DCMedical News: Tuesday, November 19, 2019
DCMedical News-DCMN
Washington, D.C.
Tuesday, November 19, 2019
DCMedical News is published every day both the House and the Senate are in session. Subscription information below.
THE BIG STORY IN HEALTH CARE
“Medicare-for-All” in Incremental Pieces
Presidential candidate Elizabeth Warren has outlined how she would implement “Medicare-for-All” in pieces, as chronicled in The New York Times (here), the Wall Street Journal (here), and Reuters (here), among others. Employer-based insurance would remain, in a transition to Medicare, and dependent on Democratic control of the Senate (and enthusiasm amongst the Democrats for the legislation). And she has a 28-page plan (here). The first phase would lower the Medicare eligibility to 50, with the addition of “Medicare-for-all-who-want-it” (buy-in to a public program), and coverage for children in CHIP and Medicaid-eligible families. Recent commentary from Prof. J.B. Silvers (here) in the Times.
Budget Cliff or Bump
The Hill reports that “Congress is likely to have to pass two more spending bills this year.” Spending authority runs out this Thursday, November 21. Congress adjourns Thursday, although Senate sessions are scheduled for Friday and again on December 2. Both Houses are back December 3, then adjourning for the year December 12.
The spending bill—a likely “Continuing Resolution”—is seen as a possible vehicle to also carry surprise and balance billing proposals, as well as authorization renewal or extensions for §330 Community Health Centers, the National Health Service Corps and miscellaneous smaller Medicare program extensions.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
ISCHEMIA Follows on COURAGE
The International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA, press report here, clinical trial page here: https://clinicaltrials.gov/ct2/show/NCT01471522) finds stenting and coronary artery bypass no more effective in avoiding mortality than medical management in patients with stable angina. Twelve years ago the COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation) study (here) reached similar conclusions, noting that “In 2004, more than 1 million coronary stent procedures were performed in the United States, and recent registry data indicate that approximately 85% of all PCI procedures are undertaken electively in patients with stable coronary artery disease.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
The Burdens on Nursing
AMN Healthcare reports on a survey of 20,000 nurses, here, with bibliography.
Emergency Departments Doing the Job
A study by Harvard’s Jha and colleagues in JAMA Internal Medicine (here) finds that “In a cross-sectional study of more than 15 million emergency department visits from 2009 to 2016 among Medicare beneficiaries, there was a significant decline in mortality rates during or after an emergency department visit. This decline was greatest for patients with a high severity of illness compared with those with a medium severity or low severity of illness.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Blue Cross Association Develops a National Network
Modern Healthcare (here) calls the “high-performance network” the first new program to serve a nationwide marketplace in 25 years (the “BlueCard”). The plan involves 36 independent Blue companies. “The Blue high-performance network, or HPN, will launch January 2021 in 55 markets reaching more than 185 million people nationwide. It was designed for large national and regional employers” who “wanted more consistent quality measurements and prices across the markets in which they operate.” A survey from benefits firm Willis Towers Watson notes that two-thirds of large employers plan to include such a network in their plans next year.
Out-of-Pocket Spending by Medicare Beneficiaries Soars
A Kaiser Family Foundation study (here) finds the average to be $5,460, $2,294 on premiums, $3,166 on services. Data sliced finely (age, area, education, income, etc.).
READINGS AND REFERENCES
The National Health Runs Short on Drugs
England’s National Health is running short of dozens of drugs according to a report from the NHS, and coverage in The Guardian (here) and the Mirror (here). An internal document seen by The Guardian reports on 17 new shortages (cancer, Parkinson’s, mental health, ophthalmic conditions), in addition to 69 existing shortage drugs (antibiotics, cancer, heart condition, hepatitis, epilepsy). The Guardian notes that physicians interviewed say the breadth of the conditions identified for which pharmaceutical shortages have appeared is “unprecedented.” All of this takes place in the context of an election in which “The Conservatives want to be the party of the NHS. Will voters swallow it?” from The Economist (here). The chief executive of the King’s Fund, a think tank, notes that “Underlying the poor performance is a basic imbalance between demand for services and staffing levels.” Pension rules have deferred some clinicians from taking on extra work, the Brexit vote cuts off a source of physicians and nurses, notwithstanding the promise of an “NHS visa.” A former Labour advisor observes, “There is no way to spin old people dying on trolleys in waiting rooms.”
Transparency
State spending of supplemental funds for Medicaid programs, proposed rule as published in the Federal Register November 18, here.
U.S. House of Representatives:
Members at https://www.house.gov/representatives
Committees and Members at https://www.house.gov/committees
U. S. Senate:
Members at https://www.senate.gov/general/contact_information/senators_cfm.
Committees and Members at https://www.senate.gov/committees
House and Senate 2019 Calendar of Regularly Scheduled Sessions, here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
November publication dates: 20, 21
December 3, 4, 5, 6, 9, 10, 11, 12
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.