DCMedical News: Monday, March 25, 2019
DCMedical News-DCMN
Washington, D.C.
Monday, March 25, 2019
DCMedical News is published every day both the House and the Senate are in session. Subscription information below.
THE BIG STORY IN HEALTH CARE
Budget and Appropriations: The Budget and Appropriations Committees of the House and Senate are deliberating the Administration’s FY 2020 proposals, and developing their own, as well. The Budget (summary here, “complete” document here, HHS portion here, “appendices,” 1320 pgs., here) will direct the near future for Medicare and Medicaid, as well as numerous specific ongoing and proposed programs. A schedule for submission of Member items, testimony and hearings before the House Appropriations Subcommittee on Labor-HHS is here.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Private Equity for Private Practice, Continued:
A year-review of private equity investments in physician practices (and other health business, published through the American Health Lawyers Association newsletter, here) highlights the growing volume of such investment, while a JAMA opinion piece (here) highlights the dangers. (Footnote #6 of the JAMA piece pays homage to the late Uwe Reinhardt’s dissection of economic lessons from the rise and fall of the physician practice management companies, while footnote #7 links to a recent Temple Law review of DoJ’s attack on private equity firms whose actions have produced False Claim Act litigation.)
Guidelines? What Guidelines?
A Duke-Stanford-UNC-Swiss group takes aim at clinical guidelines of the major cardiology and cardiovascular disease societies. The findings (in JAMA, here) bemoan the paucity of randomized controlled trials (RCT) backing the guidelines and the lack of progress in having more RCT-backed guidelines develop in the study period 2008-2018. “In this systematic review of 51 current guideline documents that included 6329 recommendations, 8.5% of recommendations in ACC/AHA guidelines and 14.3% of recommendations in ESC guidelines were classified as level of evidence A (supported by evidence from multiple RCTs), compared with 11.5% of recommendations in a systematic review of ACC/AHA guidelines conducted in 2009. . . Among recommendations in major cardiovascular society guidelines from 2008 to 2018, the proportion supported by evidence from RCTs remains small.”
HOSPITALS AND OTHER HEALTH CARE FACILITIES
Rural Hospital Closure: Where are the “Red State” Senators?
Becker’s has published a list of 102 rural hospitals closed so far this decade, by state. The list (here) shows that “of the 27 states that have seen at least one rural hospital close since 2010, those with the most closures are located in the South, according to research from the North Carolina Rural Health Research Program. Seventeen hospitals in Texas have closed since 2010, the most of any state. Tennessee has seen the second-most closures, with 10 hospitals closing since 2010. In third place is Georgia with seven closures.”
MEDICARE, MEDICAID, COMMERCIAL HEALTH INSURANCE
Medicare for All, More or Other:
Jeff Goldsmith and colleagues at Navigant take aim (with the support of AHA) at various alternatives proposed for expansion of Medicare (here), while Reed Abelson and Margot Sanger-Katz write (in The New York Times, here) a story headlined “Medicare for All Would Abolish Private Insurance. ʻThereʼs No Precedent in American History.ʼ” The Commonwealth Fund’s Sara Collins puts forward an “interactive” tool and paper (here) comparing the most-discussed alternatives.
CMS “Guidance” (and Similar Directives) on the Supreme Court Docket:
This Wednesday the Court hears oral arguments in Kisor v. Wilkie (SCOTUSBlog summary here), a case which asks how much deference should be given to an administrative agency’s interpretation of its own rules. HHS Secretary Azar delivered remarks to the American Health Lawyers Association (here) on the proposed “Regulatory Sprint” for his agency, eliminating obstacles to “coordinated care” currently found in fraud and abuse protection statutes and regulations.
DRUGS & DEVICES
Value-Based or Value-Less?
“Outcome” or “value-based” pharmaceutical purchase contracts are not delivering any additional value, according to a survey article (here) in this week’s Modern Healthcare.
READINGS AND REFERENCES
MACPAC (the Medicaid and CHIP Payment and Access Commission) March Report to Congress, here.
MedPAC (the Medicare Payment Advisory Commission) March Report to Congress, here; “fact sheet,” here; press release, 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: 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.