DCMedical News: Wednesday, July 10, 2019
DCMedical News-DCMN
Washington, D.C.
Wednesday, July 10, 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
PPACA Litigation
FierceHealthPayer seems to summarize the consensus of observers of the 5th Circuit’s oral arguments in Texas v. United States: “A federal appeals court may be poised to deem the ACA’s individual mandate unconstitutional, but appeared to be on the fence about whether they believe that strikes down the entire law.” Some of the “fence” issues involve whether to send the case back to the District Court, and with what instructions; the position of the U.S. Department of Justice that invalidation of the individual mandate and of the Patient Protection and Affordable Care Act generally would only apply to Texas and the (now) eighteen other plaintiff states seeking such a remedy; whether the Democratic states and the House of Representatives continue to have standing in the case; and of course whether the individual mandate is “severable” from the remainder of PPACA.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
FTC Stirs
The Federal Trade Commission backed Sanford Health off as that hospital chain sought to acquire Mid Dakota, its closest competitor for physician services. Following the decision of Sanford Health to abandon its proposed acquisition of Mid Dakota Clinic, FTC Chairman Joseph J. Simons issued the following statement (here):
“These two physicians’ groups have competed vigorously in the Bismarck-Mandan region of North Dakota. The FTC alleged that the proposed acquisition would give Sanford at least a 75 to 85 percent share of the market for providing adult primary care physician services, pediatric services, and obstetrics and gynecology services, and would leave the region with only one physician group offering general surgery physician services. Now that the acquisition is abandoned, consumers in the Bismarck-Mandan region of North Dakota will continue to benefit from competition between Sanford Health and Mid Dakota Clinic in these vital physician services.”
“A June 13, 2019 decision by the Eighth Circuit Court of Appeals upheld a December 2017 preliminary injunction issued by the district court that halted the acquisition (here) pending a full administrative trial on the merits. When the respondents appealed the district court’s ruling and sought to have the preliminary injunction lifted, the administrative trial was stayed.” “Vertical integration” is also the focus of this week’s Modern Healthcare cover, antitrust authorities excited about hospital-doctor combinations in a way they have not been about hospital-hospital combinations.
Also in the FTC’s sights, COPAs, Certificates of Public Advantage, arrangements for state supervision of anti-competitive conduct (here, slides by presenters; here, Chairman’s remarks; here, Milbank blog), not obviously (any longer, if ever) a “public advantage.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Health Care Adds 35,000 Jobs in June
“Employment in health care increased by 35,000 over the month and by 403,000 over the past 12 months. In June, job growth occurred in ambulatory health care services (+19,000) and hospitals (+11,000),” reports the Bureau of Labor Statistics (here).
Measure of Readmissions, Small Base and Small Results
A Michigan group reports in this month’s Health Affairs (here) that readmissions reductions may have reached a “floor” and that further reductions are unlikely. The group found that the medical readmission penalties also led to readmission reductions for surgical patients, that “targeted surgical penalties did not have an additional effect.” (Italics added). Unheralded is Gerard Anderson’s observation (here) that DRGs (a prix fixe, putting the economic incentive on rapid through-put of patients, rather than the incentive of cost-based reimbursement to keep the patient as long as needed) might have caused the “readmission problem” in the first place.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Working Families and PPACA
A CHOP/Penn group reports in Health Affairs this month (here) that “Working families have increasing enrolled their children in Medicaid or the Children’s Health Insurance Program in recent years.” For low-income families (less than 200% of the federal poverty level), CHIP coverage was 79% at small private employers, 69% at larger firms. For moderate-income families (200 – 299% of FPL) at small companies, public coverage was 64%. The authors note the “changing role of public insurance for working families as the cost of employer-based coverage grows.” On a similar note, a Harvard-related group reports in the same journal (here) that “workers in traditionally blue-collar industries (service jobs, farming, construction, and transportation) experienced the largest gains in health insurance after implementation of the Affordable Care Act.” Most of these enrollment gains came from Medicaid.
DRUGS AND DEVICES
Side-Stepping “Step Therapy”
Wisconsin Governor Evers has signed SB26 (here), allowing doctors in that state to avoid “step therapy,” a “spanner in the works” tool which compels patients to fail first with lower cost drugs, before allowing payment for the drugs their physicians have prescribed. Medicare Advantage plans are allowed to use “step therapy” this year; CMS has discussed adding the requirement to regular or “fee-for-service Medicare.”
Hospital Drug Price Mark-Up
Reporting for PhRMA, The Moran Company in 2017 (here) found that “[O]n average hospitals mark-up these 20 drugs 487 percent, though the mark-up varies materially from product to product.” Updating its report, The Moran Company reports this month (here) that “[O]n average hospitals charge 478 percent of their acquisition cost for these 20 drugs, though the percentage varies materially from product to product. These charges exclude fees charged for administering the drug.”
READINGS AND REFERENCES
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
July publication dates: 11, 12, 15, 16, 17, 18, 23, 24, 25, 26
August publications dates: None
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.