DCMedical News: Wednesday, February 12, 2020
DCMedical News-DCMN
Washington, D.C.
Wednesday, February 12, 2020
DCMedical News is published every day both the House and the Senate are in session.
THE BIG STORY IN HEALTH CARE
Novel Coronavirus, Now COVID-19
Tracking at https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6 by Johns Hopkins. At 8:00. p.m. EST Tuesday night 44,885 confirmed cases, 4,698 recovered, 1,114 deaths.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Bundles, No Joy
A review of bundled payment experiments in Health Capital Topics (here) finds that “Bundled payments are increasingly being criticized for not bringing about the predicted quality and cost-saving outcomes that were expected. These previously promising outcomes, especially as relates to joint replacement, have been found by recent research to be relatively meager. Further, there is no significant difference in quality realized when implementing bundled payments.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Public-Private-Partnerships? Take a Look at Private Finance Initiatives
The British have found that hospital projects advertised under the PFI (here) were late and dramatically over budget, with more expense to be borne by taxpayers. “The two hospitals — one in Liverpool, the other in Birmingham — were being built under the private finance initiative, which enabled companies to set up special purpose vehicles and borrow funds to construct infrastructure such as hospitals, schools and roads, and then maintain the assets over their lifetime. Criticism of the controversial financing scheme intensified after Carillion’s collapse in January 2018, and PFI was abolished by the then-chancellor Philip Hammond in September that year.” Hammond’s statement in 2018, here.
UnitedHealth Begins Primary Care for Medicare Patients in Walgreens Stores, Not Like Those CVS MinuteClinics
United has opened its first senior primary care center, in Las Vegas (here). A nurse practitioner will be on site at the centers certain days of the week for scheduled appointments with UnitedHeatlhcare Medicare beneficiaries. The appointments may include health assessments, health screenings and services to address identified care gaps. But this won't be a CVS Health-equse MinuteClinic according to a United spokesperson. “Unlike what you see with other pharmacy settings, like a MinuteClinic, this won't be available just for walk-in sort of services. It will be more structured, and it will be services that we're scheduling with members of our Medicare Part D plan for very specific purposes."
And you can’t keep private equity out here, either. Humana announces (here) that it will become a minority owner with a private equity firm in another bid to serve Medicare beneficiaries with primary care needs. The “$600 million joint venture [is] focused on giving Medicare patients greater access to value-based primary care. The Louisville-based health insurance company will work with Welsh, Carson, Anderson & Stowe to operate senior-focused, payor-agnostic, primary care centers,” to be managed by Humana’s wholly-owned, primary care subsidiary, Partners in Primary Care. Humana’s chief executive discusses other Medicare and Medicare Advantage initiatives in a fourth quarter conference call (transcript from Seeking Alpha here): “In 2019, we opened 29 senior-focused primary care centers under our wholly-owned Alliance and JV model, bringing our center total to 262.”
HCA Announces Record Results
In a conference call with analysts (transcript from Seeking Alpha here, 8-K filing here) HCA’s chief executive noted “We finished the year with strong fourth quarter results that were above our expectations. Solid volume increases, strong revenue growth and good expense management drove this quarter's results. Revenue increased on a year-over-year basis by 10% to $13.5 billion. This increase was driven again this quarter by a combination of strong same-facilities volume growth and our recent acquisitions. On a same-facilities basis, revenue increased by 6%, which was driven by 4.7% growth in inpatient admissions and 5% growth in equivalent admissions.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Medicaid “Redesign” Off and Running (Again) in New York
The second round of the “Medicaid Redesign Team” (MRT) began work yesterday in Albany, NY, on the nation’s largest and most complex Medicaid program. The Empire Center’s Bill Hammond reported (here) on some “eye-popping” numbers. Personal assistance—"non-medical care, such as bathing and feeding, provided to people with disabilities, typically by aides with little or no training,”—is covered by 33 states, but three years ago “New York alone accounted for 40 percent of national Medicaid spending on personal assistance.” Hammond notes, “Another benchmark of New York’s outlier status is per capita spending (total spending divided by total population). As of 2016, the per capita rate for personal assistance was $279, which was six-and-a-half times higher than the U.S. average and 65 percent more than the No. 2 state, which was Massachusetts. Based on the new numbers released Tuesday, that already high figure has more than doubled – to $581 as of 2020.” In a population of 19 million people, New York has 6.3 million Medicaid beneficiaries.
Webcast at https://players.brightcove.net/2886492229001/default_default/index.html?videoId=6131648465001, slides from the meeting here, MRT home page at https://health.ny.gov/health_care/medicaid/redesign/mrt2/
READINGS AND REFERENCES
Research Methods Homework
JAMA Surgery publishes a series of short essays with examples and references on research methods. Today (here), a practical guide to cost-effectiveness analysis (CEA). Summary: The recommended effectiveness measure used for CEA is the QALY (quality-adjusted life-year). Results of CEA should be summarized as a single quantitative measure, such as the ICER, which is calculated as follows: ICER or incremental cost-effectiveness ratio = [(Cost of the intervention) − (Cost of the control)]/[(QALY of the intervention) − (QALY of the control)], where intervention signifies the surgical intervention and control, an alternative intervention.” With examples, and references.
Tech, Health and Information
The Financial Times asks (here) “Can We Ever Trust Google With Our Health Data?” The story echoes themes in the recent Wall Street Journal exposé (here) of Ascension and leading hospitals giving up patient health care information.
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 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.