DCMedical News: Wednesday, November 16, 2022
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY Wednesday, November 16, 2022
The FTC and Fairness
The Federal Trade Commission announced Nov. 10 (Wall Street Journal report here) that it will expand its interpretation of existing statutory powers that could allow the agency to take action against anticompetitive corporate behavior, and especially “unfair methods” of competition (see FTC policy statement on section 5 of the Federal Trade Commission Act, here).
“The FTC's use of the law would make it easier to challenge conduct that, under other federal laws, might not be illegal on its face.” The FTC's statement explaining the change says it wouldn’t need to show that conduct harmed other market participants or consumers, but that it "has a tendency to generate negative consequences."
Senate Finance Committee Staff Study . . .
. . . on deceptive marketing practices of Medicare Advantage plans, here.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Small Payments to Ophthalmologists and Optometrists, Large Consequences
A study in JAMA Ophthalmology (here) examines the impact of industry payments to optometrists and ophthalmologists, the latter group found in other studies to prescribe the highest volume of branded medications among all specialties. This study of 26,000 optometrists and ophthalmologists prescribing prostaglandin analogs found “37% received a collective total of more than $5 million from the 3 companies that manufacture those drugs. The median payment to these individuals was $65, seemingly quite a small amount. Those prescribers had a predicted probability of primarily ordering branded PGAs of 19.6% compared with 12.9% for prescribers who did not receive payments from the same companies. This 50% higher probability of prescribing branded PGAs for those prescribers receiving payments is a noteworthy association that suggests that industry payments are effective for industry.”
The authors point out that “other research has not shown an increase in clinical effectiveness or reduction in adverse effects with the newer branded PGAs compared with the generic,” and that “data suggests that patients who are prescribed the lower-cost generic PGA tend to have better medication compliance and therefore potentially better long-term clinical outcomes.”
“The findings of this study confirm that current industry practices in developing financial relationships with prescribers represent sound business decisions that are associated with the intended outcomes for industry of influencing prescribing behavior . . . Studies have shown that physicians routinely underestimate their vulnerability to being influenced and continue to be unaware of the ways that these influences then change their practice behaviors.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Non-MD Hospital CEOs: Your Job Is Safe
A study in JAMA Network Open (here) examines this question: “Is having a physician serve as chief executive officer (CEO) associated with hospital quality assessment, indicated by Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) ratings and Leapfrog Hospital Safety Grades?” The study provides this answer: “This study found a correlation between physician leadership and a patient’s willingness to recommend the hospital; however, no significant association between CEO background and any quality measures were identified.”
Pandemic Era Changes in Emergency Department Visits and Hospital Admissions From the ED
A study from AHRQ’s Healthcare Cost and Utilization Project (here) examines changes in ED utilization April-December of 2020. “In the United States in 2019, there were approximately 143 million emergency department (ED) visits, and about 14 percent of these ED visits resulted in hospitalization. At the start of the COVID-19 pandemic, ED utilization overall declined substantially, with a 42 percent decrease in ED visits in April 2020 compared with April 2019. Studies suggest patients may be avoiding care in the ED, including patients with serious conditions, or seeking other types of urgent care (e.g., telehealth) . . . Overall, the number of emergency department (ED) visits across 29 States was lower each month in April–December 2020 compared with the same month in 2019 (e.g., April: 3.8M vs. 7.0M), whereas the ED admission rate was higher (e.g., April: 18.1 vs. 13.4 percent).”
Monopoly Pricing Across Markets, Not Only Within
A study in Health Affairs (here) notes that “Although hospital consolidation within markets has been well documented, consolidation across markets has not, even though economic theory predicts—and evidence is emerging—that cross-market hospital systems raise prices by exerting market power across markets when negotiating with common customers (primarily insurers).”
Background, from the study: “The share of community hospitals in the US that were part of hospital systems increased from 10 percent in 1970 to 67 percent in 2019, resulting in 3,436 hospitals within 368 systems in 2019. Of these systems, 216 (59 percent) owned hospitals in multiple commuting zones . . . the number of systems in urban commuting zones that could potentially exert enhanced cross-market power increased from thirty-seven systems in 2009 to fifty-seven systems in 2019, an increase of 54 percent.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
MedPAC Wrestles (Again) With “Alignment” of Payment Rates
At its meeting November 3 the Medicare Payment Advisory Commission revisited the “alignment” of Medicare fee-for-service payment rates across three ambulatory settings, physician offices, hospital outpatient departments and ambulatory surgical centers. A staff presentation (here) notes that hospital outpatient rates are higher than the physician fee schedule and the ASC payment rate, which has resulted in “higher-cost providers acquiring lower-cost providers,” and that, specifically, “Hospitals can acquire physician practices and bill at higher OPPS rates [Outpatient Prospective Payment System, the hospital outpatient department rate] with little or no change in the site of care.”
The presentation noted that the years-long acquisition of lower cost physician and other outpatient services by hospitals means that “Billing of services for office visit, echocardiography, cardiac imaging and chemotherapy administration has shifted” from the physician to the hospital rates, with higher payments required from both the Medicare program and the patient. Chemotherapy administration ambulatory market share for hospitals which was 35% in 2012 had increased to 52% by 2021; cardiac imaging increased from 34% to 48%, echocardiography from 32% to 43%.
In preparing recommendations (in April) for the 118th Congress, the staff presentation urged aligning payment rates across all ambulatory settings, to “address the principle that Medicare and beneficiaries should not pay more than necessary for ambulatory services,” and to “reduce incentives for providers to consolidate.”
Kaiser Publishes Annual Benefit Review
The Kaiser Family Foundation has published (here) its annual review of employer-sponsored health insurance, the result of nearly 2200 employer interviews and surveys. “Annual premiums for employer-sponsored family health coverage reached $22,463 this year, 1% higher but statistically similar to last year ($22,221). On average workers contributed $6,106 toward the cost of family coverage. The average deductible among covered workers in a plan with a general annual deductible is $1,763 for single coverage. Fifty percent of small firms and 99% of large firms offer health benefits to at least some of their workers, with an overall offer rate of 51%.”
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
November 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