DCMedical News: Wednesday, February 6, 2019
DCMedical News-DCMN
Washington, D.C.
Wednesday, February 6, 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:
The President delivered his State of the Union address. A key new health proposal is to eliminate HIV/AIDS by 2030; early challenges would involve protecting the HIV drugs in the shift of drug protected classes in Medicare Part D drug plans; funding for education and training program cut backs in the Administration’s 2019 budget; protection for coverage of pre-existent conditions in health insurance plans; and Medicaid expansion. (See, for example, this 2017 Kaiser Family Foundation study (here) of insurance coverage for people with HIV under the Patient Protection and Affordable Care Act.)
Several Senators had invited as some of their guests victims of outrageous drug prices, surprise bills—see letter to health insurers from six Senators here--and shoddy insurance coverage.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Senate Chairman of Health, Education, Labor and Pensions Committee on Primary Care:
Senator Lamar Alexander and the HELP Committee heard from four witnesses on innovations which might help primary care be more cost-effective in the health care system. “We’re not going to have less expensive health insurance until we have less expensive health care costs,” Alexander said. “While there are no silver bullets in life, I’ve learned there are sometimes levers that can make a difference, and primary care seems to be a logical, sensible focus for anyone seeking to improve outcomes, improve experiences and lower costs.”
The witnesses before the HELP Committee included Katherine Bennett, MD, Assistant Professor of Medicine and Program Director of the Geriatric Medicine Fellowship, University of Washington, testimony here; Sapna Kripalani, MD, FACP
Assistant Professor of Medicine, Vanderbilt University Medical Center, testimony here; Joshua J. Umbehr, MD
Co-Founder AtlasMD Family Practice, Wichita, Kansas, testimony here; and Tracy Watts, Senior Partner, National Leader for US Healthcare Reform, Mercer, testimony here.
Dr. Bennett said many older Americans receive suboptimal care, and would benefit from a model called ECHO, Extension for Community Health Outcomes. Dr. Kripalani testified that primary care was undervalued, and that perhaps telehealth or shared medical appointments would help. He added, “For every hour of face-to-face patient encounters, we must spend an additional 1-2 hours completing documentation and administrative tasks. This is unsustainable and leads many primary care doctors to leave the work force.” Dr. Umbehr espoused the benefits of direct (insurance free) care. Ms. Watts testified that the 2500 employers participating in Mercer’s National Survey of Employer-Sponsored Healthcare Plans have shown “an increase in the prevalence of onsite or near site clinics providing non-occupational health services, particularly among very large employers. General medical clinics are offered by 31% of organizations with 5,000 or more employees (up from 24% in 2012 and just 17% in 2007).” The goals of onsite clinics said Ms. Watts, were “(i) better managing overall health spend, (ii) reducing member health risk, (iii) reducing absenteeism/presenteeism and (iv) increasing employee productivity and (v) chronic condition management.” Traditional company clinic services were, generally, the opposite of primary care provided by physicians, without continuity or ongoing clinical management, focused primarily on the company’s interests.
AAMC Comments on EHR Simplification Proposals from ONC
The Association of American Medical Colleges submitted comments (here) in response to proposals from the “Office of the National Coordinator” to simplify and/or make more effective electronic health record technology. The trade group linked excessive and mis-directed EHR complexity to physician well-being, noting “Excessive documentation requirements have made it difficult for physicians and other health care professionals to locate important information in the medical record about the patient’s current condition, recent changes, and the plan of care in the medical record. The medical record has become bloated in order to meet billing rules, which has led to difficulties in following the care and proposed management of patients and has impeded quality care in some cases.” They also don’t like collapsing levels 2-4 for Evaluation and Management ambulatory service payment coding beginning in 2020.
Medical “Over-Use”
The fifth annual compendium of articles on “medical overuse” was published this week (here) in JAMA Internal Medicine. Among the findings: “[U]necessary electrocardiograms are common (performed in 22%of patients at low risk) and can lead to a cascade of services, lipid monitoring rarely affects care, patients who were over diagnosed with cancer experienced anxiety and criticism about not seeking treatment, calcium and vitamin D supplementation does not reduce hip fracture (relative risk, 1.09; 95%CI, 0.85-1.39), and pregabalin does not improve symptoms of sciatica but frequently has adverse effects (40% of patients experienced dizziness). Antipsychotic medications increased the severity of delirium in patients receiving hospice care and were associated with an increased risk of death (hazard ratio, 1.7; P = .003), and robotic-assisted radical nephrectomy was without benefits by being slower and more costly than laparoscopic surgery. High-sensitivity troponin testing often yielded false-positive results, as 16% of patients with positive troponin results in a US hospital had a myocardial infarction. One-third of patients who received a diagnosis of asthma had no evidence of asthma.”
DRUGS AND DEVICES
Clues on Drug Price Controls Which May Pass: At the AcademyHealth meeting Tuesday Wendell Primus, long-time health adviser to House Speaker Pelosi, said that he saw three legislative ideas which would enjoy bipartisan support in both the House and the Senate, dismissing other proposals seen as too grand. The three likely-to-pass proposals, according to Primus, were (1) plans to give legal remedies to generic drug makers now blocked from obtaining samples of the drug they would like to copy; (2) banning legal settlements over patent disputes from delaying the entry of generic drugs; and (3) legislation to stop pharmaceutical manufacturers from withholding negotiated discounts from Medicaid programs.
Beleaguered PBM Trade Group Begins Ad Campaign: Sample, here.
READING AND REFERENCE
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: 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.