DCMedical News: Tuesday, March 26, 2019
DCMedical News-DCMN
Washington, D.C.
Tuesday, March 26, 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
Big Health Bill to be Announced in the House, Antidote to Medicare-for-All?
House Democrats plan to unveil health care legislation today aimed at lowering costs and protecting people with pre-existing conditions. A news conference at 2:30 p.m. in H-207 will feature House Democratic leadership including Speaker Nancy Pelosi. A draft version of the bill is here.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
$36 Billion Gone, Nobody Lost Their Job:
The cover and lead story of this week’s Fortune (“Botched Operation,” undertaken jointly with Kaiser Health News, here) is the story of how “10 years after President Barack Obama signed a law to accelerate the digitization of medical records — with the federal government, so far, sinking $36 billion into the effort — America has little to show for its investment.” The major accomplishment, according to the investigation: rapid adoption. The downside: “Instead of reducing costs, many say, EHRs, which were originally optimized for billing rather than for patient care, have instead made it easier to engage in ‘upcoding’ or bill inflation . . . More gravely still, a months-long joint investigation by KHN and Fortune has found that instead of streamlining medicine, the government’s EHR initiative has created a host of largely unacknowledged patient safety risks. Our investigation found that alarming reports of patient deaths, serious injuries and near misses — thousands of them — tied to software glitches, user errors or other flaws have piled up, largely unseen, in various government-funded and private repositories.”
The major “takeaways” according to the study were patient safety challenges, the potential for fraud, “interoperability gaps,” doctor burnout and the “web of secrets” (“gag clauses”) which characterize EHRs. More poignant were individual stories: “But what is perhaps telling is how many doctors today opt for manual workarounds to their EHRs. Aaron Zachary Hettinger, an emergency medicine physician with MedStar Health in Washington, D.C., said that when he and fellow clinicians need to share critical patient information, they write it on a whiteboard or on a paper towel and leave it on their colleagues’ computer keyboards.”
Outgoing FDA Commissioner Gottlieb checked in (here) with some comments about scrutiny over EHRs, but emphasized that the FDA did not intend to regulate EHR software as medical devices, a good thing because the “21st Century Cures Act” has a manufacturer-friendly provision which prevents the FDA from doing so. Academy Health’s Datapalooza takes place March 27-28 in Washington.
HOSPITALS AND OTHER HEALTH CARE FACILITIES
DSH May Become a State vs. State “Food Fight”:
Modern Healthcare describes (here) the challenge of distributing $12 billion yearly in DSH (Disproportionate Share Hospital) funds to supplement payments to help hospitals with the cost of uninsured patients. In Connecticut the average payment is $921 per uninsured person, in Florida, $70. Also involved: the distribution of scarce supplemental Medicaid funds to states (such as Florida) which have not expanded Medicaid. MACPAC has an updated and useful summary of Medicaid base payments and supplemental payments to hospitals, here.
MEDICARE, MEDICAID, COMMERCIAL HEALTH INSURANCE
Surprise Medical Bill Activity Increasing:
The House Education and Labor Committee will hold a hearing April 2; according to The Hill this would be the first significant initiative on the House side on this issue. The Senate HELP Committee has asked the Congressional Budget Committee for an analysis of options. An industry “sign on” letter advocates for action here.
DRUGS & DEVICES
Competition at Work in Insulin Prices:
An opinion piece in JAMA this week (here) shows that “increased competition in the long-acting insulin market was associated with lower per-milliliter reimbursements in Medicaid, lending support to policies that expedite biosimilar approval and market entry. More savings should be expected once biosimilars are labeled as ‘interchangeable’ and can be automatically substituted at the pharmacy.”
Part D Spending, Dashboard:
CMS has an updated Part D drug spending dashboard (entry page here), with this qualification: “Drug spending metrics for Part D drugs are based on the gross drug cost, which represents total spending for the prescription claim, including Medicare, plan, and beneficiary payments. The Part D spending metrics do not reflect any manufacturers’ rebates or other price concessions as CMS is prohibited from publicly disclosing such information.”
Robotically Assisted Surgery for Cancer Patients: No Evidence of Better Results
The New York Times has a piece (here) on the continued expansion of robotically assisted surgery, continuing with no evidence of superior results, and an FDA warning that the results may be worse.
READINGS AND REFERENCES
Footnote Link: DCMN of 3-25 referenced a footnote link in a JAMA piece (“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”) which was broken. The Temple Law piece is 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: 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.