DCMedical News: Friday, December 2, 2022
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY Friday, December 2, 2022
House Leaders and Health Leaders, A Series
Democrats, the new Minority:
STAT reports that “House Democrats on Wednesday elected a new crop of party leaders --and none of them sit on a major health care committee. However, in a change from prior leadership, the top two leaders of the party support Medicare for All . . . He has also supported a public option, signing on to cosponsor a 2019 bill that would create one.”
“Massachusetts Rep. Katherine M. Clark will fill the No. 2 spot, filling longtime Majority Leader Steny H. Hoyer's shoes. She is also a member of the Congressional Progressive Caucus who has consistently signed on to Medicare for All legislation.”
California Rep. Pete Aguilar, outgoing caucus vice chair, was elected by unanimous consent to succeed Jeffries as caucus chair, which will move him up in leadership rankings to the No. 3 position . . . He also signed on to the 2019 legislation to create a public option.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
For the Mental Health of Patients, as Well as Physicians, and Their Office Staffs
The Senate Finance Committee published its discussion draft bill on mental health parity (here), in which one of the first assignments is “Requiring MA plans to maintain accurate and updated provider directories.”
A chart detailing provisions in the remainder of the bill (coverage for mental health services through telehealth; mobile apps for behavioral health; special provisions for youth mental health; mental health workforce enhancement; mental health care parity, integration and integrity) is here.
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
32BJ on Hospital Prices
The union of service workers, 32BJ, manages a joint employer-union benefit fund for 200,000 members in 11 states and Washington, D.C., and has had enough with high hospital prices. A union report (here) compares hospital prices using its own claims data, finding that, for example, an average colonoscopy will cost it $2,185 at the public NYC Health + Hospitals Corporation, $2,962 at Mass General in Boston, but an astonishing $10,368 at New York Presbyterian.
The report notes more generally that “Hospital prices represent the most significant driver of healthcare costs, accounting for one of every three dollars spent on healthcare in the U.S. and representing a majority of the costs of the 32BJ Health Fund; Private hospital systems in New York City charge the Fund on average more than 300 percent of what they charge Medicare for the same services; By driving up healthcare costs unnecessarily, high hospital prices negatively impact working people’s access to affordable care; [and] High hospital prices drive down the wages of working people. For example, SEIU 32BJ estimates that, if healthcare costs had increased at the rate of inflation from 2014 to 2023, an additional $5,000 in annual wages would have been available for union members.”
On health policy, the report says, “Evidence does not support many reasons given by hospitals for higher prices, like the need to subsidize public or charity care, provision of higher quality care, or impact of COVID-19 to hospital financials – nor does consolidation drive down prices for consumers.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
The Source Tells You How
The Source (on Healthcare Price & Competition) has published a guide for state legislatures and policy makers to health care price control efforts, including an interactive guide (here) and a review (“Options for states to constrain pricing power of health care providers,” here).
DRUGS & DEVICES
Alternative Dispute Resolution for the 340(B) Program
Proposed regulations have been published (here) for a new “alternative dispute resolution” for resolving contests in the pricing, availability and use of funds stemming from the 340B program. The 1992 statute creating the program, intended to provide off-federal-health-budget funds (from pharma) for the benefit of safety net hospitals (suffering low reimbursement from public health insurance programs), was amended in the Patient Protection and Affordable Care Act.
“Section 7102 of the Patient Protection and Affordable Care Act (Pub. L. 111–148) . . . added section 340B(d)(3) to the PHS Act, which requires the Secretary to promulgate regulations establishing and implementing a binding ADR process for certain disputes arising under the 340B Program. Under the 340B statute, the purpose of the ADR process is to resolve (1) claims by covered entities that they have been overcharged for covered outpatient drugs by manufacturers and (2) claims by manufacturers, after a manufacturer has conducted an audit as authorized by section 340B(a)(5)(C) of the PHS Act, that a covered entity has violated the prohibition on diversion or duplicate discounts.”
The proposal is sure to energize contesting parties in the 340B field, including the lobby 340B Health, pharmaceutical manufacturers and health care facilities benefitting from the price reductions 340B imposes on those manufacturers. Comments are due in 60 days.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
December 5, 6, 7, 8, 12, 13, 14, 15
January 3, 4, 5, 9, 10, 11, 12, 24, 25, 26, 27, 30, 31
February 1, 2, 6, 7, 8, 9, 27, 28
March 1, 7, 8, 9, 10, 22, 23, 24, 27, 28, 29, 30
Notes to Fred Hyde, MD, JD, MBA, news@dcmedicalnews.org