DCMedical News: Friday, November 16, 2018
DCMedical News-DCMN
Washington, D.C.
Friday, November 16, 2018
DCMedical News is published every day either the House or the Senate is in session. See scheduled sessions at the bottom of this newsletter. Subscribe to ensure continued receipt of your copy.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Electronic Health Record as Safety Hazard in Pediatrics: Health Affairs (devoted this month to patient safety matters) has an article (here) on the hazard of electronic health records to pediatric care. The focus is on medication error. The study was of 9,000 patient safety reports over a five-year period at three different health care institutions. Of the 9,000 such reports, 36% had a “usability” issue which contributed to the medication “event,” and 19% had an issue that “might have resulted in patient harm.” The most common medication error was improper dosing.
HOSPITALS AND OTHER HEALTH CARE FACILITIES
Attack on GPOs: Dr. Martin Makary (and colleagues) publish on group purchasing organizations (GPOs) and the impact they may have on undermining price competition and limiting hospital access to supplies (JAMA, here).
Like PBMs (Pharmacy Benefit Managers), GPOs are classic American middlemen, substituting their work for direct contracts between hospitals and manufacturers. GPO use by hospitals has grown to 98%, with the four largest GPOs in the U.S. accounting for 90% of the market for medical supplies. A 1987 exemption to the Anti-Kickback Statute has allowed a “safe harbor” for GPOs, enabling them to pursue “creative strategies [especially rebates from manufacturers]…to increase their profits.” Now GPOs can be paid by manufacturers as a condition of having products made available to hospitals. Even higher (“Premium”) fees allow manufacturers to become sole suppliers, “allowing the manufacturer that is the highest bidder to essentially purchase market share, rendering hospitals and patients dependent on a single manufacturer’s supply chain.”
Makary and colleagues note that a 2016 U.S. GAO report (here) concluded that there was a strong association between drug shortages and a decline in the number of drug suppliers, secondary to group purchasing. A U.S. Senate Finance Committee report (here) in 2010 indicated there was “no empirical, peer-reviewed data to support GPO industry claims that these organizations generate hospital cost savings.” A study in the Harvard Business Review (here) in 2010 indicated that payments from manufacturers to GPOs inflated health costs by an estimated $37.5 billion annually. The 2010 HBR paper focused on “perverse incentives” in the GPO compensation structure; in addition, hospital executives may benefit personally through participation in group purchasing organization investment or ownership.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
More Middlemen? Commonwealth Fund’s David Blumenthal and co-authors recommend employers form purchasing alliances. In Harvard Business Review, here.
READINGS AND REFERENCES
OIG on Hospital Tax Programs: The HHS Office of Inspector General reports on “Hospital Tax Programs” in seven states, brief here, full report here. The programs enable states to collect “tax revenue” from their hospitals and to use the proceeds as a portion of the state’s matching share of Medicaid payments. This results in a larger draw-down of federal matching funds.
Seven states studied by the OIG collected $38.4 billion in “Medicaid taxes” from hospitals In the years 2011-2015. These funds were used by those states for Medicaid matching. This “matching” by the states resulted in a federal draw down of $54.6 billion, and a total expenditure of $93 billion. The OIG report summarized compliance with the rules of the match for the largest of these hospital tax programs, in California, Illinois, Indiana, Michigan, Missouri, Ohio and Pennsylvania.
U.S. Preventive Services Task Force: The group makes its annual report to Congress (summary here, full report here) on “High-Priority Evidence Gaps for Clinical Preventive Services.” The group identifies three such gaps, related to cancer prevention (cervical and prostate cancer screening, behavioral counseling for skin cancer) and four gaps in cardiovascular health (screening for A-Fib, CV disease risk, non-traditional risk factors, peripheral artery disease).
EVENTS & MEETINGS (Events Newly Added to This List Noted in Contrasting Color)
Nov. 16
9:30 a.m. to 11:45 a.m., The Century Foundation, Health Affairs, the Commonwealth Fund, present a star panel (e.g. Wagner Dean Sherry Glied on Medicare-Like Plans for the 2020 Health Reform Debate) on “Health Reform: From the Midterms to 2020,” National Press Club, announcement here.
Nov. 19
2:00 p.m. to 3:30 p.m. EST, a Medicare Learning Network Update on the Calendar Year 2019 Physician Fee Schedule Final Rule. The Rule, scheduled to be published Nov. 23, is here; the press release is here; the fact sheet is here; the E&M payment chart is here; the Quality Payment Program “Fact Sheet” for Year 3 is here; and the Quick Start Guide for MIPS 2019 participation is here.
Nov. 27
9:00 a.m., The American Enterprise Institute for Public Policy Research (AEI) holds a discussion on "The new Medicare physician payment regulation: What does it mean for physicians and patients?" Seema Verma, Robert Berenson, AHIP, AMA. Contact: 202-862-5829 mediaservices@aei.org
9:00 a.m., Duke Margolis Center on “Root Causes of Drug Shortages and Finding Enduring Solutions,” Washington Marriott Metro Center, (McClellan, Gottlieb, FDA panel), agenda here.
Nov. 28
10:00 a.m., Senate HELP Committee Hearing: Reducing Health Care Costs: “Improving Affordability Through Innovation,” 430 Dirksen Senate Office Building, announcement here.
Nov. 29
The “Office of the National Coordinator” annual meeting, continuing November 30, two day tentative agenda (Jared Kushner!) here.
8:00 a.m. to 11:00 a.m., STAT Plus correspondents in a discussion of drug pricing, at Hogan Lovells in Washington, information at https://www.statnews.com/conversation-drug-pricing-2019/?utm_source=STAT+Newsletters&utm_campaign=bb45b691af-STATPlus_1113_event_subs_COPY_01&utm_medium=email&utm_term=0_8cab1d7961-bb45b691af-149691333
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
November publication dates: 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