DCMedical News: Wednesday, March 14, 2018
DCMedical News
Washington, D.C.
Wednesday, March 14, 2018
Past issues of DCMN (and linked source documents) can be accessed by clicking on “View this email in your browser.”
THE BIG STORY TODAY IN HEALTH CARE
Budget deliberations and negotiations concerning policy “add-ons” continue, with seven Congressional work days left before expiration of the current Continuing Resolution for funding the federal government on March 23. Three examples of potential policy “add-ons”: (1) C-SRs, (2) larger donut holes, (3) short-term health insurance plans.
(1) C-SR and Reinsurance restoration: conservative groups advocate against “insurance company bail-outs,” while proponents support stabilization of insurance markets. One conundrum: will it help (expand enrollment, reduce premiums) or hurt (contract enrollment, increase premiums) to restore Cost-Sharing Reduction (C-SR) payment reimbursement? (See DCMN of 3-12-2018 for Center on Budget and Policy Priorities’ report, con). Newly on the pro side: benefits consultant Oliver Wyman reporting that 3.2 million more people would be covered, at premiums lowered by 40%. But there is no report, per se, only a “proposal” on the Oliver Wyman website (here), which assumes states will supplement and leverage the $10 billion in the proposed stabilization bills.
(2) Donut holes: the Omnibus may back up: pharma lobbying to scale back a provision in the last Continuing Resolution (the Bipartisan Budget Act of 2018, P.L. 115-123) which increased required discounts from pharmaceutical manufacturers to fill the Medicare beneficiary donut hole.
(3) STLDIs: HHS Secretary Azar appears to favor statutory change to accommodate the short-term plans, and here comes Senator John Barrasso of Wyoming introducing the “Improving Choices in Health Care Coverage Act” to allow maximum coverage of 364 days, and to make such plans “guaranteed renewable” at the option of the applicant.
Secretary Azar testifies tomorrow on the HHS Department budget (10:00 a.m., see “Events” below).
HOSPITALS AND HEALTH CARE FACILITIES
Hospital pricing specialist Rick Louis reports (here, in Excel, claims data shown by hospital) that Florida, Nevada, and California have the highest hospital prices for a brain MRI without contrast, with average prices between $4,150 and $4,485, while Maine, Hawaii, Idaho, Montana and Massachusetts have the lowest prices, with average Brain MRI prices below $2,000.
HEALTH INSURANCE, MEDICARE, MEDICAID, COMMERCIAL
Idaho blinks: Insurance Commissioner says preexisting conditions and EHBs will be covered in Idaho’s state-based insurance plans, reported in InsideHealthPolicy, also noting that the state has no interest in short-term plans given their split risk pools.
Healthsprocket reports on an MCOL e-poll, “Which healthcare sectors will be better off a year from now?” (place your bets before reading): #1 Health Plans, 51%; #2 Pharmaceuticals, 49%; Employers, 46%; Consumers, 18%; Physicians, 14%; Hospitals, 4.5%.
PHARMA
More voices (no apparent actions) to lower prices: the President’s Cancer Panel (three members, all Obama appointees, panel created in the “war on cancer,” 1971) issued a report noting that “urgent action is needed” to curtail the dramatic rise in the price of cancer drugs, and to have those prices reflect value to the patient (WSJ coverage here, full report here).
An original paper in JAMA: A study (here) of 3 million deaths due to substance abuse and “intentional injuries” in the U.S. in the 35 years since 1980. Findings: rates vary widely among counties, mortality has decreased for alcohol use, self-harm and interpersonal violence, all at the national level, but not so for two-thirds of the counties for alcohol and three-quarters of the counties for self-harm. Mortality rates from drug use disorders increased nationally and in every county between 1980 and 2014, but the relative increase was from 8% to more than 8300%.
More Report$: 340B hospitals spent 50% more on unpaid care, according to a report by L&M Policy Research (here), which “proves that safety net hospitals that benefit from the program are appropriately targeting low income patients.” (The worst case--see DCMN of 2-5-2018--is that the program is working to the advantage of non-safety net hospitals; that those hospitals receive significant financial benefit from the enforced low 340B drug prices; and the mark-up proceeds becomes hospital profit when 340B-eligible hospitals acquire oncologists, ophthalmologists and other physician practices with high use of high-cost drugs.)
More reaction to “star shifting” by Medicare Advantage plans, here, from Louisville, re Humana.
Do you know ICER (Institute for Clinical and Economic Review)? It may be the only (relatively) commercial-free drug policy analyst the U.S. has. See Health Affairs blog, “America’s NICE?” here.
“Right to Try” fails in the House, 259-140 (see DCMN 3-13-2018).
TECHNOLOGY
UCHealth (Colorado) partners with Uber to get the patient to the doctor/hospital on time (here).
OTHER READINGS
Everything you need to know about U.S. health care spending is found here, NYT report here. Ashish Jha and colleagues in JAMA note that “there is little evidence that efforts to reform US health care delivery have had a meaningful influence on controlling health care spending and costs.”
Their study emphasizes that, in comparison to ten other OECD high income countries, the U.S. had the highest (17.8% in 2016, next highest was 12.4% in Switzerland) percentage of GDP spent on health care; lowest proportion of the population with health insurance, but the highest proportion with private health insurance; highest percentage of overweight adults; lowest life expectancy of the 11 countries; highest infant mortality. Some measures which were not different: physician workforce and percentage of primary care physicians, nursing workforce, hospital beds, utilization of hospitals. Much higher were administrative costs, that is, for “activities related to planning, regulating, and managing health systems and services,” pharmaceutical costs (from double to triple the other countries), and salaries of physicians.
Commentary in JAMA on causes behind these findings will be found here, here, here and here.
EVENTS & MEETINGS
Your March Calendar:
March 14
2:00 p.m., Open Payments “National Provider Call.” Provider (physician and teaching hospitals especially) chances to review the “sunshine law payment” methodology, to be followed (April 1-May 15) by the dispute period. Publication of payments for 2017 takes place in June.
Info at openpayments@cms.hhs.gov or call 1-855-326-8366
March 15
10:00 a.m., Senate Health, Education, Labor and Pensions Committee (HELP), hearing on the
340B drug discount program, 430 Dirksen S.O.B.
March 16
11:00 a.m., AHRQ, National Advisory Council for Healthcare Research and Quality, by WebEx, information at https://www.ahrq.gov/news/events/nac/.
March 26
PTAC, Physician-Focused Payment Model Technical Advisory Committee, continuing March 27, information at www.regonline.com/PTACMeetingsRegistration or livestream at www.hhs.gov/live.
FOR REFERENCE
Members of the Senate (here) and Members of Senate Committees (here), Senate Calendar (here).
Members of the House with their House Committees (here), House Calendar (here).
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
DCMedical News is published every day that either the House of Representatives or the Senate is in session.
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March publication dates remaining: 15, 16, 19, 20, 21, 22, 23.
April publication dates: 9, 10, 11, 12, 13, 16, 17, 18, 19, 20, 23, 24, 25, 26, 27.
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com