DCMedical News: Tuesday, May 21, 2019
DCMedical News-DCMN
Washington, D.C.
Tuesday, May 21, 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
Drug Pricing, Surprise Medical Bills Stay in the News
The House Energy and Commerce health subcommittee will hold a hearing today entitled “Improving Drug Price Transparency and Lowering Prices for American Consumers.” Also today, a House Ways and Means health subcommittee hearing will take place on surprise medical bills.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Title VII Health Manpower Funding Extension Introduced
Reps. Jan Schakowsky (D-Ill.) and Michael Burgess, MD, (R-Texas, an obstetrician-gynecologist) have introduced the “Educating Medical Professionals and Optimizing Workforce Efficiency and Readiness (EMPOWER) for Health Act of 2019 (H.R. 2781),” which would reauthorize the Health Resources and Services Administration (HRSA) Title VII health professions education and training programs through 2024. The Association of American Medical Colleges (AAMC) noted (here) that “Title VII health professions pipeline, education, and training programs are critical in helping shape and prepare our nation’s health workforce . . . We applaud this bipartisan reauthorization for recognizing the importance of these programs and the need to increase the federal investment in our nation’s health workforce infrastructure.” According to the AAMC, “The legislation would increase the authorization for most Title VII programs by 5% over the fiscal year (FY) 2019 appropriated levels, 7.2% for Area Health Education Centers (AHECs), and 25% for Geriatric Programs. The legislation also provides flat funding authorization for the Pediatric Loan Repayment program, which has yet to receive an appropriation. The House Energy and Commerce Committee is expected to hold a hearing on Title VII reauthorization in
June.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
A Tiered System for Valvular Heart Disease: Haves and Have-Nots Contend
"Part of the problem is the guys writing this [at the academic medical centers], they're the ones with the loudest megaphone, but they're also in competition with the other centers." So says one spokesman for smaller hospitals (here), responding to the “consensus” tiering proposal of specialty societies. Reports MedPage Today (here), “A tiered system for valvular heart disease (VHD) treatment centers akin to that for stroke and trauma treatment was jointly proposed by several medical societies. Such a system would divide hospitals into Level I (Comprehensive Valve Centers) and Level II (Primary Valve Centers), with the former being able to perform all interventional and surgical procedures and have advanced imaging modalities; and the latter capable of at least transfemoral transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement, among other criteria.” The consensus document, published in the May Journal of the American College of Cardiology (here), is entitled “A Proposal to Optimize Care for Patients With Valvular Heart Disease,” and is a “A Joint Report of the American Association for Thoracic Surgery, American College of Cardiology, American Society of Echocardiography, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons.” The proposed “Coverage With Evidence Development” decision on Transcatheter Aortic Valve Replacement (here) comment period closes June 24.
The Failure of the Hospital Readmissions Reduction Program: How Much Evidence is Enough?
Are you missing the gentle common sense of the late Uwe Reinhardt? Ashish Jha writes (here) in JAMA Cardiology “We are now approaching the ninth anniversary of the passage of the HRRP, and there is mounting evidence that the program is failing to live up to expectations. [HRRP is the Hospital Readmissions Reduction Program, part of the behavioral economics weaponry of the Patient Protection and Affordable Care Act, intended to produce part of the $716 billion savings from the Medicare program needed to subsidize exchange-based policies and Medicaid expansion.] Three studies have found an increase in mortality because of the program. Two studies have concluded that coding changes were the primary driver of the decrease in readmissions. Now, 1 study has found a comparable decrease in readmission rates in Canada. Is this enough evidence to suggest that we need to make substantial changes to the program? For the architects and advocates of the HRRP, who have a substantial interest in maintaining the status quo, this evidence may not be enough to sway them.”
MEDICARE, MEDICAID, COMMERCIAL HEALTH INSURANCE
Washington Governor Jay Inslee discusses (with Vox, here) his state’s first-in-the-nation “public option” for health insurance. The summary: “The Washington government would contract with private health carriers to sell state-sponsored health insurance plans on its Obamacare market place. The public option plan would be required to meet certain benefits and out-of-pocket requirements set by the state. The plan would pay health care providers 160 percent of Medicare rates, with a few limited exceptions. The state will explore increasing the eligibility for insurance tax subsidies from 400 percent of the federal poverty level (as set by Obamacare) to 500 percent.”
DRUGS AND DEVICES
Is Civica Rx Just Another GPO? And, if so, can it correct for the drug shortages created by GPOs?
The much-anticipated “hospitals-will-make-their-own-drugs-and-avoid-shortages” initiative known as Civica Rx announced its first product (here). It turned out to be a committed volume purchase with the Danish pharmaceutical maker Xellia, rather than any new manufacturing capability. "What makes this attractive to suppliers like Xellia is that, because of the way contracts are awarded over time, you have one or two manufacturers supplying most of the market," said a spokesman for Civica Rx. "Players like Xellia don't have access to all of the customers just because of the way pharma companies try to negotiate the contracts to get the most volume possible so they can be the most efficient in their operations. Companies like Xellia that are late to the game are locked out a little bit." These are, however, among the very charges laid at hospital group purchasing organizations (GPOs) (here, here and here), that is, through zeal to produce rebate income, the GPOs commit volume to too few manufacturers.
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: 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.