DCMedical News: Thursday, June 17, 2021
DCMedical News-DCMN
Washington, D.C.
Thursday, June 17, 2021
DCMedical News is published every day both the House and the Senate are scheduled to be in session. Subscription information and archives from 2018 to the present at dcmedicalnews.org, here.
THE BIG STORY IN HEALTH CARE
U.S. Interest Rates to Rise
The Financial Times reports (here) that “US Federal Reserve officials expect to start raising interest rates in 2023, earlier than previously forecast, according to economic projections that predict faster growth and sharply higher inflation this year.”
DOCTORS, NURSES AND OTHER HEALTH CARE PROFESSIONALS
Birthrate Falling, With Largest Declines Where Economy is Growing
The New York Times reports (here) that the U.S. is experiencing “The slowest growth of the American population since the 1930s, and a profound change in American motherhood. Women under 30 have become much less likely to have children. Since 2007, the birthrate for women in their 20s has fallen by 28 percent, and the biggest recent declines have been among unmarried women. The only age groups in which birthrates rose over that period were women in their 30s and 40s — but even those began to decline over the past three years.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Bundling of Joint Replacement Expenses, Voluntary, Mandatory and Non-Participating Hospitals
A paper in JAMA (here) explores what difference, in any, resulted in institutional expenses for patients in hospitals which voluntarily participated in the BPCI (Bundled Payment for Care Improvement) and CJR (Comprehensive Care for Joint Replacement) programs, those mandated to participate by CMS, and hospitals not participating at all (paid on traditional fee-for-service basis). The results would appear to favor the non-participants: “Risk-adjusted episodic spending decreased among voluntary hospitals from $21,182 before bundled payments to $18,452 after bundled payments; among mandatory hospitals, spending decreased from $18,390 to $15,652; and among hospitals not participating, spending decreased from $17,132 to $14,871,” although the authors claim modest differences in “risk adjusted” expenses.
Mount Sinai (NY) Walks Back Downsizing and Relocation Plans for Beth Israel
The New York hospital announced (here) that it would not downsize Beth Israel Hospital, a proposal which would have moved Beth Israel to a location that had 70 beds from its existing site licensed for more than 600 beds. The downsizing and relocation, including the loss of maternity beds, was unpopular with community and political groups, including Community Catalyst.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
MedPAC Report to Congress Explores Ten Major Health Payment Controversies
The June report (here) of the Medicare Payment Advisory Commission includes chapters on changes to the way Medicare Advantage benchmarks are determined; CMS’s portfolio of alternative payment models; the effect of private equity investments on the Medicare program, a congressional request; the skilled nursing facility value-based purchasing program; Medicare beneficiaries’ access to care in rural areas; Medicare’s indirect medical education payment policy; coverage of and payment policies for preventive vaccines; separately payable drugs in the hospital outpatient prospective payment system; payment rates for clinical laboratory tests; and the relationship between services furnished by clinicians and other Medicare services, in 403 pages.
MACPAC Report to Congress, Focus on Drug Prices, Mental Health
The June report (274 pages, here) of the Medicaid and CHIP Payment and Access Commission recommends that Congress take measures to address the effect of high-cost specialty drugs on state Medicaid programs, as well as steps that would improve access to mental health services for adults and children and adolescents enrolled in Medicaid and the State Children’s Health Insurance Program (CHIP). The report also contains additional topics of interest to Congress, such as promoting integration of physical and behavioral health care, the non-emergency transportation (NEMT) benefit in Medicaid, and state strategies for integrating care for people who are dually eligible for Medicaid and Medicare.
Healthcare Dive (here) explores highlights of both reports, noting especially the MedPAC conclusion that Medicare Advantage (MA) programs have primarily benefited MA health insurance carriers. “By many measures, the MA program has been thriving. Enrollment and participation has continued to grow . . . But despite that relative efficiency, MA contracting isn't saving Medicare money — actually, in the 35 years Medicare managed care has been active, it's never resulted in net savings for the cash-strapped program . . . MedPAC estimates Medicare actually spends 4% more per capita for beneficiaries in MA plans than those in FFS under the existing benchmark policy.”
DRUGS & DEVICES
340B in the News: Program Grows as Shown in FOI-Received Information; Court Demurs on Community Pharmacy Participation; HHS Proposes to Eliminate Requirement that FQHCs Demonstrate Benefit to Patients
The 340B program, through which “safety net” hospitals and health facilities buy drugs at discounted prices from pharmaceutical companies and resell them to third parties at higher prices, nominally applying the difference to subsidize low-income patients, continues to grow, and to generate controversy.
Drug Channels reports (here) that “Discounted purchases under the program reached at least $38 billion in 2020. That figure is an astonishing 27% higher than its 2019 counterpart—and more than quadruple the value of discounted purchases in 2014.” The actual program size was unknown, prior to Drug Channel’s FOI initiative. The list of participating hospitals and amounts of their purchases and resales still remains unknown, in part through the efforts of “340BHealth,” a trade group formed to protect participating institutions.
A federal judge (opinion here) refused HHS' request to dismiss AstraZeneca's challenge to an advisory opinion from Health and Human Resources Administration blocking drugmakers from charging a covered entity more than the ceiling price for 340B drugs. The Judge said the government's position on drugmakers' obligations under the 340B program had shifted over time, and that while “Congress may very well want pharmaceutical manufacturers to deliver 340B drugs to an unlimited number of contract pharmacies as a condition for manufacturers' participation in the Medicare Part B and Medicaid programs. But that kind of policymaking is for Congress, not this Court.”
HHS, meanwhile, proposed (CQ reports, here) to rescind a late-Trump era rule which would have required Federally Qualified Health Centers to demonstrate that the benefits had actually gone to low income patients. “This rule established a new requirement directing all health centers receiving grants . . . to the extent that they plan to make insulin and/or injectable epinephrine available to their patients, to provide assurances that they have established practices to provide these drugs at or below the discounted price paid by the health center . . . [to patients] who have a high cost sharing requirement . . . have a high unmet deductible; or who have no health insurance.” HHS cited “administrative burden and cost necessary to comply with the rule.” Comments on the new proposal by July 16.
Aduhelm May Increase Total National Health Expenditures 1% to 2.5%
Consultant Altarum projects (here) that Alzheimer drug Aduhelm will increase prescription drug expenditures by 8% and total national health expenditures by 1%, despite no evidence of effectiveness for patients. Modern Healthcare reports (here) that “Altarum's estimates are conservative because they assume one million patients will use the drug by the mid-2020s . . . about 16% of the total Alzheimer's population . . . Doubling the uptake to 2 million people—the higher end of the manufacturer's target population—has Aduhelm comprising 2.5% of national health spending and driving up non-retail drug spending by more than 50%, Altarum found.”
READINGS & REFERENCES
Select Coronavirus Public Health Resources and References (alphabetical) may be found here.
2021 CQ Congressional Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
June 22, 23, 24, 25
July 19, 20, 21, 22, 26, 27, 28, 29, 30
August - none
September 20, 21, 22, 23, 24, 27, 28, 29, 30
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.