Page explains the current status of oral anti-viral medications for COVID-19, here.
2022 CQ Congressional Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
June 7, 8, 9, 10, 13, 14, 15, 16, 21, 22, 23, 24
July 12, 13, 14, 15, 18, 19, 20, 21, 26, 27, 28, 29
August, Congress adjourned, no editions of DCMN
Notes to Fred Hyde, MD, JD, MBA, news@dcmedicalnews.org