DCMedical News: Tuesday, February 4, 2020
DCMedical News-DCMN
Washington, D.C.
Tuesday, February 4, 2020
DCMedical News is published every day both the House and the Senate are in session.
THE BIG STORY IN HEALTH CARE
The Presidential Election Begins, Health Care a Big Deal
With votes being counted in the Iowa caucuses, wrap up polls and anticipated primaries have focused attention, again, on the health care issues felt by voters to be important, namely coverage for pre-existent conditions, drug prices at the pharmacy, the avoidance of surprise medical bills (e.g., Kaiser Family Foundation poll, here), as well as a “public option.”
The Bipartisan Policy Center (here) reports that health care issues were #1 for voters in Iowa, New Hampshire and South Carolina, ahead of the economy, immigration and taxes. Former New York City Mayor Bloomberg pays special attention to the Administration record on health care (here).
The President delivers his State of the Union address tonight, one day before the Senate votes on impeachment.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Now You Have Coverage, but What About a Doctor?
Himmelstein, Woolhandler and colleagues report in JAMA Internal Medicine (here) that “Improvements in insurance coverage and access to care have resulted from the Affordable Care Act (ACA). However, a focus on short-term pre- to post-ACA changes may distract attention from longer-term trends in unmet health needs, and the problems that persist.” Their finding: “Despite coverage gains since 1998, most measures of unmet need for physician services have shown no improvement, and financial access to physician services has decreased.”
The Original Bundle
Historically, surgical fees covered post-operative care, for defined periods. A RAND group finds (here) that many of the procedures are now done by hospitalists and others, for separate fees, resulting in overpayment to the surgeons.
The group advises CMS to cut the fees, parenthetically making primary care and non-surgical careers more attractive to students in training: “The stakes are high for CMS’s decision. Cuts could have a major effect on surgeon revenue. But the current system results in inflated payments for surgical procedures relative to evaluation and management visits and other nonsurgical services that are the mainstay for many physician specialties. The discrepancy in income between procedural and nonprocedural specialties has many ripple effects, influencing the specialty choices of medical students and the number of students choosing careers in primary care.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
What to Expect
A Kaiser Family Foundation brief (here) advises readers on what to expect with Medicaid in 2020.
Medicaid Flexibility
CMS has announced new “flexibility” for state Medicaid programs (here). The ability of states to cap benefits to medically indigent adults—in a “block grant”—is reported by the New York Times (here), CQ here.
The Times noted the potential for two interpretations during the Presidential campaign (see Big Story, above): “The popularity of Medicaid raises the question of why Mr. Trump would sign off on a contentious block grant program heading into his re-election campaign. The threat posed to the program by Republican efforts to repeal the Affordable Care Act helped Democrats retake the House in the 2018 midterm elections. But if the new option is taken up by states that have not yet expanded Medicaid at all, Mr. Trump could point to it as a new expansion of health coverage.”
DRUGS AND DEVICES
Medicaid Closed Formularies
CQ reports (here) that the new CMS guidance to state Medicaid programs (see above, also here) would “allow states to accept capped federal funding in exchange for added flexibilities within the program. One of those flexibilities is the ability to negotiate drug costs by adopting a closed formulary, and potentially refusing to cover drugs, like commercial plans.” Pharmaceutical companies announced their opposition.
More Than You Wanted to Know
The New York Times has a front page expose′ of the health plan-PBM-pharmacy business, here. “In letters to state regulatory boards and in interviews with The New York Times, many pharmacists at companies like CVS, Rite Aid and Walgreens described understaffed and chaotic workplaces where they said it had become difficult to perform their jobs safely, putting the public at risk of medication errors. They struggle to fill prescriptions, give flu shots, tend the drive-through, answer phones, work the register, counsel patients and call doctors and insurance companies, they said — all the while racing to meet corporate performance metrics that they characterized as unreasonable and unsafe in an industry squeezed to do more with less.
Clinical Deci$ion Support
In the first criminal prosecution of an electronic medical records vendor, “Practice Fusion admits that it solicited and received kickbacks from a major opioid company in exchange for utilizing its EHR software to influence physician prescribing of opioid pain medications.” The company, now part of Allscripts, paid $145 million in fines.
READINGS AND REFERENCES
CBO on the Budget and Economic Outlook
The Congressional Budget Office offers slides on the Economic Outlook 2020-2030 (here), the Budget Outlook 2020-2030 (here) and a combined Budget and Economic Outlook 2020-2030 (here). Crib notes (press briefing), here.
Worth Reading
Peter Bach and colleagues report in NEJM (here) on the incentives and rewards in the American pharmaceutical industry, balancing risk, monopoly patent protection and innovation.
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 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.