DCMedical News: Thursday, May 9, 2019
DCMedical News-DCMN
Washington, D.C.
Thursday, May 9, 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
Dx: Myocardial Infarction Secondary to Pharmaceutical Price Disclosures on TV:
The demographic sought for network news (older, multiple co-morbidities, no organ system left behind) may be shocked by the Administration’s announcement (100+ page final rule, here, HHS Secretary Azar, here) compelling pharmaceutical companies to disclose prices in their television advertising. The (probably) confusing result (taking into account manufacturers’ prices, rebates, discounts, PBM pieces, cash v. plan-based purchase) may be similar to that surrounding disclosure of hospital chargemaster information, combinations of regulatory tinkering and commercial chicanery.
But the focus on prices or price-setting may be too narrow, Chicago’s Katherine Baicker warned journalists at a confab (here) on these interrelated issues, despite Harvard’s Robert Blendon noting at the same conference (Association of Health Care Journalists) that the “political” theme today is “price, price, price, price.”
The top level political focus on prices may be a response to information (e.g., Kaiser Family Foundation poll, report here, KFF study with L.A. Times here) that “Most Americans want Congress to prioritize targeted actions that address personal health care costs,” not broader reforms (Medicare for All, PPACA repeal, etc.). Also here, surprise medical bills and coverage for pre-existing conditions are the current focus of public attention. The Sycamore Institute (Tennessee) publishes a new study on medical debt, here.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Medical Economics Reports on Income:
The physician-friendly journal has made its “90th Annual Physician Report” (here), comparing average and median pre-tax income by specialty, including changes over time. Compensation was up 2017 – 2018 (for just about all practitioners), lower (inner-city), with some dramatic increases by location (rural), owners of practices doing better ($315,000 vs. $248,000), private practitioners earning more ($301,000 vs. $288,000 for hospital-owned practice), groups with 3-10 physicians doing better ($307,500) compared to solo practitioners ($280,000), and a gender gap widening ($74,000 difference in pre-tax income between male and female physicians).
Another pay gap drawing attention: “the widening pay gap between hospital execs and physicians” (here). The mean annual compensation for major nonprofit medical center CEOs increased 93% from $1.6 to $3.1 million, 2005 – 2015. CEOs went from making three times the income of an orthopedic surgeon (apparently the gold standard) to making five times as much, twelve times as much as a pediatrician. Not surprisingly, the number of health care administrators increased. The number of U.S. physicians, according to the Medical Economics article, increased 150% between 1975 and 2010, but the number of administrators increased 3200%, accounting for “20 to 30 percent of our healthcare spending.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
AHRQ Struggles to find Value in EHRs
The Agency for Healthcare Research and Quality continues to publish papers reviewing papers on the value of electronic health records, especially in hospitals. On medication reconciliation (here), “Investigators found that there was a lack of understanding about both the technical process of using the electronic health record as intended and the workflow needed.” On management of test results (here), “[Al]though some did demonstrate improvement in test result management using health information technology, there was no consistent effect. The authors conclude that health information technology alone is not sufficient to close safety gaps in test result management.”
340B Program Cuts Still in Limbo
In AHA v. Azar, (memorandum here with an extensive history of the controversy), U.S. District Judge Rudolph Contreras voided reductions in the 2019 340B drug purchase program. Modern Healthcare reports here that Judge Contreras did not grant hospitals the permanent injunction against the cuts that they wanted, but did ask CMS to undertake a do-over for 2018 and 2019 reductions.
Group Purchasing a Punch Line
Makary and colleagues say the joke is on us, here. “According to a GAO report, government oversight of GPOs by the Department of Health and Human Services (HHS) Office of Inspector General has been ineffective. Moreover, hospitals may not be financially aligned to rein in excess administrative fees because higher fees translate into higher ‘share back’ payments to hospitals. ‘Share backs’ are the portion of GPO profits paid back to hospitals. Conceptually, administrative fees are similar to drug company kickbacks to pharmacy benefit managers, also known as ‘rebates’ in the industry. Both forms of kickbacks increase costs to patients.” The financial alignment may include the possibility of personal gain.
MEDICARE, MEDICAID, COMMERCIAL HEALTH INSURANCE
Appropriations: Not Just Money
The House Appropriations Committee (30 Democrat members, 23 Republican members) gave final approval by a 30-23 vote to the FY2020 funding bill (summary here, bill here) for the Departments of Health and Human Services, Education and Labor. Numerous health policy items were included in what is nominally an appropriations bill, including an amendment that would block a Trump Administration rule on conscience protections for health workers; an amendment also would prohibit the Administration from proposing a rule that could limit the ability of Medicaid to pay for beneficiaries’ transportation to doctors' appointments for nonemergency reasons; an amendment to counter Administration efforts to allow states to restrict funding from a $286 million family planning grant program (Title X) from going to Planned Parenthood, and to restrict the total size of the funding; and against an amendment that would prevent the Administration from making any changes to a pair of rules that would have allowed sales of short-term, limited duration insurance plans, and health plans organized by associations of employers.
3M Reports on New MIPS Site, Caution for Researchers:
“A breath of fresh air” - - a description (here) of the new MIPS QPP site https://qpp.cms.gov/MIPS/overview, with user-friendly differentiation of tracks that help users “follow the breadcrumbs” for reporting. The 3M blog contains this cautionary note for researchers who use either Part B claims-based or Clinical Quality Measure (CQM) information: “The reporting guidelines and codes can vary if the measure is Part B claims-based vs. Clinical Quality Measure (CQM) based. You may also know CQM as registry-based . . . Be aware that there are certain codes reported on certain measures that are applicable to the claims-based version of the measure but not the CQM version.”
READINGS AND REFERENCES
Ioannidis and colleagues report on “missing” clinical trials, in the Annals of Internal Medicine, here; editorial by Krumholz, here.
Joynt Maddox and colleagues introduce a new JAMA series, “US Health Policy—2020 and Beyond,” here.
Schulman and Milstein take a crack at the implications of Medicare-for-All for hospitals, here.
Behavioral health apps sharing private information (here), study referenced in DCMN, 5-7-2019.
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: 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.