DCMedical News: Thursday, April 4, 2019
DCMedical News-DCMN
Washington, D.C.
Thursday, April 4, 2019
DCMedical News is published every day both the House and the Senate are in session. Subscription information below.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Opioids and Infectious Disease:
The NIH reports (here) that the opioid epidemic is increasing rates of infectious disease. The challenge: “Since 1999, nearly 400,000 people in the United States have fatally overdosed on opioid-containing drugs, with 47,600 deaths in 2017 alone. Many people with opioid use disorder (OUD), who initially were prescribed oral drugs to treat pain, now inject prescribed or illegal opioids. High-risk injection practices such as needle-sharing are causing a surge in infectious diseases. Additionally, risky sexual behaviors associated with injection drug use have contributed to the spread of sexually transmitted infections.” Meanwhile, Modern Healthcare reports (here) on “push back” from health insurers on coverage of non-opioid treatment for pain management.
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
HCUP Reports on Mental and Substance Use Disorder (MSUD) Hospital Stays:
The Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality reports (here) that “In 2016, nearly 10 million inpatient stays had a principal (2.2 million) or secondary (7.7 million) MSUD diagnosis, constituting 6.1 and 21.7 percent of all inpatient stays, respectively. In total, stays principally for MSUDs cost $15.3 billion (3.6 percent of total hospital costs). On average, stays for MSUDs cost $7,100 and were 6.4 days. The rate of stays principally for MSUDs was highest among adults aged 18-64 years. Nearly 60 percent of MSUD stays for patients aged less than 65 years were billed to public payers.”
Transfers and Discharges More Likely for Uninsured and Medicaid Patients:
A report in JAMA Internal Medicine (here) finds that “Compared with privately insured patients, uninsured patients were more likely to be discharged and transferred. Medicaid beneficiaries had comparable odds of discharge but higher odds of transfer . . . After accounting for hospital critical care capability and patient case mix, the study found that uninsured patients and Medicaid beneficiaries with common medical conditions appeared to have higher odds of interhospital transfer.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Maine and Medicaid:
The Administration approved the Maine plan to expand Medicaid, retroactive to July 2, 2018, when the expansion—long opposed by former Governor Paul LePage—was supposed to take place, following a successful 2017 ballot initiative.
One Labor Position on Medicare-for-All:
The head of the Washington (state) Labor Council makes the case (here) for taking health care off of the bargaining table, by supporting Medicare-for-all.
DRUGS & DEVICES
Insulin Price Pressure:
Cigna and its pharmacy benefit manager (PBM) Express Scripts will cap monthly insulin prices at $25 for nongovernment employer, union and individual plans. PBMs are expected to be on the receiving end of criticism and skeptical inquiry in hearings next week before the Senate Finance Committee and the House Energy and Commerce’s Oversight Subcommittee. STAT Plus reports that “Medicare Part D spending on insulin rose 840 percent in the decade between 2007 and 2017, from $1.4 billion to $13.3 billion.”
Antitrust Safe Harbor for Drug Price Negotiation:
Avik Roy’s 2017 paper (here, testimony in January 2019, here) on creation of a “safe harbor” for what would otherwise be anticompetitive negotiation by health plans is the background for a new proposal in the House to control drug prices. Roy’s paper and testimony, built on drug price negotiating structure in Switzerland, would encourage private insurers in a region to jointly negotiate with drug manufacturers. A second benefit, according to Roy, is that such a safe harbor would eliminate one rationale for health insurers to consolidate, that is, obtaining more leverage with which to negotiate drug prices. Roy’s proposal is seen as an alternative to the current proposal for Part D plans (here) to “turn rebates into discounts,” and to Democratic proposals (here, in a Modern Healthcare summary of drug price control legislation) for drug price arbitration.
More on TAVR Volume and Outcomes:
Another study (here) has addressed the question of Transcatheter Aortic-Valve Replacement technology dissemination to more hospitals. The result: “An inverse volume–mortality association was observed for transfemoral TAVR procedures from 2015 through 2017. Mortality at 30 days was higher and more variable at hospitals with a low procedural volume than at hospitals with a high procedural volume.”
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
April publication dates: 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.