DCMedical News: Wednesday, May 15, 2019
DCMedical News-DCMN
Washington, D.C.
Wednesday, May 15, 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
Prices and Surprises: Control of Surprise Bills May Presage Price Controls
The House Energy and Commerce Committee’s Chair and Ranking Member have released a draft bill (here) to prevent patients from receiving surprise medical bills. CQ calls the bill the “first major bipartisan proposal to come out of the House on the issue this Congress.” The measure involves establishment of a “minimum payment standard,” (“the median in-network rate for the service in the geographic area in which it was delivered”), not arbitration, and prohibits billing beyond that standard, although states may create their own standard-setting process as an alternative. (See Brookings program on state alternatives, here). The fee-setting proposal in the House bill is similar to that of Senators Bennett and Cassidy (a gastroenterologist). In the bill from those two Senators, a patient's health plan would pay the difference between the patient's in-network co-pay and a reasonable charge for the treatment. The “reasonable charge” would be defined as the median cost of the required service or 125% of the average allowed amount in the same geographic region. The fee-setting proposals are widely opposed by hospital-based physicians (see, e.g., Modern Healthcare report here) who favor arbitration. CQ notes that “The House bill would also authorize $50 million in grants for states to set up all-payer claims databases in an effort to increase transparency of health care costs.”
Washington Governor and Presidential candidate Jay Inslee signed legislation to create the first state-sponsored “public option” health insurance plan.
Mississippi hospitals have offered a voluntary health insurance plan (here) for $20 per month and a $100 inpatient deductible. The plan is intended to provide some coverage for the poor-but-not-poor-enough, and is a reminder that health insurance in the U.S. was a depression-era invention sponsored initially by hospitals, specifically by Baylor in Dallas. From a 1998 history of the American Hospital Association (here): “Justin Ford Kimball had recently organized the first hospital prepayment plan for Dallas teachers in 1929, when the AHA hired C. Rufus Rorem, Ph.D., a nationally recognized proponent of prepaid coverage, as its expert on group hospital insurance. . . Rorem was largely responsible for Blue Cross insurance as a national movement. By 1937, the AHA had organized the Hospital Service Plan Commission, which adopted a generic blue cross for its logo and later became Blue Cross and Blue Shield . . . Within a year, 40 Blue Cross plans had signed up. More information about the Mississippi plan at https://mississippicares.com.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Doctor-Owner vs. Doctor-Employee
The AMA publishes a policy research perspective (here) on physician ownership of medical practices, and physician employees. “2016 was the first year in which less than half of practicing physicians (47.1 percent) had an ownership stake in their practice. With this report a new milestone has been reached—2018 marked the first year in which there were fewer physician owners (45.9 percent) than employees (47.4 percent).”
Clinical Practice Guidelines, More Questions
A study reported in JAMA Internal Medicine (here) reviews clinical practice guidelines of the American Thoracic Society. The results are another chapter in the book questioning the applicability of “best practices” and other industrial metaphors for the practice of medicine. “Among 222 unique recommendations from 16 separate guidelines, 141 (63.5%) were based on low-quality evidence, whereas fewer than 1 in 10 were based on high-quality evidence. Nonetheless, 86 (38.7%) were designated strong recommendations.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
We Knew That
Becker’s reports (here) that a video has surfaced in which the President of Partners HealthCare says the Boston-based health system's market power allows it to set higher prices than its competitors — and in return, force higher reimbursement from private insurers. “In the video, Peter Slavin, MD, president of Partners' Massachusetts General Hospital in Boston, said, ‘The payments we get from insurers are higher than the average payments that go to other hospitals and physician groups in this state.’ He was responding to a question from an emergency [medicine] resident at Mass General. The resident asked Dr. Slavin how higher reimbursement from private payers to Partners could affect the viability of smaller hospitals with unfavorable payer mixes.”
MEDICARE, MEDICAID, COMMERCIAL HEALTH INSURANCE
Whose Advantage?
Sage and Modern Healthcare columnist Merrill Goozner calls (here) for opening the books on Medicare Advantage plans. With regard to a recent study showing lower expenditures per enrollee in MA plans (versus fee-for-service Medicare), he asks “[W]hat if seniors opting into MA are not only healthier, but also less prone to visiting the doctor or hospital? What if MA plans’ claims that they are succeeding in delivering higher quality care at lower cost is based on nothing more than self-selection or, more darkly, plan cherry-picking?” MedPAC recommends Medicare payment changes based primarily (and sometimes only) on FFS Medicare claims.
DRUGS AND DEVICES
AHRQ Has a New Study on Drug Expenditures—Total Spending is Up (Because?) Out of Pocket Spending is Down
The Agency for Healthcare Research and Quality has a new analysis (here) of outpatient drug spending 2009-2016. “Average total drug expenditures per person increased significantly from 2009 to 2016. In 2009, the average total expenditures per person with any medication use were $1,497, including the amount paid out of pocket plus any third party payments from health insurance or other sources. By 2016, mean expenditures had risen to $1,955, an increase of 30.6 percent . . . During this time period, out-of-pocket spending decreased. Average out-of-pocket spending for prescribed medications, among persons who obtained at least one prescribed medication, declined from $327 in 2009 to $238 by 2016, a decrease of $89. This is a 27.0 percent decrease.”
Other new numbers (here) from the National Center for Health Statistics, on prescription drug use in the U.S. population: “In 2015–2016, 45.8% of the U.S. population used prescription drugs in the past 30 days. Prescription drug use increased with age, from 18.0% of children under age 12 years to 85.0% of adults aged 60 and over. Prescription drug use was highest among non-Hispanic white persons followed by non-Hispanic black persons, and lowest among non-Hispanic Asian and Hispanic persons. The most commonly used types of drugs [an ‘ages of man’ list] included bronchodilators for ages 0–11 years, central nervous system stimulants for ages 12–19, antidepressants for ages 20–59, and lipid-lowering drugs for ages 60 and over.”
READINGS AND REFERENCES
Labor-HHS Appropriations Bill for FY2020, Committee summary here, 12 pages, Committee Report here, 346 pages. From the general summary: “Many of the bill’s programs have been shortchanged over the past eight years, and the President’s fiscal year 2020 budget request, if enacted, would do irreparable damage to critical programs that provide opportunities for millions of families. Instead, through this bill, the Committee is moving ambitiously to make up for lost ground by recommending increased investments to help provide every individual with a better chance at a better life—with a good education, a good job, and access to affordable health care.”
Milbank clears up your misunderstanding of the lexicon of “social determinants of health,” here.
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: 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.