DCMedical News: Thursday, October 11, 2018
DCMedical News
Washington, D.C.
Thursday, October 11, 2018
DCMedical News is published every day either the House or the Senate is in session. To subscribe, please see below.
THE BIG STORY TODAY IN HEALTH CARE
Aetna, I’m Glad I Met Ya’: Department of Justice (DoJ) Announces Path to Approval of CVS/Aetna Merger: The DoJ announced yesterday (press release here) that it will allow the $69 billion merger of CVS and Aetna to move forward, conditioned upon Aetna’s divestiture of its Medicare Individual Part D Prescription Drug Plan business. “Under the terms of the proposed settlement (here), Aetna must divest its individual prescription drug plan business to WellCare and allow WellCare the opportunity to hire key employees who currently operate the business. Aetna must also assist WellCare in operating the business during the transition and in transferring the affected customers through a process regulated by the Centers for Medicare and Medicaid Services…” The DoJ and five state AGs (CA, FL, HI, MS and WA) filed suit (here) yesterday to block the merger, while proposing a settlement to resolve the issue. CVS announced board and management changes (here) for the newly combined companies.
The Potential Impact of Newly Seated Justice Kavanagh on Health Law, Concluded: Lawrence Gostin and James Hodge check in on JAMA (here) with these thoughts on the Supreme Court, Justice Kavanaugh and health law: “Historically, the Supreme Court has granted agencies considerable leeway to create and enforce regulations…Judge Kavanaugh disfavors broad agency authority. As a jurist, he overrode agency action 75 times.” Concerning health care access and coverage, Gostin and Hodge write, “Judge Kavanaugh…argued that the ACA’s individual mandate…exceeded congressional powers” and “has cast doubt on the ACA’s tax credits for health exchange consumers.” With respect to complex Medicare payment disputes, Kavanaugh has “sided with hospitals challenging Medicare reimbursement rates, calling the US Department of Health and Human Services (HHS) reimbursement limits ‘arbitrary and capricious.’” The article also addresses Judge Kavanaugh’s possible influence on issues such as reproductive rights, the Second Amendment, consumer and environmental protections, medical marijuana, and antidiscrimination litigation.
Also, this summary (in italics) of (now) Justice Kavanaugh’s opinions is reprinted from DCMN of 7-11-2018:
On administrative and regulatory matters, this note in a WSJ profile (here): “Judge Kavanaugh has written 40 opinions in which he found an agency action to be unlawful, according to Jennifer Mascott, a George Mason University law professor who clerked for him.” The most famous of these is PHH v. CFPB (2017, here), in which Kavanaugh noted the concentration of administrative authority in the Consumer Financial Protection Bureau, “The CFPB’s concentration of enormous executive power in a single, unaccountable, unchecked director not only departs from settled historical practice, but also poses a far greater risk of arbitrary decision making and abuse of power, and a far greater threat to individual liberty, than does a multi-member independent agency.” And on “textual” review, Judge Kavanaugh here in the Harvard Law Review writes on the language of statutes. In U.S. v. Anthem (here) Judge Kavanaugh dissented from the court’s rejection of Anthem’s proposed acquisition of Cigna. A trial judge had ruled that the acquisition would substantially reduce competition, but Kavanaugh in his dissent said the deal should go forward for the cost savings it would create for consumers.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
MedPAC Addresses Payment for APRNs and PAs: MedPAC, the Congressional Advisory Committee for Medicare, addressed the adequacy of Medicare payment for Advanced Practice Registered Nurses and Physician Assistants at its October 4 meeting (slides here). The question is presented because of the substantial increase in authority and independence of APRNs and PAs over time. A related (nomenclature) issue is that Medicare classifies all nurse practitioners as one specialty, even though only half work in primary care, and all PAs as one specialty, although only a quarter work in primary care. Payment based on physician fee schedules may be 85% of the fee if billed under the practitioners NPI number, or 100% if billed under a physician’s NPI (“incident to” billing). Total payments for APRNs and PAs increased from $3 billion in 2010 to $6.5 billion in 2016. Five per cent of all Evaluation and Management visits billed by physicians were likely performed by an NP or PA in 2016. Staff recommended (for MedPAC consideration) elimination of the “incident to” billing and delineation of specialty designations for APRNs and PAs.
Doximity Predicts Oncologist Shortages, Shows Where They Will Occur: Doximity, which says it is the largest medical social network in the country, with more than 70% of U.S. doctors as members, has published a study (here) of coming (age and retirement related) shortages. Among the findings: about half of oncologists continue practicing where they originally trained, but the variation is from 7% of doctors in the Las Vegas metro area training in Nevada to 77% in the Detroit area. Combining age, a workload estimate and training state, Doximity found the highest risk of shortages to be in Miami, Virginia Beach, and Tampa.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Physician Financial Risk in Medicare Advantage Programs: Kaiser has news (here) of Medicare Advantage (MA) plans shifting financial risk to participating physician groups. New management middle-men companies (WellMed, ChenMed, Iora Health, Oak Street Health) have developed to assist physicians in managing risk. Patient advocates recall failure and financial collapse of pre-paid physician groups and their management companies (FPA Medical Management, PhyMatrix, for example) in the 1990s. Judith Stein, founder and executive director of the Center for Medicare Advocacy says “At the end of the day, this is a way to keep costs down and provide less care.” Sources cited in the story say ten percent of MA members nationally are in such plans now, with concentration in southern Florida and southern California.
DRUGS & DEVICES
Medical Devices Cost 6x in U.S. What They Cost in Europe: So says a report in Healthcare Finance News (here), based on a study by researchers at the London School of Economics. Germany had the lowest prices for all devices and countries studied, except for pacemakers. Factors in the variation included varying degrees of market leverage and physician preference, financial inducement or price apathy.
EVENTS & MEETINGS
Oct. 15
4:05-5:45 p.m., HHS Secretary Azar on “Affordable Medicines: Access, Innovation and the Public Interest,” at the National Academy of Medicine, Washington, DC. Additional information here.
Oct. 16
1:30-2:45 p.m., Potential Midterm Election Implications for Health Care, Alliance for Health Policy Webinar, for information contact Ann Nguyen at anguyen@allhealthpolicy.org.
Oct. 18
3:00-4:40 p.m., CMS Administrator Seema Verma at Brookings on Medicare Part D, followed by a panel (Kavita Patel, Samuel Nussbaum and others).
Information at: https://www.brookings.edu/events/a-conversation-with-seema-verma/
Oct. 19
12:00-1:30 p.m. (lunch at 11:30 a.m.), Flexibility and Innovation in Medicaid, Congressional Briefing, Alliance for Health Policy, for information contact Ann Nguyen at anguyen@allhealthpolicy.org.
Oct. 24
9:00-10:15 a.m., Health Policy in the Polls, Reporter Breakfast, Alliance for Health Policy, for information contact Ann Nguyen at anguyen@allhealthpolicy.org.
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.
Nov. 8
Through Nov. 13, 2018 AMA Interim Meeting, Gaylord Convention Center, National Harbor, Maryland
Dec. 4
9:00 a.m., CMS sponsors a “Town Hall” meeting “to discuss fiscal year (FY) 2020 applications for add-on payments for new medical services and technologies under the hospital inpatient prospective payment system (IPPS). Registration required by 11-19-2018, Federal Register notice 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
October publications dates: 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