DCMedical News: Wednesday, May 22, 2019
DCMedical News-DCMN
Washington, D.C.
Wednesday, May 22, 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
House Budget Committee Holds Hearing Today on Single-Payer System
The Budget Committee returns the spotlight today to “Medicare-for-All” legislation, with particular focus on the Congressional Budget Office analysis (here) of how a single-payer design would look in the U.S. The only witnesses today will be CBO analysts, to discuss costs, whether the government would have to take over the nation’s hospitals, the role (if any) of private insurance, and utilization and rates.
HELP Chairman to Propose Omnibus, Bipartisan Senate Health Bill
Senator Lamar Alexander, Chairman of the Health, Education, Labor & Pensions Committee, will release a comprehensive health cost control bill Thursday which may include as many as two dozen separate proposals, including prohibitions on surprise billing, limitations on drug rebates, promotion of price transparency and related issues involved with reducing patient out-of-pocket costs. He said, “If the proposals are not bipartisan, they won’t be in the draft.”
In the House, Representative Devin Nunes, ranking Republican on the House Ways and Means Health Subcommittee, outlined his strategy to combat surprise bills in a letter (here) to Chairman Lloyd Doggett. Nunes said, “Perhaps hospitals, which are responsible for those practicing within their four walls, should be held responsible for dealing with issues between doctors and insurance companies in such circumstances.” Adding, “[hospitals] have the power, and I would argue the responsibility, to solve this issue for patients.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Decision Fatigue (Looking at You, Electronic Medical Records) Lowers Cancer Screening Rates
The cumulative burden of decisions, work and patient load leads to lower cancer screening rates for patients seen later in the work day by primary care practitioners. A study in JAMA Network (here, report from HealthLeaders here), indicates that primary care doctors recommended breast cancer screening significantly more often for patients seen early as opposed to those seen later in the day, with similar differences for colon cancer screening. The study’s authors examined three years’ worth of EPIC records of 33 primary care practices. The authors hypothesize that “as the day goes on, clinicians may be less likely to discuss cancer screening with patients,” since “no observable differences were found between characteristics of the patients who had visits at different times of day.”
A White House VA Hotline Surpasses 250,000 Calls
A report from the VA (here) indicates that the White House VA hotline, implemented June 1, 2017, has answered more than 250,000 calls, “quickly becoming VA’s front door for questions or concerns about VA and community resources,” according to VA Secretary Robert Wilkie. The VA news release says the average wait time to speak to a live agent is 9 seconds, calls typically lasted 15 minutes, and 1% of all calls are compliments.
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Centers of Excellence or Marketing Tools?
A research letter in JAMA Internal Medicine (here) examined the question of whether hospital “Centers of Excellence” (COE) as designated by third-party payers actually offer any higher quality than hospitals without such designation. The article focuses on percutaneous coronary intervention (PCI) analyses by the State of New York, as well of Centers of Excellence programs by Aetna’s Institutes of Quality for cardiac medical interventions, Cigna Centers of Excellence for cardiac catheterization and angioplasty, and Blue Cross Blue Shield Blue Distinction Centers for cardiac care. A summary of findings: “We found a lack of correlation between COE designation and lower mortality or readmission rates.” To the contrary, “for hospitals with an Aetna COE designation, the mean 30-day risk standardized mortality rate after PCI was modestly, but statistically significantly, higher than for hospitals without the designation.” One implication: “Given the insufficient discrimination provided by these programs, the current system of COE designation may allow for assignment based largely on cost and other nonclinical or patient-related factors.” Meanwhile, Walmart has announced (here) the “Centers of Excellence” to which it will send employees directly, bypassing health insurers, including eleven for joint replacement, eight for spine surgery, five for bariatric surgery, three for cancer and transplant programs, and three for cardiac care programs.
Telemedicine Expands to Cover Specialty Gaps
The University of Pittsburgh Medical Center (UPMC) has formed a telemedicine company to focus on the shortage of infectious disease specialists. In a report (here) on the new company, Infectious Disease (ID) Connect, UPMC indicated that it already serves ten of its own hospitals, and five non-UPMC hospitals in Pennsylvania and surrounding states. The new company’s marketing focuses on the more than 4,000 U.S. acute care hospitals having fewer than 300 beds, which “face an especially difficult time recruiting and retaining already scarce ID specialists.” The UPMC report contends that health care-associated infections affect 5 to 10 percent of hospital patients, resulting in more than $40 billion in annual hospital costs, with up to half of all hospital antibiotic prescriptions unnecessary.
FTC Commission Wants Aggressive Review of Hospitals Mergers
In a speech to the Center for American Progress (story here), FTC Commissioner Rebecca Slaughter called for the FTC and the Department of Justice to “get tougher” on hospital mergers, “even if it means losing cases.” She added that private equity’s push into health care is a “really disturbing trend,” with more than 700 private equity “deals” in the health care industry in both 2017 and 2018.
MEDICARE, MEDICAID, COMMERCIAL HEALTH INSURANCE
CBO Summarizes Subsidies, Taxes and Penalties for Health Insurance, 2019-2029
In a set of 12 sides (report here, slides here), the Congressional Budget Office has summarized the projected government subsidies for health insurance for Americans for the next decade. CBO projects net federal subsidies to increase from $737 billion to $1.3 trillion by 2029. These subsidies, in turn, are made up in relatively equal parts (40%) of support for Medicaid and CHIP and (40%) tax benefits for work-related insurance, with Medicare 10% of the total and subsidies through the marketplace exchanges of the Patient Protection and Affordable Care Act at or below 10%.
Readmissions Reduction Under Continued Attack
Kip Sullivan and Stephen Soumerai continue the attack on the Hospital Readmissions Reduction Program, this time in STAT (here), including 40 bibliographic citations.
DRUGS AND DEVICES
CBO Unimpressed with Potential for Savings in Medicare Drug Negotiations
The Congressional Budget Office sent a letter (here) to the Chairman of the Senate Committee on Finance indicating that giving Medicare authority to negotiate price discounts with drug manufacturers would not necessarily be successful in controlling Medicare drug costs, without, for example, authority to establish a fixed or limited formulary.
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: 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.