DCMedical News: Thursday, November 17, 2022
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY Thursday, November 17, 2022
House of Representatives to Have Republican Majority, Health Focus on Oversight, Limits on Drug Price Negotiations
InsideHealthPolicy (here) reports that “House Republicans . . . are laying plans to step up oversight of Democrats’ policies on Medicare, Medicaid, the COVID-19 public health emergency and the Affordable Care Act, in lieu of pushing a major health care legislative agenda that could be blocked by presidential vetoes, lobbyists say, with the possible exceptions being Medicare pay system and telehealth reforms that could draw bipartisan support.”
“While the GOP won’t be able to get much, if any, of its legislative agenda enacted, they will be able to hold hearings on a myriad of topics. The hearings generally serve two functions. (1) They shine a spotlight on issues the GOP wants to highlight/tee-up for the 2024 elections, and (2) they take time and energy away from the Executive Branch and look to slow down work on the Biden Administration’s priorities the GOP opposes,” a Cowen Washington Research Group policy note says. One target: Medicare’s new authority for negotiation of drug prices. Reports IHP, “If they win the House, Republicans in line to chair health care committees have made it clear they will hound CMS’ implementation of drug price controls and try to hurt the popularity of Democrats’ new drug pricing law.”
The IHP report continues, “Republicans have said they want agency heads to testify, they’ve already requested a lot of information about the agency’s plans to negotiate drug prices and they’re promoting research that predicts big declines in drug inventions. House Republicans on both the Energy & Commerce and Ways & Means committees have previewed oversight plans for Medicare price negotiation. They recently asked HHS to provide monthly reports on what CMS is doing to put Medicare drug price negotiation in place, and they posed 18 questions on how HHS will address ambiguities in the law. The inquiry also lays the foundation for industry lobbying. The drug industry might try to get CMS to create price floors . . . and the House Republicans’ letter asks CMS to commit to minimum prices during negotiations, given that government negotiation is based on setting maximum prices.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Is There a Doctor in the Legislature?
A research letter in JAMA (here) spotlights doctors who are members of Congress or of state legislatures. “In the last 10 US Congresses, only between 2 and 23 (of 535) legislators have been physicians.” Currently, There were 17 federal physician-legislators (3.1%, 17/541) and 86 state physician-legislators (1.1%, 86/7552), as of July 7, 2022.
The federal physician-legislators (vs. nonphysician federal legislators) were more likely to be white, older, male and Republican. The 17 physician members of Congress (and their medical specialties) are listed here.
Focus on Private Equity in Health Care
The Kaiser Family Foundation publishes a variety of articles on private equity investment in health care, including “Patients for Profit, How Private Equity Hijacked Health Care” (here); “Private Equity’s Stealth Takeover of Health Care in the United States,” (here); “Sick Profit: Investigating Private Equity’s Stealthy Takeover of Health Care Across Cities and Specialties,” (here). PitchBook (here) launches a new quarterly report on PE in health care.
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Neighborhood Economic Status, Not Hospital Quality, Drives Hospital Heart Failure Readmission Rates
New poster studies (report here) at the early November scientific sessions of the American Heart Association cast further doubt on the utility and equity of Medicare’s Hospital Readmission Reduction Program (HRRP), in the case of heart failure (HF) patients.
“The researchers of this poster concluded that adjusted all-cause 30-day readmission rates were affected by neighborhood household income in patients hospitalized for HF in the United States from 2010 to 2019 . . . A second poster evaluated whether neighborhood socioeconomic status (NSES) was able to predict higher rates of HF readmission in a safety-net system . . . Unadjusted analyses found that NSES was associated with HF readmission and all-cause readmission in 30 days and at 1 year. Quintile 1 had a 58% higher risk of HF readmission and 56% higher risk of all-cause readmission in 1 year when compared with quintile 5 after adjusting for demographics, substance use and comorbidities . . . The researchers concluded that NSES was associated with a higher risk of HF and all-cause readmissions in 1 year in a safety-net hospital. Both posters establish evidence that neighborhood socioeconomic status and household income determine health outcomes for patients with a diagnosis of HF.”
A report on the AHA session noted “For years, HF specialists have cried foul over the HRRP, saying it works against safety net hospitals that treat poor patients who arrive with accumulated comorbidities and higher smoking rates, which are more likely to account for higher readmission rates than poor care. . . .Yet penalties can cost institutions up to 3% of Medicare payments a year, despite criticism that hospitals caring for the poor need more resources, not less. Just this week, Medicare fined 2300 institutions. Research in JAMA and elsewhere has found that HRRP creates incentives for hospitals to deny readmission to patients for fear of being penalized, leading to higher HF mortality for some groups.”
U.S. News and World Report Hospital Rankings Derided in JAMA Opinion
“In addition to the spectacle of prestigious academic institutions trolling for votes, there are other concerns with using specialty voting to dominate the assessment of process.” One concern: “Employed physicians and/or physician alumni of residency or fellowship programs have an obvious conflict of interest to vote for their own hospitals and to avoid voting for competitor hospitals in the same region, which undoubtedly skews results. Health care systems unabashedly ask board-certified physicians to vote for their own hospital.”
UK Hospitals and The National Health Sink Deeper
An opinion in The Financial Times (here) contends “Britons now have the worst access to healthcare in Europe.” A report in the same paper (here) says, “NHS England under ‘huge strain’ as waiting times hit record high,” and “Worst delays ever for A&E units, hospital care and cancer treatments, data show.” The Daily Mirror (here) raises the question of guile or incompetence, in a story headlined “Union boss accuses Tories of deliberately 'running down' NHS so someone can take it over.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
MedPAC Considers Additional Medicare Support for Safety Net Hospitals
At its November 3-4 meeting the Medicare Payment Advisory Commission began consideration of whether additional Medicare payments should be targeted to bolster reimbursement to safety net hospitals. A staff presentation (here) noted that the study was a response to a 2020 House Ways and Means Committee request for suggestions to improve access to health care for vulnerable beneficiaries. The safety net definition for this purpose would be “hospitals with high shares of low-incomed Medicare beneficiaries and/or high shares of uninsured and patients with public insurance (including Medicare).”
Existing DSH (Disproportionate Share Hospital) distribution is $3.1 billion in DSH payments (2019), about 6% of Medicare hospital payments; an additional $8.3 billion in uncompensated care payments went to DSH hospitals that year. The report noted these concerns about the allocation of such funds: “Medicare indirectly subsidizes Medicaid, DSH shares are negatively correlated with Medicare shares, meaning high Medicare share hospitals tend to get lower DSH payments; DSH payment are inpatient-only; [and] Current uncompensated care payments are distorted providing higher payments to hospitals with high Medicare Advantage shares.” A “safety-net index” is proposed in the staff report, with explanation of how it might remediate these concerns.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
November 18, 29, 30
December 1, 2, 5, 6, 7, 8, 12, 13, 14, 15
Notes to Fred Hyde, MD, JD, MBA, news@dcmedicalnews.org