DCMedical News: Wednesday, June 12, 2019
DCMedical News-DCMN
Washington, D.C.
Wednesday, June 12, 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
Anti-trust and Health Care, What Limits?
The Federal Trade Commission holds an all-day hearing today on consumer protection and competition in the 21st Century, including an appearance by Attorneys General from four states and staff from Attorney General Offices in another 11 states, agenda here. The group will address consumer protection enforcement and policy, as well as antitrust enforcement and policy in the morning session; remedies and discussion of the seminal 1984 Texas Law Review article by Frank Easterbrook, The Limits of Antitrust (here) in the afternoon.
Ways and Means to Consider Public Options
Today’s hearing of the House Ways and Means Committee at 10:00 a.m. is on means through which universal coverage might be achieved in health care, through Medicare-for-All, public option or other proposals. Half of the 25 Democratic members of the Committee have signed up as sponsors for Medicare-for-All (H.R. 1384, here), but the Committee Chair has asked that the phrase not be used (see e.g. here) during the hearing. Committee witnesses scheduled, a mixed group, include “Rebecca Wood, Patient advocate and mother who lives outside of Boston, Massachusetts; Donald M. Berwick, MD, MPP, President Emeritus and Senior Fellow at the Institute for Healthcare Improvement; Former Administrator of the Centers for Medicare & Medicaid Services; Pam MacEwan, Chief Executive Officer for the Washington Health Benefit Exchange in the state of Washington; Chiquita Brooks-LaSure, MPP, Managing Director at Manatt Health; Tricia Neuman, Sc.D., Senior Vice President and Director of the Program on Medicare Policy at the Henry J. Kaiser Family Foundation; and Grace-Marie Turner, President of the Galen Institute.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
That Sacred Trust, Again
The Chicago Tribune reports (here) that “Doctors gathered in Chicago for the American Medical Association’s annual meeting this week are increasingly finding themselves at the uncomfortable center of a national debate over ‘Medicare for All.’” AMA President Dr. Barbara McAneny, an oncologist in New Mexico, where most of her patients are on government health care, says, “If I did not have the higher rates of commercial payers to make up the shortfall of what I’m funded for Medicare rates, I would end up having to close that practice and leave a lot of people without service.” Physicians for a National Health Program noted that physician support for a single-payer has grown over time, with a 2017 survey by Merritt Hawkins finding that 56 percent of doctors surveyed either strongly or somewhat supported a single-payer health care system. In fact, The Hill reports that Tuesday “The American Medical Association's (AMA) House of Delegates voted 53 percent to 47 percent against the [Medicare-for-All] measure, but adopted a slate of proposals to shore up the Affordable Care Act.”
Single Payer Attacks Doctors, Hospitals, Local Trusts
The National Health came under attack from Members of Parliament (here) for apparent indifference to growing waiting lists and delay in the delivery of services. A Parliamentary Committee reviewing NHS performance found that “only 38 per cent of NHS trusts were meeting the 62-day waiting time limit for cancer patients to begin treatment after an urgent referral. Meanwhile, the waiting list for elective, or non-urgent, care had increased by 1.5m since March 2013 to 4.2m in November 2018.”
MEDICARE, MEDICAID, COMMERCIAL HEALTH INSURANCE
Medicare Advantage Supplemental Benefits
Which Medicare Advantage plans and beneficiaries are using “supplemental benefits”? A study in JAMA this week (here) notes that “Medicare Advantage enrolled 22 million individuals for 2019 coverage, representing 34% of Medicare beneficiaries. Social support services, including transportation and caregiver supports, are known to improve health outcomes and reduce costs. The capitated structure of Medicare Advantage could potentially be used to provide these social services through supplemental benefits. However, regulations have historically restricted offering nonmedical services. . . In April 2018, the Centers for Medicare & Medicaid Services (CMS) issued new rules permitting Medicare Advantage plans to expand the types of supplemental benefits that can be offered to enrollees starting in 2019 . . . New supplemental benefits include adult day care, home-based palliative care, in-home support, caregiver supports, memory fitness, and nonopioid pain management benefits.” Results? Not much, early days, but some findings (e.g. “Twenty-seven percent of enrollees in for-profit plans were offered new benefits compared with 3.1% in nonprofit plans.”) which may be important in the next large roll-out of supplemental benefits in 2020.
Hospital “Productivity Gains”
Reduction in updates for inpatient hospital reimbursement on the basis of “anticipated productivity gains” were provided for in the Patient Protection and Affordable Care Act. Medicare margins have dutifully been declining, but the evidence for gains in hospital productivity is not apparent. Rather, private insurer rates (recently found by RAND, based on a limited sampling, to be an average of 242% of Medicare payment) make up the difference. June 25th the USC-Brookings Schaeffer Initiative for Health Policy has a conference on hospital productivity trends and implications for Medicare policy on hospital payment, with an expert panel of economists and policy researchers, but no health system or hospital executives.
DRUGS AND DEVICES
Minimally Invasive, Then What?
Medscape Cardiology reports (here) that “One in every two patients undergoing transcatheter or surgical aortic valve replacement (TAVR/SAVR) will develop new-onset atrial fibrillation (AF) and as a result face higher odds of in-hospital mortality, a large nationwide study suggests . . . Both groups had longer lengths of stay, but the TAVR group also had higher odds of in-hospital stroke, according to the study, published online June 3 in JAMA Internal Medicine.”
READINGS AND REFERENCES
HCAHPS
The nearly 15-year old Hospital Consumer Assessment of Healthcare Providers and Systems survey may be due for an overhaul, including a more sensible name or memorable acronym. So says Modern Healthcare in a useful perspective (here) on how this “consumer voice” program works now.
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: 13, 18, 19, 20, 21, 24, 25, 26, 27
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.