DCMedical News: Monday, January 13, 2020
DCMedical News-DCMN
Washington, D.C.
Monday, January 13, 2020
DCMedical News is published every day both the House and the Senate are in session.
THE BIG STORY IN HEALTH CARE
Predictions of Success, Despite Evidence to the Contrary
CQ predicts that “Lawmakers will start 2020 hoping to resolve many of the same issues they worked on during the previous year. Lowering health care costs, a top issue for voters heading into the 2020 presidential election, will remain a focus in two main ways: ending the practice of surprise medical billing and lowering prescription drug prices” and that “Lawmakers have set themselves up for success if they want it. Short-term funding for several public health programs is set to expire on May 22, providing a ready-made vehicle for health care legislation. Lawmakers hope to include up to five years of funding for programs like community health centers, the national health service corps and graduate medical education training.” What is happening now? Nothing, or at least no news.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Income Inequality? It’s Your Fault, Doctor! Famed Economists Decry Health Care “Poll Tax”
Nobel Prize winning economists Anne Case, PhD and Angus Deaton, PhD, said Americans pay a “poll tax” of $8,000 per household per year, due to much higher pay for physicians, compared to most European countries. A report on their talk at the American Economic Association in the Washington Post (here) says the fault lies with physicians, and other “healthcare stakeholders.” Case and Deaton made no specific mention of the compensation of hospital executives, however, or pharma, medical device or insurance industry leaders. In a side tribute to the medical profession’s efforts to limit the number of physician trainees, they said “We have half as many physicians per head as most European countries, yet they get paid two times as much, on average.” They added, “Physicians are a giant rent-seeking conspiracy that’s taking money away from the rest of us.” Dr. Case added, for good measure, “A few people are getting very rich at the expense of the rest of us. The U.S. health-care system is like a tribute to a foreign power, but we’re doing it to ourselves.”
The Post reported that the “academics say it’s clear that two things need to happen in the United States: Everyone needs to be in the health system (via insurance or a government run system like Medicare-for-all), and there must be cost controls, including price caps on drugs and government decisions not to cover some procedures.” Economists have, in general, been sour on the American health care system, with The Economist, for example (here) writing that “American hospitals are a racket,” with hospital rates across the board (here) soaring and community hospital net revenue exceeding $1 trillion for the first time in 2018 (here).
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Another Debacle from the Hahnemann-Private Equity Scandal
The Association of American Medical Colleges (AAMC) has noted that malpractice insurance for 1,000 physicians, primarily residents formerly in training at Hahnemann Hospital, will lapse February 10. The AAMC reported (here) that “In a disturbing new twist to the closure of Hahnemann University Hospital in Philadelphia last summer, the 572 residents and approximately 100 attending physicians displaced by the closure — plus about 300 additional residents who previously trained at the hospital — now find that the professional liability insurance they had during their time at Hahnemann is about to expire.” The AAMC noted that “The private-equity firm that owned Hahnemann, the Philadelphia Academic Health System (PAHS), LLC, purchased a claims-made insurance policy for its residents and attending physicians, which only covered physicians for claims made during a specific time period. That policy is now set to expire on Feb. 10, 2020, and once the policy expires, the coverage will lapse except for those claims that have already been filed. Tail insurance coverage to cover future claims had been a key component of the Sept. 2019 sale of Hahnemann in bankruptcy court. However, the Department of Health and Human Services appealed the bankruptcy court’s approval of the sale and the U.S. District Court postponed the sale’s closing until the appeal is decided. With the sale on hold and the insurance lapse deadline looming, the Pennsylvania Department of Health and an ad hoc resident committee filed motions on Dec. 11 asking the bankruptcy court to order PAHS to obtain tail insurance. The resident committee’s motion warned that failure to have continuous liability coverage in some states, including Pennsylvania, can result in the revocation of or the inability to obtain a physician’s medical license.” A hearing will be held on the motion January 31.
GAO Faults 340B Hospital Accountability
The General Accountability Office issued a report (here, summary here) on the §340B drug discount purchase program which involves more than 2400 hospitals, two-thirds of them private, non-profit hospitals. GAO reported nongovernmental hospitals qualify for the program, in part, “based on having contracts with state or local governments to provide health care services to the 340B-specified low-income population—low-income individuals not eligible for Medicaid or Medicare. GAO’s review of contract documentation for 258 nongovernmental hospitals found that most contracts obligated these hospitals to provide health care services to low-income individuals. However, few of the contracts reviewed included details about those obligations, such as the amount or type of care hospitals were required to provide. The statute does not require the contracts to contain such details. GAO found that HRSA’s processes do not provide reasonable assurance that participating nongovernmental hospitals meet eligibility requirements.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Fed Up, Not Going to Take it Any More
Small and medium sized employers (according to a report in Modern Healthcare here) are “Faced with sharp premium increases--more than double the rate of inflation in 2019, according to the Kaiser Family Foundation. Smaller and midsize employers increasingly want to identify lower-cost, high-quality hospitals and physician groups and design their health plans to encourage employees to go to those providers.”
Medicare and Medicaid Notes
MedPAC, the Congressional advisory body on Medicare policy, is meeting this Thursday and Friday, agenda here. Medicaid and CHIP enrollment is at 71.4 million, details by state here. “Next Generation” (risk assuming) Accountable Care Organizations end up costing Medicare more, not saving, news report here. MACPAC, the Congressional advisory body on Medicaid policy, publishes its annual “MACStats: Medicaid and CHIP Data Book,” here.
READINGS AND REFERENCES
Medicaid Expansion
Kaiser Family Foundation and map on Medicaid expansion and §1115 waivers, here.
PPP? Not So Fast
The British National Audit Office reports on the “Private Finance Initiative” or PFI (here) that “schools built using the PFI are 40 per cent more expensive and hospitals cost 60 per cent more than the public sector alternative.” The Financial Times also reports (here) that “Senior UK ministers warned in 1995 and 1996 of serious problems with prime minister John Major’s flagship private financing of public projects, anticipating issues that plagued the scheme in the following decades. Cabinet papers released on Tuesday under the 25-year rule show that Downing Street pledged to ‘push forcefully ahead’ with its Private Finance Initiative, despite technical delays, tendering problems and concerns that departmental budgets would be squeezed.” Hard pressed state universities and hospitals in the U.S. regularly consider the upside (only) of “Public-Private Partnerships” (PPP).
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 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.