DCMedical News: Tuesday, January 14, 2020
DCMedical News-DCMN
Washington, D.C.
Tuesday, January 14, 2020
DCMedical News is published every day both the House and the Senate are in session.
THE BIG STORY IN HEALTH CARE
FTC and DOJ May Examine Hospital-Physician Group Mergers
The Federal Trade Commission and the Department of Justice jointly announced (here) proposed new guidelines for examination of the anticompetitive impact of vertical mergers, that is, between organizations which do not directly compete with one another, but which are part of the same supply chain, such as hospitals and physician groups. The draft guidelines (here) “are not intended to describe how the Agencies will conduct the litigation of cases they decide to bring. Although relevant in that context, these Guidelines neither dictate nor exhaust the range of evidence the Agencies may introduce in litigation.” Also, “The Agencies are unlikely to challenge a vertical merger where the parties to the merger have a share in the relevant market of less than 20 percent, and the related product is used in less than 20 percent of the relevant market.” Comments are due by February 11 and may be submitted as noted in the announcement.
Vertical consolidation of physician groups and hospitals—in addition to the “horizontal” consolidation of hospitals—played a role in the recent California suit against and proposed settlement by Sutter Health. A 2018 study (here) on the phenomenon in California is “Consolidation in California’s Health Care Market 2010-2016: Impact on Prices and ACA Premiums” from the Nicholas C. Petris Center on Health Care Markets and Consumer Welfare, School of Public Health, University of California, Berkeley.” A motion on the settlement (here) will be heard February 25. A report in NEJM Catalyst (here) contends that “integrated delivery systems” (physician and hospital business combinations) have not worked for patients or the public.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Executive Health Physical Screening Tests
A review (here, editorial by Rita Redberg and Mitchell Katz here) of 12 cardiovascular screening tests performing as part of “executive health physicals” shows how many of them would rank as high quality, recommended tests, with benefits based on evidence exceeding direct or indirect costs: none. The editorial, in JAMA Internal Medicine, notes “Ge and Brown describe the executive screening programs offered by top cardiology hospitals in the United States. Forty-three percent of the programs offered coronary artery calcium scans, the same [unnecessary] test received by President Obama. Only 3 of the 28 programs (10.7%) would submit bills to insurance companies, likely reflecting that these procedures are not recommended for asymptomatic persons. Indeed, none of the 12 screening tests, as well as the resting electrocardiogram, offered by these programs are recommended for asymptomatic adults by any of the major academic or governmental consensus groups.” The programs queried were chosen from the U.S. News & World Report list of top cardiovascular hospitals. The Cleveland Clinic’s “Premier Executive Health Program” came in #1 for cost, at $25,000.
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
The Good (and Less Expensive) Death
The New York Times’ Gina Kolata writes (here) that “For the first time over a half century, more people in the United States are dying at home than in hospitals, a remarkable turnabout in Americans’ view of a so-called ‘good death.’ In 2017, 29.8 percent of deaths by natural causes occurred in hospitals, and 30.7 percent at home, researchers reported on Wednesday in the New England Journal of Medicine . . . The last time Americans died at home at the current rate was the middle of the last century, according Dr. Haider J. Warraich, a cardiologist at the Veterans Affairs Boston Healthcare System and a co-author of the new research. In Boston in 1912, about two-thirds of residents died at home, he said. By the 1950s, the majority of Americans died in hospitals, and by the 1970s, at least two-thirds did.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Final 2019 Report on Healthcare.Gov
“Approximately 8.3 million people selected or were automatically reenrolled in plans using the HealthCare.gov platform during the 2020 open enrollment period.” News release from CMS here, with state-by-state enrollment count.
DRUGS AND DEVICES
Supreme Court to Review PBM Regulation Exemption Under ERISA
The Court granted certiorari to an appeal from the federal government (brief here) and 30 states of an 8th Circuit Court of Appeals decision invalidating an Arkansas law regulating Pharmacy Benefit Managers. Some 38 states have such laws, most seeking to control the cost of drugs by making pharmacy-PBM-insurer-consumer relationships and transactions more transparent. The 8th Circuit (decision here, docket here) has twice (Arkansas and Iowa) decided in favor of the PBMs and the PBM argument that the Employee Retirement Income Security Act pre-empts such state regulation.
READINGS AND REFERENCES
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 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.