DCMedical News: Wednesday, March 21, 2018
DCMedical News
Washington, D.C.
Wednesday, March 21, 2018
THE BIG STORY TODAY IN HEALTH CARE
There are two Congressional working days remaining before expiration of the Continuing Resolution on March 23. Health insurance and health policy (most recently the “Alexander-Collins-Walden” (ACW) bill, see DCMN of 3-20) have been thrown off the Omnibus, at least in the House. There will apparently be a vote on the ACW bill in the Senate, and resolution which may spill over into this coming weekend. “Policy feuds” (see WSJ, here, especially limitations on the use of funds for abortion) keep the timing and contents of the “Omnibus” budget in flux.
The Alexander-Collins-Walden proposal (here) and accompany CBO report and CBO cost estimate (here and here) were presented to the House leadership, which turned thumbs down, and to the Senate leadership, which decided to allow debate. The Center for Budget and Policy Priorities (report here) reiterated its view that reinstating Cost-Sharing Reduction payments (as proposed in “ACW” and in previous bills sponsored by Senator Alexander) would raise costs for moderate-income consumers and decrease coverage.
DOCTORS, NURSES, HEALTH PROFESSIONALS
The recent Avalere report (here) on physician practice featured the (to some startling) observation that the number of physicians whose practices were acquired by hospitals increased by 14,000 from July 2015-July 2016. The report had other insights and interesting numbers, as well, including these:
From July 2014-July 2016 more than 40,000 physicians became hospital-employed;
Between July 2012 and July 2016 the number of physician practices owned by hospitals doubled, from 36,000 to 72,000, 29% of physician practices;
More than half of all physicians in the Midwest are employed by hospitals;
Physicians employed by hospitals or health systems perform more services in the hospital outpatient setting than do independent physicians, with increased cost to Medicare and increased out-of-pocket cost to patients;
For example, risk-adjusted payment differences for a cardiac imaging episode of care averaged $2,862 in a physician’s office, $5,148 in a hospital outpatient department.
HOSPITALS AND HEALTH CARE FACILITIES
The Ambulatory Surgery Center Association reports that the “Oregon Assembly unanimously passed legislation that creates a license for extended stay recovery centers. Patients in these extended stay centers can have 48 hours to recover from the time of admission at the ASC, as compared to the 24-hour limitation for ASC.” Recovery time (multiple shifts of staff) and the absence of intensive cardio-pulmonary support (ICUs), laboratories and blood banks are the main limitations on ASCs taking all surgery out of the hospital.
SEIU buys $882,000 worth of radio ads (here) to criticize high infection rates at Stanford University Medical Center. Stanford demurs, citing favorable “standardized” metrics, “benchmarks” and Hospital Compare “star” ratings in response.
HEALTH INSURANCE, MEDICARE, MEDICAID
The New York State Health Foundation released a report (here) on employer-sponsored health insurance. Coverage in the Empire State is the third most expensive in the nation, $19,375 per year for a family of four (higher in Alaska and Wyoming, national average $17,710), having grown more than twice as fast as median household income 2008-2016. The average family deductible doubled from $1,524 in 2008 to $3,099 in 2016 (47% had a deductible in New York 2008, 72% in 2016).
Report (here) from the American College of Cardiology meetings: 30-day hospital-level risk adjusted mortality rate is better than readmissions rate for measurement of hospital care of heart failure patients.
PHARMA
Researchers in the British Medical Journal report (here) on off-patent drugs which might have only one manufacturer in the U.S. The article asks whether there are other manufacturers worldwide whose products should be imported to the U.S., to avoid price gouging. Their conclusion: “[M]ore than half the off-patent drugs with no generic competition in the USA had at least one independent manufacturer approved by a non-US peer regulatory agency; slightly fewer than half had four or more total manufacturers. Facilitating US patient access to such manufacturers could help sustain affordable access to essential off-patent drugs.”
UnitedHealth, owner of pharmacy benefit manager OptumRx, releases report (here) showing how pharmacy benefit management could save $100 billion for managed Medicaid.
Politico reports (here) on the high promise of non-profit systems developing their own generic drug manufacturer.
EVENTS & MEETINGS
Your March Calendar:
March 20
10:00 a.m., House Labor-HHS-Education Appropriations Subcommittee, fy 2019, 2358-C, Rayburn.
March 21
9:00 a.m., Energy and Commerce Health Subcommittee begins two days of hearings (bills here) on “Combating the Opioid Crisis: Prevention and Public Health Solutions,” 2123 Rayburn H.O.B., continuing March 22 at 10:00 a.m.
10:00 a.m., Improper Payments in State-Administered Programs: Medicaid, Subcommittee on Government Operations and Subcommittee on Intergovernmental Affairs, 2154 Rayburn.
2:00 p.m., House Ways and Means Health Subcommittee, hearing on the implementation of MACRA’s physician payment policies, 1100 Longworth H.O.B.
March 22
1:30 p.m., Competition and Consolidation, Webinar sponsored by Alliance for Health Policy, AHCJ, NIHCM, worth a listen (Tom Scully, Chapin White, flyer here).
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.
Past issues can be accessed by clicking on “View this email in your browser.” Subscription information is found at the bottom of these pages. Trial subscriptions may end without notice.
March publication dates remaining: 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