DCMedical News: Monday, March 11, 2019
DCMedical News-DCMN
Washington, D.C.
Monday, March 11, 2019
DCMedical News is published every day that both Houses of Congress are in session. Subscription information below.
THE BIG STORY IN HEALTH CARE:
Administration Budget for FY 2020 (October 1, 2019-September 30, 2020) Unveiled
The 2020 budget is unveiled today. The first look at health programs will be by the House Energy and Commerce Committee Subcommittee on Health, tomorrow, followed by the House Appropriations Committee Subcommittee on Labor and Health and Human Services, Wednesday. HHS Secretary Alex Azar will appear at these hearings to discuss the proposed budget, followed by a Senate Finance Committee hearing on Thursday, the 14th.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE:
CMS Publishes “RFI” to Promote Sale of Individual Health Insurance Coverage Across State Lines:
CMS publishes in today’s Federal Register (here) a Request for Information (RFI) on ways in which “barriers” in the sale of individual health insurance policies across state lines might be eliminated. CMS is interested in promoting “Health Care Choice Compacts,” and in implementing part of the President’s Executive Order from October, 2017 (here) on promoting health care choice and competition.
MedPAC Meeting March 7 – 8, Modest Changes Proposed:
Meetings of the Medicare Payment Advisory Commission March 7-8 revealed satisfaction with the current rate of payment to clinicians (here); desire to have more “real world” encounter data involved in risk adjustment for Medicare Advantage (here); Medicare’s role (generally failing) in producing an adequate number of primary care physicians (here); alarm at the growth of emergency department spending, notwithstanding the growth of urgent care and freestanding centers (here); the movement of drug expenses from Part B (where Medicare has no negotiating leverage) to Part D (where the private plans have some leverage) (here); the evaluation of episode-based payment for post-acute care (they don’t like it) (here); and a technical (but important to the people in that area) analysis of issues with post-acute and hospice care changes after the long-term acute care hospital dual-payment experiments (here). The ED issue brought about a discussion (again) of national ED-level-of-service coding advice to hospitals (see report in Modern Healthcare, here).
DRUGS & DEVICES
Avik Roy on Drug Spending Growth:
Forbes’ Apothecary reports (here) that “In 2017, biologic drugs represented 2 percent of all U.S. prescriptions, but 37 percent of net drug spending. Since 2014, biologic drugs account for nearly all of the growth in net drug spending: 93 percent of it, in fact.” Roy uses as his reference an IQVIA analysis of 2017 drug spending (here) published in April, 2018. Roy’s analysis of pricing growth contrasts the legislative basis for approval of generic small molecule drugs (the Hatch-Waxman Act) with the legislative basis for approval of biosimilars (part of the Patient Protection and Affordable Care Act). He writes that the narrow margin for PPACA passage (seven votes in the House, one in the Senate) compelled Obama White House strategists to cede outsized influence to pharmaceutical manufacturers concentrated in “blue” states.
READING AND REFERENCE
Part II (see DCMN 3-8-2019 for Part I), Federal Trade Commission Hearings on Competition Continue, Including the Health Field:
The FTC has announced that its hearings on competition will continue April 12th (announcement here). In making the announcement, the Bureau of Economics noted its long history of evaluations of consummated mergers, including the following studies:
A Retrospective Analysis of the Clinical Quality Effects of the Acquisition of Highland Park Hospital by Evanston Northwestern Healthcare, (from 2011), here.
The Accuracy of Hospital Merger Screening Methods, (from 2016), here.
Price Effects of a Merger: Evidence from a Physicians’ Market, (from 2017), here.
Health Care Competition or Regulation: The Unusual Case of Albany, Georgia, (from 2017), here.
The Effects of Physician and Hospital Integration on Medicare Beneficiaries’ Health Outcomes, (from 2018), 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
March publication dates: 12, 13, 14, 25, 26, 27, 28
April publication dates: 1, 2, 3, 4, 9, 10, 11, 12, 29, 30
May publication dates: 1, 2, 7, 8, 9, 10, 14 15, 16, 17, 20, 21, 22, 23
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.