DCMedical News: Tuesday, January 28, 2020
DCMedical News-DCMN
Washington, D.C.
Tuesday, January 28, 2020
DCMedical News is published every day both the House and the Senate are in session. The House adjourns today for a Democratic party retreat. Both houses will resume work February 4, when DCMN will resume publication.
THE BIG STORY IN HEALTH CARE
Wuhan Coronavirus Distribution
Johns Hopkins tracks worldwide reports of suspected or confirmed cases of the virus, summarized (here) by Statista. The Hopkins site is: https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6. Are American hospitals ready? It depends, says Betsy McCaughey in the Wall Street Journal (here), on what priority they place on infection control.
Immigrant Health Care Imperiled as Supreme Court Allows “Public Charge” Rule
The Hill reports that “The Trump administration can move forward with a rule to make it harder for immigrants who rely on public assistance to gain legal status while a court challenge plays out . . . The high court's order [here] lifts a nationwide injunction imposed by a federal judge in New York and upheld the Second Circuit Court of Appeals. The Supreme Court voted 5-4 along ideological lines to let the administration move forward with the proposal. . . . Under current regulations, the criteria for deciding if an immigrant would become a public charge is whether they are likely to rely on certain cash benefits. The new rule would expand that, defining public charge as someone who relies on cash and non-cash benefits like housing or food [or health care] assistance for more than 12 months in a three-year period.”
The Department of Homeland Security September 2018 draft of the rule is here, Federal Register official publication October 10, 2018 is here. Opposition statements and positions were taken by physician groups (here), the Association of American Medical Colleges (here in 2018 and here in 2019), and by the American Hospital Association (here). Analysis was undertaken in the New England Journal of Medicine (here), by the Kaiser Family Foundation (here, here and here) and by MACPAC (here), the Congressional Advisory body on Medicaid. The New York City Health + Hospitals Corporation estimated (here) that the rule will reduce its revenue by $362 million.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Georgia Women, Physician Group Leaders
The Atlanta Business Chronicle reports (here) that “For the first time ever, three of the nation’s top medical associations are led by female physicians, all of whom also are from Georgia. Dr. Patrice Harris is president of the American Medical Association (AMA) and the first black woman to hold the post. Dr. Sally Goza of Fayetteville, Ga., is president of the American Academy of Pediatrics (AAP) and Dr. Jacqueline Fincher of Thomson, Ga., is president of the American College of Physicians (ACP).”
MVP: CMS!
Thomas Sullivan writes in Policy & Medicine (here) that CMS 2018 “Quality Payment Program” data recently released (CMS announcement here) showed nearly 900,000 clinicians participating in the program. All but 2% of those received additional payment (“adjustment for exceptional performance,” “positive payment adjustment”). Sullivan reports that “Large practices fared the best in 2018, with a mean score of 92.32 (out of 100), while rural practices achieved a mean score of 85.99, and small practices had a mean score of 65.69” and that “In small practices, 57.91% of clinicians will receive an additional adjustment for exceptional performance, while 26.00% will receive a positive payment adjustment, 2.89% a neutral adjustment and 13.20% a negative payment adjustment.”
CMS also recently announced (here, with video link) that they have finalized the MIPS [Merit-based Incentive Payment System] Value Pathways (“MVPs”) proposal in the 2020 Physician Fee Schedule final rule. The MVP is intended to “transform the MIPS program into one that engages clinicians and specialty societies, to craft measures that assess them on what matters most – outcomes.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
MACPAC Materials from the Meetings of January 23-24
The Medicaid and CHIP Payment and Access Commission discussed Access to Treatment for Pregnant Women with a Substance Use Disorder and Infants with Neonatal Abstinence Syndrome (here); Improving the Quality and Timeliness of Section 1115 Demonstration Evaluations (here); Geographic Availability of Integrated Care Models for Dually Eligible Beneficiaries (here); Integrating Care for Dually Eligible Beneficiaries: Policy Options (here); a Draft Chapter for March Report: State Readiness for Mandatory Core Set Reporting (here); Improving Participation in the Medicare Savings Programs (here); Interpreting Trends in Spending Data: Impact of Prior Period Adjustments (here); and Maternal Morbidity among Women in Medicaid (here). Meeting agenda and panelists here.
DRUGS AND DEVICES
Where Does the Drug Dollar Go?
Berkeley Research Group (BRG) publishes a study (here), sponsored by PhRMA, showing an increasing percentage of drug purchase dollars going to middlemen, especially health plans and their pharmacy benefit managers. “Hospitals, health insurers, pharmacy benefit managers, the government and others got nearly 50% of what was spent on brand medicines in 2018, up from 33% five years prior.” For payers (private and government), climbing drug prices paid off: “Nearly half of the increase in the total amount spent on brand medicines went to payers between 2015 and 2018. Twenty percent went to hospitals, pharmacies and other health care providers, which is the same amount that went to biopharmaceutical companies that research, develop and manufacture medicines.” For the hospitals, the money came in handy: “The amount hospitals, pharmacies and other health care providers retained on the sale of brand medicines nearly doubled between 2013 and 2018, increasing from $24.7 billion to $48.6 billion. This trend was primarily driven by unprecedented expansion in the 340B drug pricing program. In fact, the amount hospitals and other 340B entities retained from the sale of brand medicines purchased through the 340B program was 9 times larger in 2018 than in 2013.” The study makes the claim that 340B profits now account for 63% of provider and pharmacy profit, up from 14% in 2013.
The paper is an update of one from 2017 (here, summary here) on the flow of dollars in the US pharmaceutical marketplace, how total spending on brand medicines at the point of sale is distributed. “Since publication of that study, spending on prescription medicines in the US has continued to grow, and many of the market dynamics in place during the period of the original study (2013 through 2015) have persisted from 2016 through 2018.”
None of it apparently came back to employers, according to results of a Kaiser Family Foundation study reported by Axios here. Total large employer spending on underwritten (insured) health plans was roughly the same as total large employer spending in self-insured plans over two decades. The Foundation’s Drew Altman implies that the barrels of ink, number of invasive “wellness” programs and bonus awards for employer cost containment efforts were for naught, on grounds that the basics (that the “benefit” should not irritate the employee beneficiary) were the same in underwritten and self-insured plans.
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
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.