DCMedical News: Tuesday, February 5, 2019
DCMedical News-DCMN
Washington, D.C.
Tuesday, February 5, 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:
State of the Union:
Tonight at 9:00 P.M. Eastern. The President will ask Congress to help him bring down the price of drugs (reports CQ), manage surprise (out-of-network) bills from health professionals, and embark on a new campaign against HIV (reports Politico).
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
This might have helped before HITECH:
Authors from the MedStar Center for Human Factors in Health Care write in JAMA this week (here) that “Overcoming usability challenges that have affected HIT for the last decade will require shared responsibility and greater collaboration among vendors, researchers, policy makers, health care organizations, clinicians, and patients . . . success is dependent on . . . vendors who should now consider greater transparency of their products . . because another decade of poor usability and related patient safety challenges would be unbearable, especially for patients.”
HOSPITALS AND OTHER HEALTH CARE FACILITIES
Hospital Price Increases Exceeded Those for Physician Services, by a Factor of 2.5x, 2007-2014
Health Affairs publishes (here) an analysis of cost increases based on Hospital Care Cost Institute data (Aetna, Humana, Kaiser and, until this week, UnitedHealth). A report on the work (here) in Modern Healthcare notes “For inpatient care, hospital prices grew 42% from 2007 to 2014 while physician prices rose 18% . . . Similarly, for hospital-based outpatient care, hospital prices increased 25%, while physician prices grew 6%.” Cooper, Gaynor, Krumholz and colleagues mince no words in discussing the implications: “Our work suggests that efforts to reduce health care spending should be primarily focused on addressing growth in hospital rather than physician prices. Policy makers should consider a range of options to address hospital price growth, including antitrust enforcement, administered pricing, the use of reference pricing, and incentivizing referring physicians to make more cost-efficient referrals.”
Hospitals Under Financial Attack for “Cost Shifting/Price Gouging” in Colorado
Modern Healthcare reports (here) that Colorado’s Governor has sponsored a report (here) which holds that “this cost shift was not the fault of low-ball payments to hospitals from Medicare or Medicaid . . . the shift was likely due to overall growth in hospitals' spending and profits. In 2017, for instance, hospitals charged privately insured patients $1.2 billion more than was needed to cover losses from treating Medicare and Medicaid patients.” The hospitals had preemptively issued their own report on costs, here.
MEDICARE, MEDICAID, COMMERCIAL HEALTH INSURANCE
Optum to Manage VA Private Access:
The VA award calls for “Optum to manage provider networks within Community Care Network, the next program for veterans to obtain health care services from private clinics depending on drive-times to a VA Medical Center and waits for care in the government-run system.” The contracts are worth up to $55 billion.
Economies of Scale in Health Insurance Plan Size? Not Really:
Sherlock’s Plan Navigator for February (here) discusses economies of scale in health insurance plan management. Background: “Economies of scale occur when per unit costs decline as volume of output increases. The ‘output’ of a health plan is health coverage services to its members. The units of output are members per month, so the expenses potentially subject to economies of scale is administrative costs, expressed in Per Member Per Month (PMPM). The administrative costs that are the subject of this analysis are: claims, customer services, enrollment and so forth. Each reporting plan reported its costs segmented into more than sixty functions, allowing each of the activities to be analyzed individually.”
Results: “If calculated based on total administrative costs, economies of scale of administrative expenses are not very significant or meaningful.”
READING AND REFERENCE
Academic Health Policy Wonkery?
AcademyHealth kicked off its “National Health Policy Conference” with remarks by HHS Secretary Azar (here). Two-day agenda (here) highlights journalists and politicians, academics not so much.
Opioid Litigation:
Massachusetts Attorney General’s Complaint (277 pgs., here) in COMMONWEALTH OF MASSACHUSETTS v. PURDUE PHARMA L.P., RICHARD SACKLER, and others, KHN coverage here.
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: 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.