DCMedical News: Tuesday, April 30, 2019
DCMedical News-DCMN
Washington, D.C.
Tuesday, April 30, 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 House in Action:
The Appropriations Subcommittee with jurisdiction over the Departments of Education, Labor and Health and Human Services has released a bill (here, summary from the Committee Chair here) for markup planned today. The new bill would provide $76 billion for the Education Department, compared to the Trump administration request of $62 billion and $71.5 billion provided for the current year. The Labor Department would receive $13.3 billion, compared to $12.1 billion provided for the current year and the Administration’s FY20 $10.9 billion request. The bill would provide HHS with $99 billion, a figure that doesn’t include the estimated $5 billion for the FDA and $5 billion for the Indian Health Service, funded in the Agriculture and Interior appropriations.
The House Committee on Rules will hold a hearing on HR 1384, the “Medicare for All Act” of 2019 today, witness list here.
The House Energy and Commerce Committee will hold a hearing today on drug prices for Medicare beneficiaries, notice here, Democratic member memorandum here.
Two bills have been reported by the House Energy and Commerce Committee: H.R. 1010 (CBO report here) would prevent the Administration from implementing or enforcing regulations aimed at increasing the number of people with short-term limited duration insurance, and would prohibit the Administration from promulgating similar regulations in the future. According to the CBO, with this bill 1.5 million fewer people would purchase short-term plans each year over the 2020-2029 period, of whom 500,000 would instead purchase nongroup coverage through the marketplaces established by PPACA, a small number would obtain coverage through an employer, and about 500,000 would become uninsured. The additional enrollees in the nongroup market would have the effect of lowering nongroup premiums by about 1 percent on average because those enrollees are likely to be healthier than the average nongroup enrollee under current law.
H.R. 986 (CBO report here) would prohibit the Departments of Health and Human Services and the Treasury from taking any action to implement or enforce the regulatory guidance entitled “State Relief and Empowerment Waivers” (potentially undermining protections for patients with pre-existent conditions) or from issuing similar guidance in the future. To date, no states have submitted a waiver application under the guidance that would be eliminated by this legislation.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
MA vs. FFS Coronary Artery Disease (CAD) Treatment:
An all-star cast of authors has published a study (here) on the outcomes for Medicare Advantage and Fee-for-Service Medicare patients with CAD. The result: “[A]mong outpatients with coronary artery disease, those who were enrolled in Medicare Advantage were slightly younger but had more comorbidities than those in FFS Medicare. Importantly, patients in Medicare Advantage were more likely to receive recommended secondary prevention treatments, including β-blockers and angiotensin-converting enzyme inhibitors (or angiotensin receptor blockers) than those in FFS Medicare. However, the authors noted that this improvement in the process of care did not translate into an improved intermediate outcome of blood pressure control.” More comorbidities? The authors contend that the registry used for the study (involving clinical judgment) protects against the peril of using claims data, namely coding enthusiasm (by MA plans) or coding indifference (for the FFS patients).
Meanwhile, Krumholz and colleagues report (here) on twenty-year trends in one measure of the ultimate outcome, the results from treatment of acute myocardial infarction (AMI). Summary: “The last 2 decades were marked by large changes in the number of people hospitalized with AMI—and marked improvements in the short- and long-term outcomes along with increases in cost per hospitalization and number of procedures.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Ischemic Stroke Treatment:
A paper in Physical Therapy (accepted note here) says only 61% of patients with ischemic stroke treated in hospitals received both physical and occupational therapy. “[M]ale patients, being dually enrolled in Medicare and Medicaid, prior hospitalization, ICU stay, and feeding tube were associated with lower odds of receiving any rehabilitation services. These same variables were generally associated with fewer minutes of therapy. Patients treated by tissue plasminogen activator, in limited and non-teaching hospitals, and in hospitals with inpatient rehabilitation units were more likely to receive more therapy minutes.”
READINGS AND REFERENCES
Ashish Jha (here) on deprescribing health policies: “One of the most difficult clinical tasks is deprescribing a medicine that was previously prescribed—a significant challenge when patients have too many medications, some of which no longer benefit the patient but continue to have adverse effects. Health policy suffers from the same problem, and the same factors that make deprescribing so difficult in clinical medicine also make deprescribing a health policy intervention a challenge. The same harms we see in patients exposed to polypharmacy are likely in the health care delivery system. It’s time to take a different approach. One place to begin is the Hospital Value-Based Purchasing (VBP) program, which is ripe for policy deprescribing.”
From late Uwe Reinhardt (“Priced Out: The Economic and Ethical Costs of American Health Care”), available here. “Merely bringing up the topic of distributive social ethics for health care can easily raise the ire of an audience . . . so instead, we prefer to discuss health reform mainly in technical terms—usually economic ones—and let social ethics fall where they may.”
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
May publication dates: 1, 2, 7, 8, 9, 10, 14 15, 16, 17, 20, 21, 22, 23
June publication dates: 5, 6, 7, 8, 11, 12, 13, 14, 25, 26, 27, 28
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.