DCMedical News: Monday, February 4, 2019
DCMedical News-DCMN
Washington, D.C.
Monday, February 4, 2019
DCMedical News is published every day either the House or the Senate is in regular session.
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THE BIG STORY IN HEALTH CARE:
Moving on. The President delivers his delayed State-of-the-Union address tomorrow night, likely health subjects “surprise” (out-of-network) billing and drug price control (see “Drugs,” below). Georgia Gubernatorial candidate Stacey Abrams delivers the “response,” her campaign having been strongly supportive of Medicaid expansion.
An active Congressional hearing schedule this week includes a Senate HELP Committee hearing Tuesday on primary care and health costs and a House Energy and Commerce Committee hearing Wednesday on the Texas v. Azar PPACA case and health insurance protection for patients with pre-existent conditions.
HOSPITALS AND OTHER HEALTH CARE FACILITIES
You Know About Blockchain in Healthcare, Right?
Well, there are blocks . . then some chains of blocks . . An essay in Healthcare Financial Management (here) provides help, noting that “Providers, both for-profit and not-for-profit, are investing in blockchain at record levels—as are insurers and technology vendors. A 2018 study found that blockchain investment was up 316 percent in the previous year.” Investing with what expectations? “The networks that will make a splash in 2019 are in supply chain, credentialing, provider directories, and contracting. This reality may not hold the same appeal as some of the more visionary applications, but the networks that succeed will have tackled and addressed a complex set of technical and nontechnical variables that so far have put many use cases out of reach.”
MEDICARE, MEDICAID, COMMERCIAL HEALTH INSURANCE
Race to the Bottom:
RWJ and the Urban Institute supported Corlette and colleagues at the Georgetown Center on Health Insurance Reforms in a study (here) of marketing for PPACA-compliant (“Essential Health Benefits,” maternity, mental health, no disqualification for pre-existent conditions) vs. non-compliant (Short Term Limited Duration Insurance) plans. “Our marketing scan suggests that consumers shopping online for health insurance, including those using search terms such as ‘Obamacare plans’ or ‘ACA enroll,’ will most often be directed to websites and brokers selling STLDI or other non–ACA compliant products. These websites and brokers often fail to provide consumers with the plan information necessary to inform their purchase. Brokers selling STLDI over the phone push consumers to purchase the insurance quickly, without providing written information.” States lack the resources or skills to prevent the misleading of consumers, say the authors.
Commercial Success:
4th quarter earnings report (transcript here) for CIGNA shows “Our full-year consolidated adjusted revenue increased by 15% to $48 billion and we reported full-year adjusted income from operations of $3.6 billion or $14.22 per share representing a per share increase of 36%.”
DRUGS AND DEVICES
New Rule Proposed to Prohibit Drug Rebates to PBMs in Medicare and Medicaid:
HHS Secretary Alex Azar and Inspector General Daniel Levinson issued a proposed rule (here, CMS Fact Sheet here, news release here, see also DCMN 2-1-2019) “Fraud and Abuse; Removal of Safe Harbor Protection for Rebates Involving Prescription Pharmaceuticals and Creation of New Safe Harbor Protection for Certain Point-of-Sale Reductions in Price on Prescription Pharmaceuticals and Certain Pharmacy Benefit Manager Service Fees.” An HHS announcement says “The Department’s Medicare Part D analysis in the rule is based on the CMS Office of the Actuary’s work commissioned specifically for this rulemaking [here] and two commissioned actuarial analyses independent of the CMS Office of the Actuary,” a Milliman study here, a Wakely study here.
Forbes’ Avik Roy analyzes (here) the new rule for pharmacy benefit managers, part of his larger exegesis of pharmaceutical economics (here, Roy’s testimony before the House Oversight and Reform Committee). The largest publicly-traded PBMs are UnitedHealth’s OptumRx, CVS Health’s Caremark and Cigna’s Express Scripts.
READING AND REFERENCE
Site Neutral Medicare Payment: Suit as filed January 18, here. Assessment of “exceptions” under the final OPPS rules, here.
Super Bowl Player Census: at https://www.census.gov/library/visualizations/interactive/big-game-census-2019.html?utm_campaign=20190203msdvzs1ccdtars&utm_medium=email&utm_source=govdelivery. Among the teams from California and Massachusetts are players from 27 states and 3 countries.
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 February publication dates: 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.