DCMedical News: Thursday, Sept. 20, 2018
DCMedical News
Washington, D.C.
Thursday, Sept. 20, 2018
DCMedical News is published every day either the House or the Senate is in session. Is DCMedical News new in your in-box? Subscription information is below, courtesy trials end without notice.
THE BIG STORY TODAY IN HEALTH CARE:
Health Spending Moderating? Not for Employer-Sponsored Insurance Plans: Frost, Brennan and colleagues analyze Health Care Cost Institute claims data in the October Health Affairs (here). They found a 44% increase from 2007-2016, slowing as the Great Recession took hold in 2009, increasing in the two full years of PPACA implementation, 2014-2016. Health spending by the 54% of Americans with employer-sponsored health insurance totaled $1.12 trillion in 2016, compared to the $672 billion in claims recorded for Medicare. Excluding premium contributions from income and payroll taxes cost an estimated $268 billion in 2016, comparable, say the authors, to total federal spending on Medicaid.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Surprise Medical Bills: Senator Cassidy’s proposal (here) would shift emergency, out-of-network and out-of-network-doctors-at-in-network hospital bills to health plans, amounts to be based on state law or federal calculation.
AI or GI (Genuine Intelligence): A study in the Journal of Medical Internet Research (here) on “Patient and Consumer Safety Risks When Using Conversational Assistants for Medical Information: An Observational Study of Siri, Alexa, and Google Assistant” found that “Reliance on conversational assistants for actionable medical information represents a safety risk for patients and consumers” and that “(29%) reported actions that could have resulted in some degree of patient harm, including 27 (16%) that could have resulted in death.”
HOSPITALS AND OTHER HEALTH CARE FACILITIES
Hospitals and Insurers Create Additional Expense Through Preferred or Exclusive Contracting: The Wall Street Journal (here) featured an article on “secret hospital deals” driving health costs. Said the Journal: “Dominant hospital systems use an array of secret contract terms to protect their turf and block efforts to curb health-care costs. As part of these deals, hospitals can demand insurers include them in every plan and discourage use of less-expensive rivals. Other terms allow hospitals to mask prices from consumers, limit audits of claims, add extra fees and block efforts to exclude health-care providers based on quality or cost.”
340B Stewardship: The American Hospital Association has begun a “340B stewardship” in an attempt to bring more accountability and transparency to the drug discount program. Growth of the program was chronicled in an August JAMA Internal Medicine research letter, here. AHA is one of several groups also suing HHS in an attempt to reverse significant cuts in the program’s reimbursement for hospital drug costs, complaint here.
PHARMA
Step Therapy: Push-back against CMS proposal (here) to allow step therapy in Medicare Advantage programs notes that it subverts physician judgment, causes an increase in unnecessary physician office visits as less-definitive drugs fail, and unnecessarily prolongs patient suffering.
Opioid Legislation: Senate bill as passed in the Senate, here, 348 pages; House version, here, 460 pages.
READING and REFERENCE
H-CUP Statistical Brief “Opioid-Related Inpatient Stays and Emergency Department Visits Among Patients Aged 65 Years and Older, 2010 and 2015, (here).
“Opioid misuse in older adults is an underappreciated and growing problem. . . the rate of opioid misuse among older adults nearly doubled between 2002 and 2014. In 2016, a third of the more than 40 million Americans enrolled in Medicare Part D received prescription opioids and a substantial number received higher doses than recommended for prolonged periods of time, putting them at increased risk of misuse. Between 2005 and 2014, the rate of opioid-related hospitalizations increased fastest among patients aged 65 years and older compared with all other age groups. Eighty percent of U.S. adults aged 65 years and older have multiple chronic conditions (e.g., heart disease, diabetes, arthritis, and depression) compared with less than 20 percent of adults aged 18–44 years. Chronic pain is common among older adults.”
Medicine’s Financial Contamination: Editorial from the New York Times, 9-14-2018, here, concerning the influence of money on medical research and practice.
Be Happy, or Healthy: Researchers primarily from Yale (home of a “happiness” course for undergraduates) report (here) that “the overall well-being of a geographically defined population was inversely associated with its health care spending for people 65 years and older.”
EVENTS & MEETINGS
Sept. 20
9:00 a.m., Alliance for Health Policy, discussion with Joseph Grogan, Associate Director for Health Programs at the Office of Management and Budget, 1299 Pennsylvania Ave., registration here.
Sept. 25
3:30 p.m., Senate HELP Committee, “Health Care in Rural America: Examining Experiences and Costs.”
Sept. 26
8:30 a.m. to 4:00 p.m., Medicare & Medicaid Programs, and Other Program Initiatives, and Priorities; Meeting of the Advisory Panel on Outreach and Education. Registration required, information at https://www.regonline.com/apoe2018sept26meeting, notice and background here.
9:00 a.m. to 4:00 p.m., continuing September 27, meeting of the National Advisory Council on Nurse Education and Practice. Details here.
Sept. 27
10:00 a.m., Senate HELP Committee continues hearing on costs, this hearing focusing on innovation, witnesses Dr. Lee Gross (Docs 4 Patient Care Foundation, Epiphany Health Direct Primary Care; Cheryl DeMars (The Alliance, Madison, WI); Dow Constantine (Executive of King County, Seattle); Dr. Jonathan Perlin, CMO, HCA, Nashville).
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
September publication dates: 21, 24, 25, 26, 27, 28.
October publications dates: 1, 2, 3, 4, 5, 9, 10, 11, 12, 15, 16, 17, 18, 19, 22, 23, 24, 25, 26
November publication dates: 13, 14, 15, 16, 26, 27, 28, 29, 30
December publication dates: 3, 4, 5, 6, 7, 10, 11, 12, 13, 14
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com