DCMedical News: Tuesday, March 5, 2019
DCMedical News-DCMN
Washington, D.C.
Tuesday, March 5, 2019
The publication schedule and subscription information for DCMedical News will be found below.
THE BIG STORY IN HEALTH CARE:
“Patient Safety Penalties” to Cost 800 Hospitals 1% of Their Medicare Payments:
CMS released the list of hospitals suffering penalties for 2019 (pdf here, sortable Excel file here) because they fell in the bottom quartile of hospitals for patient safety violations. The list excludes the 1300+ Critical Access Hospitals, all Maryland hospitals (saving money in an all-payer system, see below) and some specialized (children, veterans, psychiatric) facilities. The 800 penalized from the remaining 3300 or so hospitals represent the highest number penalized since the program was launched (part of PPACA, aimed at “savings” for the Medicare program) five years ago. At the bottom are 110 hospitals being punished for the fifth consecutive year, primarily safety net hospitals and academic medical centers.
Among those penalized five times over the five years: Banner University Tucson, John Muir, Loma Linda, Long Beach Memorial, Hartford (CT), George Washington University, Medstar Washington Hospital Center, Jackson Memorial, Tampa General, UF Health Jacksonville, Grady, University of Louisville, Tulane Medical Center, Robert Wood Johnson (NJ), Presbyterian and University of New Mexico, Albuquerque, Montefiore Medical Center (NY), Westchester Medical Center (NY). On the other hand, 1435 of the hospitals have gone five years without a penalty. The list of those penalized for five years (“Yes” shown in five columns) and those not penalized in any of the five years (“No” shown in five columns) is here.
Each year the quarter of general hospitals with the highest rates for infections, blood clots, sepsis, bedsores and other “avoidable” complications (a total of six measures) are punished, even if their overall showing has improved from the previous year. The American Hospital Association, examining the 2017 results, reported no significant statistical difference between a large fraction (40%+) of the 768 hospitals punished and those not in the penalty group. Many hospitals have noted that diligence in reporting infections, for example, is penalized.
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Maryland Continues to Mystify:
Another paean to the Maryland all-payer experiment in this week’s JAMA (here) lists (in its footnotes) only one study not written by a Maryland State official, namely last year’s RTI report (here). RTI (contracted by CMS) observed: “Inpatient admissions declined for both Medicare beneficiaries and commercial plan members, but there were no savings in expenditures for inpatient hospital services for either population because the change in utilization was offset by an increase in payment per inpatient admission.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Medicare for All:
Here’s the (Rep. Jayapal) bill, here are some definitions which may be useful in discussion, here is an analysis of the Democratic politics, and another analysis of the politics from Republican members of the House Energy & Commerce Committee, here, while here is an interesting comment on doctors favoring “Medicare for some more” from Forbes.
Rap on RAPS Data:
MedPAC (here) comments on the risk adjustment proposed rule, generally supportive but seeing big problems with Risk Adjustment Processing System (RAPS) data, and, inferentially, with other derivative measures. The esoteric debate masks the potential for billions in profit by Medicare Advantage plans using risk adjustment to their own advantage.
DRUGS & DEVICES
The Hill Explains Insulin Prices:
The Congress-watching newsletter published a summary (here) of the positive reaction to Lilly’s announcement that it will sell half price insulin. It turns out to have been a modest concession: “According to the American Diabetes Association, the average price of insulin nearly tripled between 2002 and 2013 and then nearly doubled from 2012 to 2016.” The Hill reports that “Eli Lilly is following in the footsteps of two other major drug companies. Following outrage over massive price hikes, Mylan in 2016 introduced an authorized generic version of the EpiPen. Last year, Gilead did the same for two versions of its most expensive hepatitis C treatment.” Bottom line: “The new version is helpful for people that don't have insurance, or people with high deductibles or high co-insurance” because the “new insulin” will “be exactly the same product as the current version. Insurers do not actually pay that full price because they receive discounts known as rebates, and they will be paying about the same amount for the generic as for the brand name. The company could have just lowered the list price for everyone, but instead it is keeping a separate version with the much higher price. The higher list price means bigger rebates, so pharmacy benefit managers will have to decide if they want to stick with the expensive brand name and higher rebates, or use the generic.” [Italics added.]
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
March publication dates: 6, 7, 8, 11, 12, 13, 14, 15, 25, 26, 27, 28, 29
April publication dates: 1, 2, 3, 4, 5, 8, 9, 10, 11, 12, 29, 30
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.