DCMedical News: Friday, September 30, 2022
DCMedical News is published every day both the House and the Senate are scheduled to be in session. Publication will resume with the edition of October 11, 2022.
THE BIG STORY Friday, September 30, 2022
Government Likely to Remain in Business
The Continuing Resolution to keep government functioning until December 16 passed the Senate and is scheduled for action in the House today.
Gearing Up For Cost Battles in the Next Congress
The Congressional Budget Office (CBO) published (here) a 50-page summary of policy proposals for consideration in the next Congress. The subject: ways commercial health insurers can pay less for hospital and physician services.
The problem, as stated by CBO: “The prices that commercial health insurers in the United States pay for hospitals’ and physicians’ services are much higher, on average, and have been rising more quickly than the prices paid by public health insurance programs. Those rising prices—rather than growth in the per-person use of health care services—are an important driver of recent increases in premiums for commercial health plans. Higher premiums in turn increase the amount that individuals and employers pay for health insurance coverage and increase total federal subsidies for commercial health insurance. In this report, the Congressional Budget Office describes policy approaches available to the Congress that would reduce the prices that commercial insurers pay providers and thereby reduce premiums for that coverage.”
The diagnosis, per CBO: “The prices that providers negotiate with commercial insurers are high because of several factors, including hospitals’ and physicians’ market power and consumers’ and employers’ lack of sensitivity to those prices.”
Some solutions, suggested by CBO: “Promoting competition among providers, which would aim to reduce prices by targeting providers’ market power; Promoting price transparency, which would aim to reduce prices by targeting consumers’ and employers’ price sensitivity; and Capping the level or growth rate of prices, which would aim to reduce prices by regulating them.”
The recommendation, from CBO: Capping prices through federal legislation would be more effective than promoting competition or promoting price transparency: “In CBO’s assessment, price-cap policies could have the largest effects on prices.”
Gearing Up for Drug Price Controls
InsideCMS reports that “President Joe Biden on Tuesday (Sept. 27) touted the Medicare drug pricing reforms in the Inflation Reduction Act and the newly announced drop in Part B premiums while hitting back at Republicans for not supporting the IRA — coming a week after House Republicans pegged strengthening Medicare as a midterm election talking point. The back and forth portends a tug of war between the parties to win over public opinion as the party best suited to strengthen Medicare.”
STAT+ reports (here) that CMS has developed a work plan (letter from Secretary Becerra here) and organization chart with six divisions and 95 new FTEs (here) to implement the drug price control portions of the IRA. From the STAT+ report, “Congress passed a law in August that gives Medicare new authorities, as well as new funding to carry it out — $3 billion to start. Health and Human Services Secretary Xavier Becerra called the powers ‘novel,’ and told lawmakers that they don’t fit into any current Medicare office.” Also, “The first part of the law to kick in will be penalties for drugmakers that raise prices faster than inflation, and the measurement period starts on Saturday.” The first penalties would not begin until 2026, however.
Gearing Up for New Players
The newest member of the Federal Trade Commission (here) announced that his special concern will be pharmacy benefit managers. The FTC began an investigation in June into the practices of CVS Caremark, Express Scripts, OptumRx, Humana, Prime Therapeutics and MedImpact Healthcare Systems. The new FTC Commissioner, Alvaro Bedoya, said “The lodestar of antitrust [today] is not fairness, but efficiency . . . How did this happen? ... I think it is time to return to fairness."
HOSPITALS, NURSING HOMES AND OTHER HEALTH FACILITIES
Cardiology Procedures the Next Big Thing for Ambulatory Surgery Centers
Becker’s ASC (here and here) puts the spotlight on the growth of cardiac procedures in ASCs, at the expense of hospital in-and outpatient surgical volume. “ASCs have seen a massive opportunity for growth in cardiology in the last few years, as payers and CMS see financial gain in performing these procedures in the ASC setting.”
Cardiac procedures will join orthopedic and spine in this transition from hospital to free-standing ASC, according to reports gathered by Becker’s. “Cardiology procedures received the highest estimated Medicare payment increases in 2021, making it the fastest growing ASC specialty . . . Additionally, a 2020 Bain & Co. report projected that by the mid-2020s, 33 percent of cardiology procedures will be performed in ASCs, a 23 percent increase from 2018. ASC leaders are seeing this play out on the policy side, with CMS adding cardiac procedures to the ASC-covered list.”
In the recent past CMS added diagnostic and interventional coronary procedures, peripheral vascular interventions, and placement of pacemakers and defibrillators to the ASC covered list. Some price comparisons (here) show significant “savings” for the Medicare program if these procedures are done in an ASC, and not in a hospital outpatient department, if the ASCs are able to manage the complexity of that cardiac care.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
October 11, 12, 13, 14, 17, 18, 19, 20, 21
November 14, 15, 16, 17, 18, 29, 30
December 1, 2, 5, 6, 7, 8, 12, 13, 14, 15
Notes to Fred Hyde, MD, JD, MBA, news@dcmedicalnews.org