DCMedical News: Tuesday, February 26, 2019
DCMedical News-DCMN
Washington, D.C.
Tuesday, February 26, 2019
The publication schedule and subscription information for DCMedical News will be found below.
THE BIG STORY IN HEALTH CARE:
Drug Prices:
The Senate Finance Committee will hear this morning (committee agenda here) from the chief executives of seven pharmaceutical companies, a discussion about drug pricing. Kaiser Health News has a nice piece (here) on the history of Congressional inquiry concerning drug prices (at least one major inquiry each decade for sixty years), beginning with the Kefauver hearings: “[T]he subjects likely to surface Tuesday — high drug prices and profits, limited price transparency, aggressive marketing, alleged patent abuse and mediocre, ‘me-too’ drugs — are identical to the issues senators investigated decades ago, historical transcripts show.” PhRMA, meanwhile, issued a Milliman “poster report” (here) showing how “Sharing Negotiated Discounts Could Save Some [fill in the name of a state with a Senator on the Finance Committee] Patients $1,000 at the Pharmacy Counter” and why “Sharing all of the negotiated rebates and discounts with patients may increase premiums 1 percent or less.”
Fraud, Drugs and Pain:
The House voted to support a bipartisan measure (HR 525, here) to codify the “public-private partnership (in this paragraph referred to as the ‘partnership’) of health plans, Federal and State agencies, law enforcement agencies, health care anti-fraud organizations . . . for purposes of detecting and preventing health care waste, fraud, and abuse” and to “enter into a contract with a trusted third party for purposes of carrying out the duties of the partnership” with a particular charge to “perform an analysis of aberrant or fraudulent billing patterns and trends with respect to providers and suppliers of substance use disorder treatments.”
CMS, meanwhile, expands its efforts (bulletin, here) to promote non-opioid pain management in the Medicaid program.
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
California Had 43, Texas 5, New York 7:
Healthgrade’s “top hospitals,” that is, list here. The scoring group, which advertises that its ratings are based on clinical metrics, rather than (e.g. U.S. News) “reputational” quality, chose a total of 250 hospitals, about 5% of the nation’s total. Thirteen of the California facilities were Kaiser hospitals, twelve California hospitals were in the top 1%.
Tenet 10-K Report (here) for the Period Ending 12-31-2018:
Net operating revenue $18.3 billion for the year, income from continuing operations $463 million (-$320 million in 2017) from 68 hospitals and 227 ambulatory facilities, expense per adjusted patient admission (Q4) $10,861, 428 pages, a course in health care finance.
Low Value Procedures Bring Additional (Hospital Acquired Conditions, HACs) Harms to Patients:
An Australian study in JAMA Internal Medicine (here) noted that “Studies of low-value care have focused on the prevalence of low-value care interventions but have rarely quantified downstream consequences of these interventions for patients or the health care system.” Across the 225 hospitals and 9330 episodes of low-value care, rates of HACs were low for low-value endoscopy, knee arthroscopy and colonoscopy but higher for low-value spinal fusion, endovascular repair of abdominal aortic aneurysm, carotid endarterectomy and renal artery angioplasty. The most common HAC was health care–associated infection, which accounted for 26.3% of all HACs observed.
MEDICARE, MEDICAID, COMMERCIAL HEALTH INSURANCE
HHS’ “Office of National Coordinator” for Health Information Technology Proposes 687 Pages of New Requirements:
The draft regulations, to be published in the Federal Register March 4 (here), bring important new requirements for IT developers, certifiers and users, including “conditions” and “maintenance of certification” requirements for developers.
Urban Institute Finds Slower Growth in Public Health Programs:
In a study of the National Health Expenditures, the Urban Institute found (here) that “Medicare and Medicaid have successfully moderated growth in spending per enrollee over the last decade and do not require major restructuring to lower national health spending. Overall, Medicare and Medicaid are doing a good job of keeping per capita costs under control, and the continuation of recent policies is critical to sustain this control. The larger cost containment problems the nation faces are in the private insurance market.” Highlights: Between 2006 and 2017 Medicare spending per enrollee grew 2.4% per year, Medicaid 1.6% per year, private enrollees 4.4% per year.
What is ABC Up To?
The Amazon-Berkshire Hathaway-JPMorgan joint venture was the subject of testimony by its COO unsealed in a Boston courtroom where UnitedHealth’s Optum was seeking to keep a former executive from ABC’s employ (WSJ story here). The “unsealed” testimony revealed an interest by the new venture in primary care, benefit design, the reduction of complexity, waste, variation, etc., namely everything and nothing, that is, nothing actually revealed.
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
Remaining February publication dates: 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.