DCMedical News: Wednesday, February 5, 2020
DCMedical News-DCMN
Washington, D.C.
Wednesday, February 5, 2020
DCMedical News is published every day both the House and the Senate are in session.
THE BIG STORY IN HEALTH CARE
Health Care Continues as Top Presidential Campaign Issue
The President used part of his State of the Union address Tuesday night to extol his plan for drug price control, and to oppose single-payer government plans. A “sneak peek” sent by The White House (here) revealed that “Tonight, he’ll call on Congress to support his efforts to lower healthcare costs without compromising America’s world-leading standard of care.”
In “another lesson from Iowa,” Politico reports that nearly six in ten Democratic caucus-goers preferred government-run health care to private insurance; that it was the most important issue for Democratic caucus-goers Monday night, with four in ten saying that it matters more than climate change, income inequality and foreign policy; but that, overall, caucus-goers had very different views as to what changes they wanted see, split evenly between a single-payer system (Senator Bernie Sanders) and private insurance with a government-run public option (former Mayor Pete Buttigieg). Washington Post report here.
The debate continues on whether employers paying 82% of the $7,188 per person for work-based coverage would raise wages if taxes substituted for their premium payments (Austin Frakt, here, in the New York Times). The evidence from limited studies shows “little to no evidence of a comparable trade-off between wages and health insurance premiums,” for example, two studies (here and here) from the Journal of Health Economics.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
$cope of Practice
The AMA has announced that “Lawmakers in New Jersey this week opted against moving forward with legislation that would have allowed advanced practice registered nurses (APRNS) to prescribe without any physician oversight. The legislation would have also given APRNs full signatory authority, meaning they could have signed off on any document requiring a physician signature by law.” The AMA noted that, in 2019, it had secured 50 victories over proposed scope of practice expansions by other health professionals, including Nurse practitioners & independent practice (AR, CA, FL, IL, IN, LA, MS, MT, OH); Nurse anesthetists & opt out of Medicare supervision (CO, MS); Nurse anesthetists & independent practice (AR, IL); Nurse midwives & independent practice (NE); Physician assistants & independent practice (IL, LA, ME, MT, NV, OR); Psychologists & independent prescribing of psychotropic medications (CT, FL, HI, IL, MT, VT); Optometrists & surgery (MD, ND, VT); Pharmacists & prescribing (AZ, IA, IL, IN, VT); Naturopaths & licensure (CT, IL, MD, OR); Physical therapists & direct access (AL); and Podiatrist & surgery of lower leg (ME).
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Medical Bills and Public Trust
Johns Hopkins’ Dr. Martin Makary makes the case that the quality of billing by health care facilities is a key component of the quality of medical care. Makary writes (here) that “A 2019 report from the US Consumer Financial Protection Bureau . . . . found that more than 25% of individuals had delinquent debt on their credit reports, with medical bills accounting for 58% of all debt.” In patients with stage IV breast cancer, “50% reported that they had been contacted by debt collectors regarding a medical bill, suggesting their medical bills were significantly overdue.”
Makary concludes that “High medical prices and billing practices may reduce public trust in the medical profession and can result in the avoidance of care.” He notes that “The field of quality science in health care has developed measures of medical complications; however, there are no standardized metrics of billing quality.”
Makary notes lack of competence, or worse, in the transparency of hospital prices: “A recent study found that only 53 of 101 hospitals were able to provide a price for standard coronary artery bypass graft surgery. Notably, among the hospitals that provided a price, the price ranged from approximately $44 000 and $448 000 and was not associated with quality of care.” He notes that “The lack of availability of prices before elective care not only reduces competition among health care centers but can result in avoidable financial hardship for patients,” and suggests five metrics for billing quality.
Certificate of Monopoly?
Bloomberg reports that “Kentucky health-care providers have an interest in protecting the state’s certificate of need [CoN] law that won’t be represented adequately by state government officials.” The Kentucky Hospital Association has therefore moved (here) to join a suit to assist those officials in upholding CoN.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Life Expectancy Up, a Bit
The CDC reports (here) that “In 2018, life expectancy at birth was 78.7 years for the total U.S. population— an increase of 0.1 year from 78.6 years in 2017. For males, life expectancy changed from 76.1 in 2017 to 76.2 in 2018—an increase of 0.1 year. For females, life expectancy increased 0.1 year from 81.1 years in 2017 to 81.2 in 2018.” Wall Street Journal coverage here, New York Times coverage here.
Low Value Care: Easy to Get in Florida and Arkansas, Harder in Alaska
Altarum and PhRMA report on low value care and variation in such care by state (here). They report, “Low-value care is still occurring too often, [but] reduction in low-value care is possible, given that rates of care provided in some states is less than half of that in others.” The study has a useful chart (Appendix A) with links to professional societies and their recommendations concerning low value care.
More on state variation and the Johns Hopkins Overuse Index last year in BMC Health Services Research (here).
READINGS AND REFERENCES
One More Thing to Worry About
Facial recognition software is largely accurate in identifying images from MRI studies which have included the face. In the NEJM, here.
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 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.