DCMedical News: Monday, February 11, 2019
DCMedical News-DCMN
Washington, D.C.
Monday, February 11, 2019
The publication schedule and subscription information for DCMedical News will be found below.
THE BIG STORY IN HEALTH CARE:
Congress, Continued:
Medicare Negotiating Drug Prices: Democratic Senators Sherrod Brown, Amy Klobuchar (the latest to announce her candidacy for President) and Tammy Baldwin and House Ways and Means Committee Health Subcommittee Chair Lloyd Doggett and 100 House co-sponsors have introduced a bill (here) which would require HHS to negotiate prices for drugs covered by Medicare Part D and MA plans. Criteria for such negotiation would include: “(A) The comparative clinical effectiveness and cost effectiveness, when available from an impartial source, of such drug. (B) The budgetary impact of providing coverage of such drug. (C) The number of similarly effective drugs or alternative treatment regimens for each approved use of such drug. (D) The associated financial burden on patients that utilize such drug. (E) The associated unmet patient need for such drug. (F) The total revenues from global sales obtained by the manufacturer for such drug and the associated investment in research and development of such drug by the manufacturer.”
Senate Hearing: Bloomberg reports that all seven major pharmaceutical companies invited by Senate Finance Committee Chairman Chuck Grassley will testify on drug prices February 26, perhaps hoping to avoid a picture reminiscent of CEOs of another unpopular industry on April 15, 1994 (here).
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Low Dose Computed Tomography Screening for Lung Cancer, 16% Reduction in Mortality, 22% Costly False Positives:
A University of Florida / MD Anderson group reported in JAMA Internal Medicine (here) that the new Medicare lung cancer screening benefit comes with hidden costs, greater than those shown in clinical trials which preceded establishment of the benefit. The complication rates and resulting medical costs associated with invasive diagnostic lung cancer screening were summarized as follows: “In this cohort study of 344,510 patients in national databases, the estimated complication rate was 22.2% for individuals in the younger age group (55-64 years) and 23.8% for those in the Medicare group (65-77 years). The complication costs varied by patient age and complication type, ranging from $6,320 to $56,845.”
Bitter Dispute Gets More So Over “Maintenance of Certification”:
Individual physicians and ad hoc groups (including a “GoFundMe” campaign) opposed to the American Board of Internal Medicine’s “Maintenance of Certification” requirements filed an amended complaint (here) alleging that “ABIM has successfully waged a campaign in violation of RICO [Racketeer Influences and Corrupt Organizations act] to deceive the public, including but not limited to hospitals and related entities, insurance companies, medical corporations and other employers, and the media, that MOC, among other things, benefits physicians, patients and the public and constitutes self-regulation by internists. Believing ABIM’s misrepresentations to be true, hospitals and related entities, insurance companies, medical corporations and other employers require internists to participate in MOC in order to obtain hospital consulting and admitting privileges, reimbursement by insurance companies, employment by medical corporations and other employers, malpractice coverage, and other requirements of the practice of medicine.”
MOC began as ABIM’s “Continuous Professional Development Program” in 1974; unsuccessful as a voluntary program, according to the suit, MOC was revived when ABIM announced that internal medicine board certification would have to be periodically renewed, although internists “board certified” prior to 1990 were “grandfathered.” Interim requirements (acquiring CME “points,” completing “MOC activity,” changing the every-ten-years recertification period to every-five-years, interim program fees, “knowledge check in” tests in lieu of more rigorous recertification exams) took place in 2006, 2014 and 2018, all intended, according to the suit, to produce income for ABIM. PPACA included a temporary .5% increase in physician fees for MOC.
HOSPITALS AND OTHER HEALTH CARE FACILITIES
Cancer the Big Financial Ticket for London’s Private Hospitals:
The Financial Times (here) reports that “Private medical insurance still accounts for the bulk of private hospital earnings in the UK capital, but this has been falling by about 3 per cent a year as companies cut back on employee benefits . . . an increase in individuals paying for their own treatment as a result of long NHS waiting lists has helped to compensate and now accounts for about a quarter of income. Oncology — which includes immune and radio therapies — is now the largest and fastest growing speciality by revenue in the private hospital market, followed by orthopaedics, such as hip and knee operations, and cardiology.”
MEDICARE, MEDICAID, COMMERCIAL HEALTH INSURANCE
Managed Medicaid Profitability:
Centene chief executive Michael Neidorff reported (transcript here) to analysts that “2018 was another year of strong growth and accomplishment for Centene, capped off by the robust fourth-quarter results we reported this morning. In 2018, we added 1.8 million members, surpassing the 14 million mark. We grew revenues by 24% to $60.1 billion and adjusted EPS by 41% to $7.08.” The company has Managed Medicaid contracts in 31 states, most recently through a joint venture with the medical society and a group of FQHCs in North Carolina. The company also provides correctional health services in 15 states.
Medicare’s Value Based Insurance Design (VBID) “Year One” Report:
A webinar on Year 1 results on the 14th; register here https://engage.vevent.com/index.jsp?eid=5779&seid=1378
DRUGS AND DEVICES
Outcomes-Based Contracts get Boost from Pharma and from Pharma-Supported Advocacy Groups: the “PAVE Act” (here, for Patient Affordability, Value and Efficiency) would exempt “performance-based” drug payment contracts from existing safeguards in the Medicaid best price rule, the Anti-Kickback Statute and the Stark self-dealing prohibitions. The senators sponsoring the bill are asking for feedback to be submitted no later than February 19, 2019. Comments and feedback can be submitted via email to Senator Cassidy (a gastroenterologist) at paveact@cassidy.senate.gov or Senator Warner at paveact@warner.senate.gov. CMS has already approved “outcome-based” pharma contracts by the Oklahoma and Michigan Medicaid programs.
READING AND REFERENCES
“Why is Medicine So Expensive?” Daniel Kevles reviews three new works for The New York Review of Books, and in doing so writes a history of drug policy in the U.S., here.
“The New 'Golden Age' of Medicine: 'There's No Better Time to Be a Doctor'” by Arlen Meyers, Doximity News, here, a discussion of roles and perspectives on opportunities for physicians.
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: 12, 13, 14, 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.