DCMedical News: Friday, January 10, 2020
DCMedical News-DCMN
Washington, D.C.
Friday, January 10, 2020
DCMedical News is published every day both the House and the Senate are in session.
THE BIG STORY IN HEALTH CARE
Guidelines vs. Expert Opinion: A Losing Battle?
Yale’s Harlan Krumholz, Editor-in-Chief of NEJM Journal Watch Cardiology, flagged as one of the top ten stories of 2019 that guideline recommendations in cardiology were still largely based on opinion, not on “evidence.” He noted that “In 2009, a review of clinical practice guidelines found that only 11% of recommendations had a level of evidence (LOE) of “A,” that is at least one large randomized trial, or multiple randomized trials. The 2019 article Krumholz referenced (Fanaroff, in JAMA, March 19th, here) studied whether reliance on high quality evidence for the development of guidelines had improved in the intervening years, pitting guidelines of the American College of Cardiology/American Heart Association (ACC/AHA) and the European Society of Cardiology (ESC) against expert opinion. The findings: In a study of ACC/AHA guidelines, 8.5% of recommendations were based on “grade A” ratings, and more than 41% on expert opinion only. Krumholz’s conclusion? “Over time, no meaningful change occurred in the proportion of recommendations” based on level of evidence graded “A.”
Value-Based Payment for Physician Practices: Which Table is the Concierge Offering?
Another potential controversy in private equity and venture investment in physician practices is highlighted in the Financial Times, here, in a discussion of the initial public offering for One Medical. “Recurring revenue from subscriptions of $199 per year for individuals (corporate clients get a negotiated rate) also sounds good. But revenue per member was about $500 for the first nine months of the year, meaning subscriptions account for less than half of the total. The rest comes from more opaque deals with health networks and insurers.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
“Hotspotting” Not a Solution to the Cost Inferno
A report on the Camden, New Jersey experiment that focused on intervention (“hotspotting”) with “super-utilizers” finds that it is, in general, ineffective. The report (in the New England Journal of Medicine, here, New York Times summary, here) notes that reductions in readmissions of super-users were no different from system-wide reductions, without the expensive and sophisticated intervention. The experiment may give pause to those investing in social determinants of health, at least insofar as those investments are intended to be paid for through savings in health care expenses.
Bankruptcies Up Among American Hospitals
Thirty hospitals filed for bankruptcy in 2019. The Polsinelli TrBK Health Care Services Distress Index which tracks health care and hospital bankruptcies (https://www.distressindex.com/reports/latest) had nearly quadrupled as of the end of the third quarter, using 2010 as its benchmark year.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
CSR Payday May Disappear for Insurers
Bloomberg reports that “A panel of judges on the U.S. Court of Appeals for the Federal Circuit seemed to signal during oral arguments Jan. 9 that insurers had already recouped their expenses through additional tax credits by raising premiums.” The insurers were seeking reimbursement for the Cost-Sharing Reduction (CSR) payments promised but not paid (but also not authorized by Congress as payments) to health insurers participating in the Exchanges under the Patient Protection and Affordable Care Act. The U.S. position is that the insurers, through “silver loading” and other premium increases, have already recovered these amounts. Docket here, U.S. position here, insurer position here.
State Ranking on Affordable Health Care—It’s All Relative
Altarum Healthcare issued a scorecard (here) rating states on their adoption of policies to improve affordability of healthcare. The report provides a guide to where states might focus regulatory and reform efforts. States were ranked in four policy areas (extending coverage, lowering out-of-pocket costs, reducing low-value care, curbing excess prices) and outcomes (percent of population uninsured, percent of population that is forgoing needed care, rates of known low-vale services delivered by providers, private payer prices relative to the national median).
Q3 Individual Health Insurance Market, Report from KFF
The Kaiser Family Foundation reported (here) on the third quarter of 2019 individual health insurance market. Highlights: Medical loss ratios for the individual health insurance market were 75%, average monthly premiums were $515 and claims were $384, average annualized hospital days per 1,000 enrollees were 278.
DRUGS AND DEVICES
A Pricing Dilemma “Overheard” on The Street:
The Wall Street Journal reported Thursday (here) that drug price inflation is slowing down, “better news for investors than it seems,” since lower price increases in an election year will “avoid attracting unwanted attention from Washington.” Notwithstanding the advice, Morgan Stanley found 2,167 price increases in the first week in January, a 17% increase from last year. But the Journal advises that “this time around, the industry has a much stronger case to avoid price control legislation,” on grounds that “spending on prescription drugs has grown much less quickly than hospital or physician services since 2016.”
READINGS AND REFERENCES
Authoritarian Recipe for Population Growth
The Financial Times reports (here) that “Viktor Orban has designated fertility clinics a ‘strategic’ sector for Hungary as part of his efforts to push a nativist agenda and increase the population by offering medically assisted pregnancy treatment for free . . .the Hungarian prime minister said in vitro fertilisation treatments, or IVF, would be available for all women starting next month. It follows the Hungarian government’s nationalisation last month of six private fertility clinics. ‘We bought all the firms that were operating on this market,’ Mr Orban said, adding that the sector was now deemed ‘of national strategic importance’ and become a quasi-state monopoly . . . He suggested private investors stay away from investing in the sector because ‘there will not be any permission’.”
JPMorgan Health Conference Convenes Next Week, Jan 13-15
Inheritor of Hambrecht and Quist, the conference is 20 years of deals, scandals and new memes, according to a report (here) from STAT+.
Commonwealth Fund Has New (and Useful) Summary of Drug Price Control Proposals in Congress
The study, here, notes that “Overall, the respective revisions of H.R. 3 [Cummings, Pelosi] and S. 2543 [Grassley] demonstrate each chamber’s attempt by leadership to appease its caucus, rather than reach a bicameral solution. A core
issue, for example, is drug price negotiations.”
U.S. House of Representatives:
Members at https://www.house.gov/representatives
Committees and Members at https://www.house.gov/committees
U. S. Senate:
Committees and Members at https://www.senate.gov/committees
CQ 2020 Calendar of Regularly Scheduled Sessions, here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
January 13, 14, 15, 16, 27, 28
February 4, 5, 6, 7, 10, 11, 12, 13, 25, 26, 27, 28
March 2, 3, 4, 5, 9, 10, 11, 12, 23, 24, 25, 26, 27, 30, 31
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.