DCMedical News: Thursday, June 6, 2019
DCMedical News-DCMN
Washington, D.C.
Thursday, June 6, 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 Works to Extend Important Public Health Bills
The Health Subcommittee of the House Commerce and Energy Committee held a hearing June 4 (background Committee memo with program descriptions, legislative history and pertinent literature studies, here) to move forward the extension of a wide variety of important public health measures for which legislative authorization expires September 30 of this year.
The bills include Community Health Centers (12,000 of them, the source of primary care for one in 13 Americans); the National Health Service Corps; Teaching Health Centers for Graduate Medical Education; the Special Diabetes Program and the Special Diabetes Program for Indians; Family to Family Health Information Centers; the Patient-Centered Outcomes Research Institute (PCORI, see DCMN 6-5-2019); State Health Insurance Programs; Area Agencies on Aging; Aging and Disability Resource Centers; the National Center for Benefits and Outreach Enrollment; the National Quality Forum; Certified Community Behavioral Health Clinics (proposed expansion of funding to eleven more states); Disproportionate Share Hospitals (DSH, see below); and the Medicare Limited Income NET Program.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
White Coats vs. Suits:
Modern Healthcare reviews the 2017 990 tax exempt filing forms for healthcare membership associations (here), finding the most profitable to be the American Medical Association, followed by the radiologists, with the American College of Healthcare Executives one of the very few showing a deficit.
Hospital Acquired Infections and Hospital Nursing Unit Under-staffing
Patients had a higher risk of infection if cared for on hospital units that were understaffed for both the day and night shift. This from a study (headnote here) in the Journal of Nursing Administration. Data between 2007 and 2012 from a large urban hospital system were examined to assess an association of nurse staffing with subsequent (2 days) hospital acquired infections (HAIs). “Fifteen percent of patient-days had 1 shift understaffed, defined as staffing below 80% of the unit median for a shift, and 6.2% had both day and night shifts understaffed. Patients on units with both shifts understaffed were significantly more likely to develop HAIs 2 days later.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Repealing DSH Cuts Proposed, Seen as Unlikely
The House Energy and Commerce Committee (see above) is also considering the proposal of Rep. Eliot Engel of New York (here) for full repeal of the Medicaid Disproportionate Hospital Share cuts to hospital payments. In its report on these deliberations, Modern Healthcare inferred conflict among the members of trade groups representing DSH hospitals; given the potential for conflict in rearranging moneys, these groups are promoting a two-year delay in execution of the cutbacks. New York receives $1.8 billion of the annual $12 billion in current expenditures for DSH; without delay, the cutbacks will amount to $4 billion nationally in fiscal year 2020, beginning this October 1, and $8 billion in fiscal year 2021.
MEDICARE, MEDICAID, COMMERCIAL HEALTH INSURANCE
Medicaid Expansion and Cardiac Disease
Twenty-six states (and the District of Columbia) expanded Medicaid coverage under the Patient Protection and Affordable Care Act, nineteen did not. How did the citizens of the two groups of states fare medically? A study in this week’s JAMA Cardiology (here) finds that “counties in expansion states had 4.3 fewer deaths per 100 000 residents per year from cardiovascular causes after Medicaid expansion than if they had followed the same trends as counties in non-expansion states.”
DRUGS AND DEVICES
Haven for What?
STAT reports (here) that Jamie Dimon, the CEO of JPMorgan Chase, “dropped the pretense” that “Haven” will be focused only on the health services used by his company’s employees and those of Amazon and Berkshire Hathaway, the other two partners in a joint venture. “It will take years, but we’re hoping to come up with ideas that are going to help the American public get better health and reduce the costs.” Thus far, the most revealing information about Haven’s scope and goals has come in a suit filed in January (Complaint here) by Optum to attempt to keep a former executive from using his knowledge to benefit Haven.
NY, MA, Other States Focus on PBMs
New York (in a report from a Senate investigating committee, here) and Massachusetts (in a report from the Health Policy Commission, here) both take aim at Pharmacy Benefit Management (PBM) practices. STAT+ reports, “In New York, the Senate committee report urged the state to take such steps as licensing and registering PBMs; prohibiting PBMs from requiring patients to use retail or specialty pharmacies, given that some of the largest PBMs own such businesses; passing through rebates and discounts received from drug makers; and regulating spread pricing.” STAT+ also noted that “The Massachusetts Health Policy Commission, meanwhile, found that, for some drugs, the markup was nearly $16 above a generally accepted benchmark. And even though prices for some widely prescribed generics were falling, the rate at which PBMs charged the state rose. For example, from early 2016 to late 2018, the average cost for buprenorphine fell by 60% while the price charged by PBMs rose by 13%.” The STAT+ report (here) also included links to state activity focused on PBMs in California, Kentucky and Ohio.
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
June publication dates: 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.