DCMedical News: Thursday, Sept. 27, 2018
DCMedical News
Washington, D.C.
Thursday, Sept. 27, 2018
DCMedical News is published every day either the House or the Senate is in session. Subscription information is below. Subscribe to assure your continuation of the newsletter. Non-paid addresses will be removed at the end of each month.
THE BIG STORY TODAY IN HEALTH CARE
The Senate Judiciary Committee hearing on Judge Kavanaugh takes place today at 10:00 a.m. The Committee has announced it will vote on the nomination Friday morning at 9:30 a.m.
Appropriations: The House passed an $854 billion spending bill (conference report here, summary allocation of Labor-HHS-Education funds here) by a vote of 361-61, a week after the Senate passed an identical measure by a vote of 93-7. Appropriations in the bill will fund the Defense, Labor, Health and Human Services (HHS) and Education Departments for FY 2019, which begins October 1. Also included is a Continuing Resolution extending current funding levels for other yet-to-be-funded Departments through December 7.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Proposed CVS-Aetna Merger Alarms Physicians: HealthcareFinance reports (here) that the Association of American Physicians and Surgeons has joined the AMA in opposing the proposed merger between CVS Health and Aetna. The proposal would combine the country’s third-largest health insurer and the largest national pharmacy chain and its pharmacy benefit manager. The physician group noted that 70% of all prescriptions in America are filled by one of three pharmacy benefit managers, Express Scripts, CVS Caremark and OptumRx (owned by UnitedHealth Group).
Doctors Aren’t The Only Objectors: New York State Department of Financial Services chief Maria Vullo sent a letter (here) to the Connecticut Insurance Department; Connecticut is holding a hearing on the proposed acquisition October 4. Ms. Vullo noted that there are “key issues that may be harmful to both New York and Connecticut consumers and markets.” Among those effects are an “Unfair Competitive Advantage For Aetna,” “Concentration in PBM [Pharmacy Benefit Management] Market,” and “Increase in Medicare Prescription Drug Plan (‘Part D’) Concentration.” These were characterized as harms to the market. Harms to consumers included that there is no commitment in the proposed transaction to lower premiums or to pass any savings on to consumers, the likelihood of drug price increases, data privacy concerns, and, then for the corporation, the effect of substantial debt (more than $40 billion) that CVS would be taking on to finance the transaction.
HOSPITALS AND OTHER HEALTH CARE FACILITIES
Bipartisan Support for Opioid Legislation: House and Senate Members of the Conference Committee on Opioid Legislation reached agreement on the bill (H.R. 6, 660 pages, here) to address different aspects of the public health epidemic, including addiction treatment, prevention, and law enforcement. In June, the House passed H.R. 6, the SUPPORT for Patients and Communities Act by a vote of 396-14. On September 17th, the Senate passed the Opioid Crisis Response Act of 2018 by a vote of 99-1. This bill is the reconciliation of the two comprehensive initiatives.
The final opioid measure would partially repeal a provision in Medicaid (present since the beginning of Medicaid, in 1965), by allowing payments for inpatient addiction treatment services in IMD (Institutions for Mental Disease). Left out, but considered in a House version: easing of prohibition on the sharing of patient substance abuse treatment records; higher Medicare payment for opioid alternatives in the treatment of post-surgical pain; and reduction (sought by the pharmaceutical industry) in how much the manufacturers pay for drugs in the “donut hole” (coverage gap) in Medicare Part D.
Hospitals Protest ‘Site of Service’ Payment Compression: The American Hospital Association unveiled a new initiative to protest plans by the Centers for Medicare and Medicaid Services to eliminate the ‘site of service’ differential payment between hospital satellites and physician offices. The payment compression (between currently higher hospital “satellite” payment and payment for the same services in a doctor’s office) is contained in the Outpatient Prospective Payment System regulations (here) for calendar year 2019.
The AHA released reports by KNG Health Consulting showing that patients in general (here) and cancer patients (here) are likely to be “sicker and poorer than those cared for in an independent physician office.” In general, physician groups have supported the CMS proposal, on grounds that hospitals have been charging “facility fees” to hospital outpatient department patients. A group representing independent physicians has underlined another consequence of the $75 - $85 average additional reimbursement paid to hospital outpatient departments, compared to physician offices: These funds make it possible for hospitals to offer higher compensation to doctors, inducing doctors to sell their practices to hospitals. Once acquired by the hospital, physician practices become significantly more expensive, and physicians in those practices order more tests from the owner-hospitals (study and report examples here, here and here). Without the additional income, hospitals would be left to pay the higher salaries that have been promised to the acquired physicians, without a source of revenue with which to do so.
DRUGS AND DEVICES
“Health Care” Stocks in Market Rally: The Wall Street Journal reported (here) that pharmaceutical, insurance and medical device stocks are all market leaders in the third quarter, as a “safety play.” The Journal notes that “The health-care sector is the best performer of the S&P [Standard and Poor’s] 500’s 11 groups in the third quarter, up 13% and on pace for its strongest showing in more than five years.” The health care sector was up 14% in performance year-to-date, compared to the S&P 500, up 9%. The sector was also near the top of repurchasing the most shares so far this year, giving the share prices of companies which bought stock back an added boost. Technology companies as a whole bought back $135 billion, financials as a whole bought back $64 billion, heath care bought back $63 billion worth of stock. Also, the Journal noted that “Hedge funds have built up their biggest position in health-care shares in the past five years. About 17% of their assets are in the sector, second only to shares of tech companies.”
EVENTS & MEETINGS
Sept. 27
POSTPONED, New date not yet set. 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).
10:00 a.m., Energy & Commerce Subcommittee on Health holds a hearing on “Better Data and Better Outcomes: Reducing Maternal Mortality in the U.S.” Webcast at http://energycommerce.house.gov/, announcement here.
Oct. 25
1:00 to 5:00, “Top Minds,” Chernew, Dafny and more, “Disrupting the Health Care Landscape: New Roles for Familiar Players,” NEJM Catalyst webinar, https://join.catalyst.nejm.org/events, also sign up for “New Marketplace Survey: Payers and Providers Remain Far Apart,” which reports (here) that “health care stakeholders are not working together to achieve value-based care, but instead are waiting on government regulators to change the payment model – including, possibly, single-payer health care.”
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: 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