DCMedical News: Tuesday, February 12, 2019
DCMedical News-DCMN
Washington, D.C.
Tuesday, February 12, 2019
The publication schedule and subscription information for DCMedical News will be found below.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Impact of consolidation on quality and cost, cardiology practices: Koch and colleagues report in Health Services Research (headnote here) that a study of eight years’ of Medicare enrollment and claims data “[F]inds that an increase in consolidation leads to statistically and economically significant increases in negative health outcomes” and that “[I]ncreases in cardiology market concentration are associated with worse health outcomes and higher health care expenditures.”
P4P—Hard to Kill, Hard to Credit: In JAMA Network (here) Navathe and colleagues from Penn note this: “Despite limited effectiveness of pay-for-performance (P4P), payers continue to expand P4P nationally.” They undertook a study, “To test whether increasing bonus size or adding the behavioral economic principles of increased social pressure (ISP) or loss aversion (LA) improves the effectiveness of P4P.” Results? Money works, behavioral economics/P4P does not. “Increased bonus size was associated with significantly improved quality of care relative to a comparison group. Adding ISP and opportunities for LA did not improve quality.”
HOSPITALS AND OTHER HEALTH CARE FACILITIES
“The hospital industry claims that mergers result in better care. Evidence shows otherwise.” So reads the subtitle on an article by Austin Frakt (“The New Health Care,” here) in The New York Times. Frakt summarizes the evidence concerning consolidation and quality, citing especially Carnegie Mellon’s Martin Gaynor: “[E]vidence from three decades of hospital mergers does not support the claim that consolidation improves quality.” In fact, according to Gaynor, “When prices are set by the government, hospitals don’t compete on price; they compete on quality.”
Falling U.S. Birth Rates Draw International Attention: The Financial Times presents a graphic (here) based on the work of Buckles, Guidi and Schmidt, Fertility Trends in the United States 1980 – 2017 (here), with special focus on the decline in unintended births. The U.S. birth rate, as previously noted in DCMN, reached an historic low in 2017, with 60.2 births per 1,000 women age 15 – 44, a 13% decline over the previous ten years.
MEDICARE, MEDICAID, COMMERCIAL HEALTH INSURANCE
Commonwealth Fund Reports on the state of health insurance eight years after passage of PPACA: In sum, fewer uninsured, shorter coverage gaps, more underinsured, paper here, news release here.
Waivers Left and Right? CMS’ policy on Medicaid waivers and speculation about “liberal” as well as “conservative” state waivers reached the national audience Monday (here). A Wall Street Journal column focused on the fact that Medicaid waivers had been granted to Republican-led states which had been given the authority to require Medicaid recipients to be work eligible. Now, the column asks, will waivers be given to Democratic-run states which are poised to ask for approval to expand coverage, including statewide single-payer or public health options?
UnitedHealth Becomes a $226 Billion Company, Optum $101 Billion of That Total: Form 8k filing through 1-15-2019, here.
DRUGS AND DEVICES
“Big Pharma’s Big Cancer Hope is Fizzling”: If your business model is to develop high profile, very expensive drugs which are complicated and labor intensive to administer, designed to treat a fairly small number of patients with a one-time treatment, you may not be headed for prosperity, says a “Heard on the Street” column in the Wall Street Journal Monday (here). One big (financial) disappointment: CAR-T, the chimeric antigen receptor T-cell therapy, which has extraordinary list prices, possibly “dangerous side effects. Only a relatively small number of hospitals are certified to administer the treatment because it is complicated and labor intensive. Clinical trial results needed to expand the market…are likely years away…”
READING AND REFERENCE
Primer on Drug Prices and Medicare:
Kaiser Family Foundation, “10 Essential Facts About Medicare and Prescription Drug Spending,” here.
Also, KFF, a graphic, “Medicare’s Share of Prescription Drug Spending Increased More than 10% Since 2006” (18% of the total to 30% of the total), here.
“Out of Pocket Cost Burden of Specialty Drugs in Medicare Part D in 2019,” here.
Kaiser Health News, “Winners and Losers Under Trump Plan to Slash Drug Rebate Deals,” 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: 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.