DCMedical News: Wednesday, March 27, 2019
DCMedical News-DCMN
Washington, D.C.
Wednesday, March 27, 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
The Administration, through the Department of Justice, told the Fifth Circuit court hearing Texas v. United States that the entire Patient Protection and Affordable Care Act should be declared unconstitutional, here.
While The New York Times reported this significant reversal of the Administration’s position from December (here), it also urged Congress (here) to consider the $845 billion in proposed Medicare budget reductions over the period 2020-2029. The Times editorial called attention to what it considers the inappropriate “site of service” differential payment to hospital-owned physician offices, although that particular provision accounts for less than $30 billion of the $845 billion in Medicare “savings.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
TAVR to Expand to Low Risk Patients, Possibly to Smaller Hospitals:
Transcatheter Aortic Valve Replacement had positive results (compared to surgery) in low risk patients, according to reports at the New Orleans meeting of the American College of Cardiology (“We essentially changed the treatment of aortic stenosis in low-surgical-risk patients. TAVR indications have expanded now. It was approved for high-risk patients and intermediate-risk patients, and today, young, low-risk patients--which is the majority of patients--will now be preferentially treated using transcatheter techniques,” Dr Raj Makkar, associate clinical director of Cedars-Sinai Heart Institute, quoted here in Medscape). Dr. Makker added “the combined endpoint of death, stroke, and rehospitalization was cut in half with the use of TAVR compared with traditional conventional surgical aortic valve replacement. Not only did we see some reduction in mortality, but also a significant reduction in stroke rates.”
The expansion of the potential pool of patients comes as smaller hospitals are arguing for access to the technology, according to this piece in the Wall Street Journal. Both reports arrive on the eve of an announcement of a National Coverage Determination by CMS.
Physicians with Malpractice Claims (Not a High Proportion, But a Hazard to Patient Safety):
A new study (not yet online) published in The New England Journal of Medicine focuses on physicians with poor malpractice liability records. The researchers (including authority Michelle Mello) compared the claims on the National Practitioner Data Bank to Medicare Data on Provider Practice and Specialty, for the period 2008 through 2015. They compared paid claims, exits from medical practice, changes in clinical volume and geographic relocation. The half million physicians whose records were reviewed showed the following: 89% had no claims, 8.8% had one claim, 2%+ had two or more claims and accounted for almost 40% of all claims. Doctors in this latter group did not relocate, but did shift into smaller practice settings, especially into solo practice.
Medical Expense Increases—Diabetes Treatment Increasing the Fastest
The Agency for Healthcare Research and Quality reports (in JAMA, here) on the increase in medical care expenses among the five most common disorders in 1996 and 2015. The number of people being treated for mental disorders, diabetes and arthritis in that period doubled. Only diabetes had a per capita expense increase, and most of that due to the cost of insulin and other drugs.
HOSPITALS AND OTHER HEALTH CARE FACILITIES
Cost to Charge Ratio and Value-Based Purchasing:
Eyes glaze over with talk of Cost to Charge Ratios (CCR) in hospital Medicare cost reports, but the stakes may be higher with value-based purchasing. A paper in JAMA Surgery (here) contends that CCR for an entire hospital is misleadingly high when compared to CCR for surgery services only, resulting in mis-overestimation of the cost of surgery in calculating value-based purchasing expenses.
MEDICARE, MEDICAID, COMMERCIAL HEALTH INSURANCE
GAO Studies Market Concentration for Health Insurance in 2015 and 2016, Doesn’t Like Results:
A General Accountability Office study (here) of individual and small group market concentration found that a very small group of insurers dominated both.
“For the individual market exchanges, in each year, three or fewer issuers held 80 percent or more of the market, on average, in at least 46 of the 49 state exchanges for which GAO had data. Further, the largest issuers increased their market share in about two-thirds of exchanges . . . many individual exchanges generally had a decreasing number of participating issuers over time.”
“For the small group market exchanges, in each year, three or fewer issuers held 80 percent or more of the market in at least 42 of the 46 state exchanges for which GAO had data.”
READINGS AND REFERENCES
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: 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.