DCMedical News: Wednesday, July 18, 2018
DCMedical News
Washington, D.C.
Wednesday, July 18, 2018
DCMedical News is published every day either the House or the Senate is in session.
THE BIG STORY TODAY IN HEALTH CARE
Drug prices continue to be front page news. In DCMN 7-17 a variety of views (sent in response to the Administration drug price control “blueprint”) were linked. Here is the MedPAC offering, largely supporting the Administration proposals.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Data, Privacy and HIPAA: JAMA has three views this week, Berwick here, Mello here, Gostin here.
HOSPITALS AND OTHER HEALTH CARE FACILITIES
Administration Co$ts: The Incidental Economist/Upshot author and economist Austin Frakt took off on health care administration costs (“The Astonishingly High Administrative Costs of U.S. Health Care,” here) in the American health system. He cited the classic 2003 Woolhandler-Himmelstein study of administration costs in the U.S. and in Canada, here; the 2009 Casalino study (“What Does It Cost Physician Practices to Interact With Health Insurance Plans?” here), poignant, as so many physicians are now employed, and have turned the billing headache over to their employer health systems; a study in Health Affairs (here) which found that “0.67 nonclinical full-time-equivalent (FTE) staff working on billing and insurance functions per FTE physician . . . [and] The cost to medical groups, including clinicians’ time, was at least $85,276 per FTE physician.” In the same year, 2009, the National Academy of Medicine (cited here) calculated US spending on billing and insurance-related costs at 14.4% of total health expenditures.
Another study from Casalino and colleagues in 2011 (here) found “US Physician Practices Versus Canadians: Spending Nearly Four Times As Much Money Interacting With Payers,” and another one by Himmelstein and colleagues in 2014 (here) which did “A Comparison of Hospital Administrative Costs in Eight Nations: US Costs Exceed All Others by Far.” Academic medical centers were not immune, even those with “certified” electronic health records systems: one such study (here) showed “Of professional revenue, professional billing costs were estimated to represent 14.5% for primary care visits, 25.2% for emergency department visits, 8.0% for general medicine inpatient stays, 13.4% for ambulatory surgical procedures, and 3.1% for inpatient surgical procedures.”
And of course costs avoided by one party do not disappear, as another study (here) of the burden of the under-insured on providers shows: bills above $200 were paid only two-thirds of the time, instant bad debt, eroding the integrity of patient accounts receivable, and therefore of current assets (and also affecting, parenthetically, bond security provisions triggered by falling current ratios.) The 2017 Kaiser survey of Employer Health Benefits (here) showed “Over the last five years . . . the percentage of covered workers with a general annual deductible of $1,000 or more for single coverage has grown substantially, increasing from 34% in 2012 to 51% in 2017 . . . Thirty-seven percent of covered workers in small firms are in a plan with a deductible of at least $2,000, compared to 15% for covered workers in large firms.”
Where Do We Die? An original investigation in JAMA this week (here) found “In a retrospective cohort study of a 20% sample of the Medicare fee-for-service population that included 1 361 870 decedents, the site of care changed between 2000 and 2015 from acute care hospitals to the community. The proportion of deaths that occurred in acute care hospitals decreased to 19.8%, intensive care unit use during the last 30 days of life increased and then stabilized at approximately 29%, and health care transitions during the last 3 days of life decreased after 2009.”
Nursing Home Staffing Numbers: Kaiser reported (here) that “self-reported” staffing numbers from nursing homes (important in reimbursement) were unreliable, stating that “Over the past decade, the government's five-star rating system for nursing homes often exaggerated staffing levels and rarely identified the periods of thin staffing that were common. Medicare is now relying on the new data to evaluate staffing, but the revamped star ratings still mask the erratic levels of people working from day to day.”
MEDICARE, MEDICAID, COMMERCIAL HEALTH INSURANCE
That Individual Mandate: RAND researchers in a Commonwealth Fund study (here) report “a decline in coverage [of] from 2.8 million people to 13 million [people] when the mandate is eliminated and an increase in bronze plan premiums of 3 percent to 13 percent.”
PHARMA
The AHA appeal of the 340B reimbursement reduction was rejected by the DC Court of Appeals (here) on grounds that the case was not “ripe,” no final reimbursement decisions having been made.
EVENTS & MEETINGS
July 20
12:00 p.m. – 1:30 p.m., “State Responses to the Evolving Individual Health Insurance Market,” Commonwealth and Alliance for health Policy, Dirksen SD-106.
July 25
7:30 a.m. – 4:30 p.m., Medicare Evidence Development and Coverage Advisory Committee (MEDCAC), volume requirements for aortic valve replacements and percutaneous coronary interventions.
Maria Ellis, MEDCAC, (410) 786-0309, maria.ellis@cms.hhs.gov. Federal Register notice of meeting here, National Coverage Determination request for comment (6-28-2018) here.
Aug. 20
Meeting of Medicare Advisory Panel on Hospital Outpatient Program (through August 21), APCs, OPPS, the works. Evaluation of Advanced Primary Care (APC) groups; packaging of Outpatient Prospective Payment System (OPPS). Federal Register notice (5-3-2018), here.
Aug. 22
7:30 a.m. – 4:30 p.m., Medicare Evidence Development and Coverage Advisory Committee (MEDCAC), CAR-T cell therapies, collection of patient reported outcomes in cancer clinical studies.
Maria Ellis, MEDCAC, (410) 786-0309, maria.ellis@cms.hhs.gov. Federal Register notice (6-15-2018) here.
FOR REFERENCE
Members of the Senate (here) and Members of Senate Committees (here), Senate Calendar (here).
Members of the House with their House Committees (here), House Calendar (here).
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
DCMedical News is published every day that either the House of Representatives or the Senate is in session.
Trial subscriptions may end without notice, and all will end July 31.
July publication dates: 19, 20, 23, 24, 25, 26, 27, 30, 31.
August publication dates: prn, Senate may be in session.
September publication dates: 4, 5, 6, 7, 12, 13, 14, 17, 18, 20, 21, 24, 25, 26, 27, 28.
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com