DCMedical News: Thursday, May 16, 2019
DCMedical News-DCMN
Washington, D.C.
Thursday, May 16, 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
Energy and Commerce Republicans Gather Endorsements for Bipartisan Proposal to Prohibit Surprise Health bills, here. The alternative, arbitration, has as its model the five-year-old program in New York, the subject of a favorable review (here) in a Georgetown case study. The NY process “Establishes an independent dispute resolution (IDR) process for out-of-network ER services and surprise bills for non-ER services. IDR chooses either the provider bill or the insurer’s payment as reimbursement for services. IDR must consider (1) whether there is a gross disparity between the provider charge and (a) fees paid to the involved physician for the same services rendered by the physician to other patients in health care plans in which the physician is not participating; and (b) fees paid by the health care plan to reimburse similarly qualified physicians for the same services in the same region who are not participating with the health care plan; (2) the provider’s training, education, experience, usual charge, the complexity of the case, individual patient characteristics, and UCR as reported by a benchmarking database. The loser pays for the cost of the IDR process.” Holes in the process: does not apply to self-funded health insurance plans (ERISA), to hospital bills or other than physician and insurance bills, and “does not protect consumers who are misinformed about their provider’s network status, either because they relied on an out-of-date provider directory or were given inaccurate information by their physician’s office staff.”
The House Will Vote Today on Generic Drug Approvals
The bill combines three generic drug pricing initiatives with an unrelated measure (HR 987, here) to strengthen the individual health insurance market. The basic theme of the three drug measures is that generic versions of prescription drugs should not be impeded from coming to market.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
M.D. Wealth and Debt, Medscape Survey
Medscape reports (begin here, 27 slides) on physician wealth and debt, the result of surveys returned by 20,000 doctors in 30 specialties. Highlights: (1) For full time work, combining salary, bonus, income of all types, specialists averaged $341,000 per year, primary care physicians $237,000 per year; (2) Half of the respondents had a net worth over $1 million (36% of the women, 48% of the men); 7% had a net worth over $5 million (3% of women practitioners, 9% of men); the other half had a net worth under $1 million; (3) at the top of the net worth chart, 20% of gastroenterologists had a net worth over $5 million, 19% of dermatologists; for context, the study cites figures showing 12 million households nationally to have net worth over $1 million, 1.3 million people to have net worth over $5 million; and (4) 22% of respondent physicians had mortgages over $500,000, led by dermatologists and ophthalmologists. Roughly a third of emergency department physicians, PM&Rs, family medicine, pediatric and obstetric practitioners were still paying off student loans.
Conscience Rule Explicated
Lawrence Gostin pens a JAMA blog (here) on publication of the final “conscience” rule, the history of predecessor efforts, and how the new rule might affect patient access to health services. He writes, “On May 2, 2019, the US Department of Health and Human Services (HHS) and Office of Civil Rights (OCR) released a final rule that heightens the rights of hospitals and health workers to refuse to participate in patients’ medical care based on religious or moral grounds. The rule covers OCR’s authority to investigate and enforce violations of 25 federal ‘conscience protection’ laws.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Birthrate Falls Further, Below Replacement Rate Since 1971
The U.S. birthrate, below the 2.1 “replacement rate” for half a century, has fallen further, reported (here) in the Wall Street Journal. The report, “The number of babies born in the U.S. last year fell to a 32-year low, deepening a fertility slump that is reshaping America’s future workforce [and utilization of hospital obstetrical units]. About 3.79 million babies were born in the U.S. in 2018 . . . a 2% decline from the previous year and marked the fourth year in a row that the number fell. The general fertility rate—the number of births per 1,000 women ages 15 to 44—fell to 59.0, the lowest since the start of federal record-keeping.”
Another Call for Reduction in the Readmissions Reduction Program
Joynt Maddox and colleagues (here) in the New England Journal of Medicine point to error in measurement and findings in the nine year old Hospital Readmissions Reduction Program. The HRRP measures “inpatient hospitalizations — not observation stays or emergency department (ED) visits — as readmissions, which has artificially inflated estimates of its success. Although readmission rates have decreased for targeted conditions, rates of observation stays and ED visits after inpatient stays have increased; as a result, the proportion of patients who return to a hospital within 30 days after discharge has not changed. This blind spot also creates strong incentives to treat patients in EDs or observation units to avoid readmissions, even if inpatient hospitalization would improve their access to appropriate care. The HRRP also doesn’t include observation stays as index events, so little is known about post discharge outcomes.” Also, “the HRRP metric doesn’t account for the competing risk of death. A patient who dies can no longer be readmitted. But because deaths aren’t factored into readmission rates, hospitals that keep more patients alive and therefore discharge a sicker group of people may be penalized for having higher readmission rates rather than rewarded for having good outcomes. This problem is exacerbated by the fact that penalties for high readmission rates under the HRRP are much larger than penalties for high mortality under the Hospital Value-Based Purchasing program.”
Leapfrog Spring 2019 Report
“A’s” and “F’s” were handed out by Leapfrog to 2,600 hospitals yesterday, a semi-annual event by one of many hospital rating methodologies (CMS Stars, now with 64 “quality” metrics; U.S. News, largely reputational ratings; IBW Watson fka Truven Analytics fka Solucient ratings, based largely on financial strength; etc.), all critiqued here by Ashish Jha and colleagues in 2015. 32% of the hospitals rated by Leapfrog earned an “A,” 26% a “B,” 36% a “C,” 6% a D, less than 1% an “F.” For metro area readers, New York hospitals are here, New Jersey here, Connecticut here.
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
May publication dates: 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.