DCMedical News: Friday, January 11, 2019
DCMedical News-DCMN
Washington, D.C.
Friday, January 11, 2019
DCMedical News is published every day either the House or the Senate is in regular session.
THE BIG STORY IN HEALTH CARE:
Drugs, Drug Prices, Drug Policy: Senators Sanders and Klobuchar introduce a bill (summary here) to require the administration to develop regulations for the importation of drugs from Canada, certifying which Canadian pharmacies are eligible to send drugs across the border, excepting controlled substances. Background in the summary presented in support of the “The Affordable and Safe Prescription Drug Importation Act” says “In 2017, the U.S. spent about 40 percent more on prescriptions per person than Canada, twice as much as the average major industrialized country, and more than three times as much as Denmark”; that 20% of adults did not fill a prescription in the last year because they could not afford it; that 8% of American adults have already imported a drug at some point to get a lower price; and that 72 percent of Americans favor steps to allow prescription drugs to be purchased and imported from Canada. Independently, Senate Finance Chairman Grassley has offered his own import bill, here.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Private Equity Buying Physician Practices: Casalino and colleagues publish a study of the phenomenon in the Annals of Internal Medicine (here). In sum, “Acquisition of physician practices by private equity firms has increased dramatically during the past few years. Such acquisitions are a significant phenomenon with unknown consequences for physicians and patients, although they have received little attention from researchers and policymakers.” Unintended consequences (higher prices, less access, bureaucracy) followed the wave of hospital acquisition of physician practices, may be repeated by private equity. FierceHealthcare reports on the study that “The private equity firms typically take anywhere from 60% to $80% ownership, although they will sometimes accept minority ownership in a very large practice. The amount paid to practice owners varies but can be as much as $1 million to $2 million per physician, the researchers said. The equity firms look to sell the practice within three to seven years. The focus has been on specialties that have the potential to bring in additional income from elective procedures and ancillary services. Dermatology has been a major focus, with an increase in interest in ophthalmology, urology and gastroenterology practices.”
The study follows on a December effort by an association of urologists to publicize a survey (here) of “1,191 adults that revealed more than sixty percent of adult Americans are concerned about the impact of hospital mergers and acquisitions on their access to affordable care, with 25 percent reporting that this increasing trend is a threat to their health. Additionally, the survey found that patients trust smaller enterprises, such as independent physicians, more so than those employed by hospital systems . . . The poll also revealed more than two-thirds of American adults want a solution to the growing trend of hospital purchases of independent practices, and the single most desired solution is requiring insurers to compensate all medical practices equally,” site neutrality, a key change in Medicare physician payments for 2019.
MEDICARE, MEDICAID, COMMERCIAL HEALTH INSURANCE
Medicaid, Pending Changes in 2019, Compendium: Virginia Medicaid expansion begins this week; Maine’s new Governor signs an executive order to begin expansion of that state’s program. New Hampshire and Indiana begin to phase in work requirements. Three states (Idaho, Nebraska, Utah) have approved but as yet have not implemented Medicaid expansion programs, with the ballot initiatives now pending legislative action. Potential future expansion: Kansas, North Carolina, Wisconsin. Work programs: Arkansas, now with 17,000 individuals terminated; Kentucky, disallowed by a judge, new version expected in April. Comments on the proposed work requirement in Virginia were due this week. New Hampshire work requirements began Tuesday. Indiana work requirements will phase in over six months.
More on DSH: Senator Rubio entered the fray concerning allocation of Disproportionate Hospital Share (DSH) funds, a $12 billion pool of federal money meant to supplement Medicaid payments to hospitals serving a “disproportionate” government patient volume. His “SAFE” Act (proposed bill here, news release here)“[C]hanges the DSH allocation formula so states’ allocations are based on the number of low-income earners living in the state, as a percentage of the total U.S. population earning less than 100% of the Federal Poverty Level (FPL); “Expands the definition of uncompensated care to include costs incurred by hospitals to provide certain outpatient physician and clinical services”; and “Allows states to reserve some of their DSH funding allocations to be used in future years in order to give hospitals more certainty or consistency in the amount of DSH funding they can expect.” The news release announcing the Senator’s initiative noted that, for example, hospitals in his home state of Florida receive less money than those in Connecticut. Some $4 billion of the DSH pool is scheduled to disappear October 1 barring Congressional action to defer that reduction, reallocate funds, or both.
READINGS & REFERENCES
U.S. House of Representatives: Members at https://www.house.gov/representatives, Committees and Members at https://www.house.gov/committees
U. S. Senate: Members at https://www.senate.gov/general/contact_information/senators_cfm.cfm, Committees and Members at https://www.senate.gov/committees/membership_assignments.htm
House and Senate 2019 Calendar of Regularly Scheduled Sessions, here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
Publication dates are the regularly scheduled days the House or the Senate is in session.
Remaining January publication dates: 14, 15, 16, 17, 18, 28, 29, 30, 31
February publication dates: 1, 4, 5, 6, 7, 8, 11, 12, 13, 14, 15, 25, 26, 27, 28
March publication dates: 1, 4, 5, 6, 7, 8, 11, 12, 13, 14, 15, 25, 26, 27, 28, 29
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.