DCMedical News: Wednesday, April 3, 2019
DCMedical News-DCMN
Washington, D.C.
Wednesday, April 3, 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
Uncertainty at the Top:
Having had the Department of Justice notify the Fifth Circuit Court of Appeals (Texas v. United States, here) that the U.S. now agreed with the position of Texas, the President indicated that his substitute health plan (to replace PPACA, if that legislation is invalid) would be ready only after the next Presidential election (see NYT coverage, here). Democratic Senators Bennet and Kaine, meanwhile, offered (see The Hill, here) “[A] proposal Tuesday that would allow anyone to buy Medicare plans . . [which] they say is a more realistic than proposals like Medicare for all that would eliminate private insurance companies and reshape the American health care system.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Massachusetts Health Policy Commission Reports on Annual Spending:
The report (here) included wide-ranging analysis of all spending. What made a difference in spending?
The provider makes a difference: “Total health care spending per patient varies substantially by provider system. Based on the affiliation of a patient’s PCP, annual spending per commercially-insured patient ranged from $5,393 per year (for patients with PCPs in the Boston Medical Center Health System) to $7,668 per year (for patients with PCPs in the Partners HealthCare system), a 30 percent difference in 2017. These differences grew between 2015 and 2017.”
Physician led organizations make a difference: “Spending for patients with diabetes with PCPs in physician-led organizations was 19 percent lower than spending for similar patients with PCPs in hospital-based organizations anchored by an academic medical center (AMC), such as Partners HealthCare or Beth Israel Deaconess Care Organization (BIDCO).”
Site-of-service makes a difference: “The difference in spending was particularly stark in the area of outpatient services, such as labs, tests, and minor surgeries, where average spending at the AMC-anchored organizations was over 70 percent higher than spending at physician-led organizations. These services are typically performed in hospital outpatient departments in the higher-spending organizations, often involving additional facility fees.”
What happens in the emergency department makes a difference: “There is considerable variation among hospitals in the likelihood that a patient’s emergency department (ED) visit results in an inpatient admission. Controlling for patient characteristics including diagnosis, rates of admission from the ED ranged from 18 percent to 30 percent among the 25 Massachusetts hospitals with the highest ED volume,” and “Patients discharged from the ED at hospitals with lower admission rates did not generally experience higher rates of revisits to the ED than those discharged from hospitals with higher admission rates.”
Observation Status and Two-Midnight Rule Litigation Going to Trial:
After eight years, the business of “observation status” and the “two-midnight rule” will be going to trial, according to InsideHealthPolicy.
IHP reports: “A federal district court judge denied multiple requests from the federal government to stop a lawsuit beneficiary advocates first brought about eight years ago seeking appeal rights for Medicare beneficiaries that are put under observation rather than admitted to the hospital, and the judge says the suit should quickly move to trial.”
Judge Michael Shea in the Connecticut District Court wrote, “This case is now approaching its eighth year. It has been to the Circuit and back, through two motions to dismiss, through two lengthy periods of discovery, and survived two rounds of summary judgment. I have certified a class, reconsidered that decision, and declined to decertify the class. All of the named Plaintiffs who were alive when the case was filed have since passed away. The time for motion practice is over.” IHP noted, “Patients under observation may be in the hospital but are not considered admitted and coverage comes from Medicare Part B, rather than Medicare Part A inpatient care coverage. Time spent in the hospital under observation also doesn’t count toward the three days that Medicare requires beneficiaries stay in a hospital before the program covers nursing home care. Beneficiary advocates, including the Center for Medicare Advocacy and Justice in Aging have brought a class-action lawsuit seeking to allow Medicare beneficiaries to appeal their placement into observation rather than inpatient admission.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Medicaid Legislation Passes Both the Senate and the House:
CQ reports that a Medicaid bill which had passed in the House has now passed in the Senate and is expected to be signed by the President. It would extend funding to allow individuals whose spouse receives long-term care under Medicaid to keep some of their income, fund “Money Follows the Person,” which helps individuals move from assisted living back into the community, provide limited extension for funding for two states with expired pilot programs that help individuals with substance use disorders and mental illness, and provide funding for establishing health homes for children with complex medical conditions. The bill is funded by an offset, fines for drug makers who improperly classify drugs as generic in order to qualify for a Medicaid rebate.
DRUGS & DEVICES
Insulin Prices in the Spotlight:
The House Energy and Commerce Oversight Subcommittee held its first hearing on insulin costs; the second, with the three manufacturers of insulin in the U.S., will take place April 10. In Massachusetts the Health Policy Commission reported (here) on out-of-pocket costs for insulin, higher as a percentage of total out-of-pocket cost than any other health spending category. Other findings on diabetes from the Massachusetts report, an annual summary of health spending: “For example, patients with diabetes had similar utilization of HbA1c lab tests, but prices per test averaged 38 percent higher in AMC-anchored organizations,” and “Despite the differences in spending, relevant quality indicators were no different across the organization types.”
READINGS AND REFERENCES
“Skimpy health plans touted by Trump bring back familiar woes for consumers,” Los Angeles Times, here.
“Americans Borrowed $88 Billion to Pay for Health Care Last Year,” Gallup Survey here. Summary: Americans borrowed an estimated $88 billion over the last year to pay for health care, one in four Americans have skipped treatment because of the cost, and nearly half fear bankruptcy in the event of a health emergency.
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
April publication dates: 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.