DCMedical News: Friday, October 12, 2018
DCMedical News
Washington, D.C.
Friday, October 12, 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
Let’s Get Vertical: So says Dr. Adam Fein of Drug Channels. Here is his previous analysis of insurer and pharmacy benefit manager (PBM) company combinations, together with an exhibit of PBM market share, here. See also DCMN of 10-11-2018. The score now: the Department of Justice approved the $69 billion merger between CVS Health (which includes its PBM, CVS Caremark) and Aetna this week; the department approved Cigna's acquisition of Express Scripts; UnitedHealth Group reports healthy growth in its Optum PBM; and Anthem reports it is in the process of developing its own in-house PBM. More on the CVS Acquisition of Aetna: NYTimes report, here; AXIOS analysis, here.
HOSPITALS AND OTHER HEALTH CARE FACILITIES
Senator Grassley Follows up Anti-competitive Business Combinations of Insurers and Health Systems: Senator Charles Grassley, active in the health field in monitoring the governance and behavior of tax-exempt organizations, has a new health field target. The Senator sent a letter to the Federal Trade Commission (here), reported in The Wall Street Journal (here), following up on a Journal investigation (here) of allegedly anti-competitive and monopolistic contracts between hospitals and insurers.
The Journal article and the inquiry from Senator Grassley ask the FTC to focus on this point: Have health insurers and large systems conspired to leave out smaller hospitals which, although less costly, are inconvenient for major health systems’ network strategy? Earlier this year (here) Deputy Assistant AG Barry Nigro spoke to the American Bar Association’s Antitrust in Healthcare Conference, focusing on collusion, price fixing and market allocation agreements in the health field, with examples.
Ways and Means Committee Leaders Say They Will Investigate Rising U.S. Maternal Death Rates: Citing a report that the U.S. is one of only three countries in the world with rising maternal death rates (with Afghanistan and Sudan), Committee Chair Kevin Brady announced an investigation into the causes and possible strategies to reverse the trend. In the press release (here), the Chairs of the Oversight Subcommittee (Lynn Jenkins, R-KS) and Health Subcommittee (Peter Roskam, R-IL) join Brady in stating that they “have launched an investigation to determine why maternal mortality and morbidity rates are rising in America and what federal agencies, states, and hospitals are doing and can do to address this issue.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
MedPAC and Medicare’s Role in the Supply of Primary Care Physicians: MedPAC is preparing recommendations for its 2019 report to Congress in January. Primary care and primary care physicians were one focus (here) of the October 4 meeting of the Congressional advisory committee. Primary care physicians (family medicine, general internal medicine, geriatrics and pediatrics) were 19% of professionals who billed Medicare in 2016.
Many of the Commission’s previous recommendations (Primary Care Incentive Payment 2011-2015; repeal of the Sustainable Growth Rate payment penalty and substitution of higher updates for primary care, 2011; identification of “overpriced” fee schedule services and reduction of rates to those of “efficient practices,” 2011; and establishment of per beneficiary payment for primary care to replace the PCIP, 2015) appear to not have been “budget neutral,” and to have created additional bureaucratic hurdles to payment (MIPS). One result, “Beneficiaries more likely to report trouble finding a new primary care doctor than a specialist,” with primary care physicians decreasing from 3.8 per 1,000 beneficiary in 2011 to 3.5 in 2016 (specialists per 1,000 beneficiaries decreased from 8.4 per 1,000 to 7.8 in the same time period).
A bright spot: the National Health Service Corps, tripling in number to 10,200 physicians serving two years in underserved areas, almost 60% in FQHCs. Among the new options MedPAC discussed: additional scholarship or loan programs, or pressure on the medical schools and hospitals (which receive graduate medical education payments).
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
MedPAC on Opioid Use in Hospital Inpatient and Outpatient Settings: CMS does not operate opioid tracking programs in Medicare part A and Part B, relying instead on data available in the Part D program. Slides here from an October 4 presentation.
MedPAC on Policy Issues Related to Non-Urgent and Emergency Care: MedPAC discusses (here) the growth in claims for urgent care centers (UCC), but also for hospital emergency departments (ED). For the 8,100 UCCs from which Medicare processed claims in 2017, low volume, but rapid increase in claims per beneficiary. For a “level 4” visit, Medicare paid $476 to hospital EDs, $246 to hospital-affiliated UCCs, $167 to independent UCCs. But the ED patients were older, had higher risk scores and had more chronic conditions. Also, MedPAC staff reported hospitals using their own (not national) guidelines for coding, leading to a shift to level 5 (the highest) code for more than 25% of patients in 2016, compared to 10% in 2005. Dx? Upcoding, not more conditions or more complex patients. Possible Rx? Collapsing codes to one, or enforcement of national guidelines. The former was proposed in 2014 but encountered strong hospital and doctor resistance; the latter was endorsed by physician and hospital leaders, but not implemented by CMS due to “complexity.”
DRUGS & DEVICES
Cardiac Care Device Cost: Wenzl and Mossialos write in this month’s Health Affairs (here) that prices for cardiac implant devices in the U.S. may be up to six times higher than in some European countries. Their study also confirmed earlier findings of significant price variation between hospitals.
EVENTS & MEETINGS
Oct. 12
2:20 p.m., CQ Panel Discussion on disruption in the health care industry and the future of health care delivery, with Larry Merlo, president and CEO of CVS Health, The Economic Club of Washington, DC, 1331 Maryland Ave SW, Grand Ballroom, RSVP to media@economicclub.org, Contact: (202) 223-3959
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
9:30 a.m., U.S. Chamber of Commerce seventh annual Health Care Summit, press invited at 202-463-5682.
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: 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