DCMedical News: Thursday, January 7, 2021
DCMedical News-DCMN
Washington, D.C.
Thursday, January 7, 2021
DCMedical News is published every day both the House and the Senate are scheduled to be in session this year. Subscription information and archives here.
THE BIG STORY IN HEALTH CARE
Coronavirus
Tracking: Johns Hopkins (here) shows at 8:00 p.m. on 1-6-21 worldwide 87,015,526 COVID-19 cases, 21,252,296 U.S. cases, 24%. Deaths worldwide are 1,878,581, of which 360,443 are in the U.S., 19%.
Vaccination: Dueling opinions, Drs. Wachter and Jha (here) in the Washington Post, for delay in the second dose, Rasmussen and Schwartz in The Guardian (here) urge sticking to the schedule which won the EUA.
Testing: The FDA issues a warning (here) concerning false negatives appearing with the test being used widely in Los Angeles county, for the U.S. Air Force and also for Members of Congress (MedCity report here). The problem involves unobserved and unmonitored sample collection.
Health Care Workers: Statista has summarized the work of The Guardian and Kaiser Health News (here) on deaths caused by COVID-19 infection among health care workers. “An analysis by The Guardian and Kaiser Health News found that the number of U.S. healthcare workers that died during the pandemic is considerably higher than official figures released by the government. It documented 2,921 deaths among healthcare workers up to December 23, 2020 compared to 928 deaths reported by the Centers for Disease Control and Prevention as of 17 December, though the agency has stated that its figures are likely an undercount. More than half of the nearly 3,000 deaths in The Guardian/KHN analysis involved people under 60. It stated that the median age of death from Covid-19 in the general population is 78 but that it is just 59 among the medical staff on the front lines of the pandemic.” In charts, Statista displays the most common job categories (nurses the highest number, here), and immigrant status (here), the latter showing that 30% of those for whom country of origin could be identified among U.S. health worker COVID-19 deaths were in fact immigrants from other countries. A positive note on the impact of vaccination of health workers in a study of four hospitals in NEJM, here: “This study provides useful (albeit partial) answers by showing that presence and titer of anti-spike or anti-nucleocapsid IgG antibodies correlate with protection against reinfection that lasts for at least 6 months. Reinfection was uncommon and asymptomatic. The study was not designed to assess whether reinfections are contagious.” And how about “Pay to Protect” proposals to pay people to be vaccinated? An essay in JAMA (here) discusses various proposals, pros and cons.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Data From Health Insurance Claims May Be Affected by Repeal of the McCarran-Ferguson Act
The “Competitive Health Insurance Reform Act of 2020” (here) has passed the House and the Senate and awaits the President’s signature, or veto. The bill (CHIRA) would repeal the federal antitrust immunity enjoyed by health insurers, now regulated only by the states. A memo from law firm ReedSmith (here) notes that “CHIRA preserves some protections for compiling historical loss data, determining loss development factors, and performing certain actuarial services, as well as for developing standard insurance policy forms.”
The McCarran-Ferguson Act, enacted in 1945, left with the states the primary authority to regulate the insurance industry, exempting insurance companies from federal antitrust liability when the activity involves the business of insurance, when it is regulated by state law and when it does not “constitute a boycott, coercion, or intimidation.” The law firm memo says “Arrangements between insurers to share data for the purpose of developing premiums that previously were immune from federal scrutiny may be subject to the rule of reason and a weighing of the procompetitive benefits and anticompetitive effects of the arrangements . . . In addition, health insurers would be subject to suits by private plaintiffs brought under the federal antitrust laws that may previously have been subject to dismissal under the McCarran-Ferguson Act.”
Over seven decades the McCarran-Ferguson immunity has played a significant role in the development of commercial health insurance practices, especially as health data, access to health insurance claims and establishment of payments to doctors and hospitals based on that data has become vigorously contested. In 1996 the company now known as UnitedHealth Group, the nation’s largest commercial health insurer, formed a subsidiary called Ingenix. Ingenix was the vehicle through which most commercial health insurers collected claims data, and shared that data with one another, immunized against antitrust claims by the McCarran-Ferguson Act. In 2003 Ingenix became OptumInsight and was led (beginning in 2006) by Andy Slavitt; Slavitt was called on in 2013 by the Obama administration to fix the flawed roll-out of healthcare.gov, a key tool for the subsidized commercial plans created in the Patient Protection and Affordable Care Act. Slavitt later became acting Administrator of the Centers for Medicare and Medicaid Services, and will reportedly have a key role in the incoming Biden administration. OptumInsight, now Optum (including pharmacy benefit management), is today a $120 billion+ subsidiary of UnitedHealth Group.
Ingenix had a practical and (from the physician viewpoint) highly negative impact on physician reimbursement. From [then] New York State Attorney General Andrew Cuomo [now Governor]’s office (here and here) announcement that the state was expanding an investigation that focused on Ingenix . . . At a briefing held on February 13, Cuomo stated, “This involves fraud in the hundreds of millions of dollars, affecting thousands and thousands of families ... Too many people have been hurt. It has to stop. We believe there was an industry wide scheme perpetrated by some of the nation’s largest health insurance companies to defraud consumers.” In describing the alleged fraud committed by Ingenix, Mr. Cuomo said an out-of-network doctor might charge $200 for an office visit, but the patient is told that the going rate is $77. The insurer would then normally pay only 80% of that $77 figure, leaving the patient responsible for the difference of about $138. The $77 figure was derived from a database of claims data created and maintained by Ingenix, and shared with and sold to other insurers. A frequent consequence was discord between doctors and their patients, the latter having been told that while their doctor charged $200, the “going rate” was $77. In fact, the Ingenix data base and the “going rate” was created from claims submitted by participating (contracted) doctors; doctors who did not “participate” in a plan did not have their (almost always higher) claim amounts included in the data base or in the calculations of the “going rate.” Through Ingenix, doctors who accepted lower fees from health insurers in order to participate in health insurance plans inadvertently established the “ceiling” for payment of physician services. By way of restitution and settlement of Mr. Cuomo’s suit, the commercial health insurers paid significant amounts which helped Mr. Cuomo to establish (on SUNY campuses) FAIR Health, and also made payments to a number of physician-oriented organizations, for example The Physicians Foundation, which today conducts the leading national surveys on physician compensation and business organization.
READINGS & REFERENCES
Select Coronavirus Public Health Resources and References (alphabetical):
AMA resource page for physicians here. AMA guide to medical education and COVID-19, here.
CDC information page for professionals here, Morbidity and Mortality Weekly Reports on Coronavirus, here.
CMS (Centers for Medicare & Medicaid Services) Current Emergencies website, here.
HHS Protect Public Data Hub, https://protect-public.hhs.gov/datasets/state-representative-estimates-for-hospital-utilization/data?orderBy=state_name&page=4
JAMA Network’s COVID-19 resource center here.
New England Journal of Medicine update here, New England Journal of Medicine Journal Watch here.
The Lancet COVID-19 Resource Centre here and real-time dashboard to monitor clinical trials, here.
STAT COVID-19 Tracker, here.
State actions, Kaiser Family Foundation, here.
The COVID Tracking Project (The Atlantic Monthly), here.
UC Hastings College of Law’s “The Source” (on health care prices and competition) COVID-19 page, here.
2021 House Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
January 8, 21, 22, 25,26, 27, 28
February 8, 9, 10, 11, 23, 24, 25, 26
March 16, 17, 18, 19, 22, 23, 24, 25
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.