DCMedical News: Thursday, May 23, 2019
DCMedical News-DCMN
Washington, D.C.
Thursday, May 23, 2019
DCMedical News is published every day both the House and the Senate are in session. Subscription information below. This is the last issue of DCMedical News until Congress reconvenes June 4.
THE BIG STORY IN HEALTH CARE
Congress is Going Home:
Congress adjourns today and is in recess from tomorrow, May 24, reconvening Tuesday, June 4. The House went home with a bang, holding a second hearing (the Budget Committee, following a hearing on the same subject by the Rules Committee) on “Medicare-for-All” proposals. Testimony was limited to staff from the Congressional Budget Office, on subjects addressed in the CBO paper (here) seen by some as a “road map” of pathways to a single payer system. CBO Deputy Director Mark Hadley told the Budget Committee and audience “Many more people would probably have health insurance as a result but the government would take much more control over the health care system." Hadley noted that if more people gained coverage while payment rates to doctors and hospitals went down there could be a lack of supply, with queues and other barriers to care.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Walmart is Choosing Doctors for its Employees, Too
It turns out that Walmart is not confining its preferred provider network to selection of orthopedic, cardiac or bariatric centers (here, see DCMN 5-22-2019 and “Centers of Excellence”), but is also choosing doctors (here) for an increasing number of its 1.5 million U.S. associates. For some services there is a carrot (knee surgery is “free” with the preferred surgeon), and for others (such as back surgery) a stick (“More than half of those covered by Walmart’s health plan who traveled for spine surgery between 2015 and 2018 recommended by a local doctor discovered the procedure wasn’t necessary, according to Walmart. Twenty percent who had been told they needed new hips or knees didn’t.” Walmart is also steering employees to one of 800 or so diagnostic imaging centers (here), “based on diagnostic accuracy,
not price, to curb misdiagnoses.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
The Hottest Topic in Hospital Management: Patient Engagement? IT system interoperability? Nope, its cost accounting, here, as described in Modern Healthcare, a mini-revival taking place in honor of the prospect of cost management. UPMC’s chief financial officer notes a triumph involved in reduction of fixed cost infrastructure, and credits “management willpower and initiative,” going on to note that unsubstantiated rate increases and overutilization “won’t work anymore.” A survey of members of the Healthcare Financial Management Association found “At the end of 2016, 38% of respondents said they agree or strongly agree it’s difficult to determine the cost of activities using information provided by their current cost accounting system. That was down from 68% in 2004.”
AHRQ Examines Health System Sponsorship of Insurance Products
The Agency for Healthcare Research and Quality examined 626 hospital health systems to see what those systems were doing in the health insurance business. The report, in the form of an infographic (here), began with the 2015 American Hospital Association (AHA) Annual Survey Database and responses to the following AHA survey question: “Does your hospital, health system or health network have equity interest in any of the following products?” The types of insurance products that a respondent can report are health maintenance organization (HMO), preferred provider organization (PPO), and indemnity fee-for-service plan. The survey asked whether the hospital or health system had an equity interest in each of those products or a joint venture with an insurer.
Q1 2019 vs. Q1 2018 for 31 Largest Hospital Systems
Axios has collected first quarter revenue, operating profit, and net profit figures, and calculated operating margin % and net margin % for the largest U.S. health systems, here, in pivot tables.
MEDICARE, MEDICAID, COMMERCIAL HEALTH INSURANCE
Inslee-Care
Washington’s Governor now has the distinction of being the only Presidential candidate with a demonstrated, in-place health care program. Jay Inslee recently signed the first-in-the-nation “public option” health insurance plan (see DCMN 5-21-2019, Inslee discussion of his state’s new public option plan with Vox), and now has signed legislation (here) attempting to protect Washington citizens against surprise medical bills. According to the Washington state Insurance Commissioner (here), “The new law takes effect starting Jan. 1, 2020. Key protections include: A consumer who receives emergency care in an out-of-network emergency room or who has a nonemergency medical procedure in an in-network hospital or facility cannot be balanced billed. An insurer cannot balance bill a patient if they seek emergency care at an out-of-network facility in a state that borders Washington. Insurers must pay the out-of-network provider or facility directly for care their enrollee receives. If the insurer and provider or facility do not agree on a commercially reasonable payment for out-of network services within 30 days, their dispute goes to binding arbitration.”
Medicaid Expansion, Children and Maternal Health
A Georgetown Center for Children and Families Study (here) gathers the evidence that Medicaid expansion reduced the number of uninsured children and mothers, also evidence for better pre-natal and newborn care, but as yet an incomplete link to the ongoing challenge of maternal morbidity and mortality.
MACPAC, New Members and Leaders
The Comptroller General has appointed (here) a new Chair, Vice Chair and two new members of MACPAC, the Medicaid and CHIP Payment and Access Commission.
DRUGS AND DEVICES
Highest Revenue, Most Profitable Companies
The Forbes 500 list of companies with the highest annual revenue (here) has 41 companies. Measuring profitability, use this list.
READINGS AND REFERENCES
America’s Health Rankings by State: The UnitedHealth Foundation publishes (here) its 29th Annual Report, continuing the United Health Foundation’s longest-running annual assessment of the nation’s health on a state-by-state basis.
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
June publication dates: 5, 6, 7, 8, 11, 12, 13, 14, 25, 26, 27, 28
July publication dates: 9, 10, 11, 12, 15, 16, 17, 18, 23, 24, 25, 26
August publications dates: None
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.