DCMedical News: Monday, July 15, 2019
DCMedical News-DCMN
Washington, D.C.
Monday, July 15, 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 Moves Forward with Measure Against “Surprise” Medical Bills
July 11 the House Energy and Commerce Subcommittee on Health voted to send H.R. 3630 (here) to the full Committee, by voice vote. This measure would use median in-network rates in the geographic areas where the health service is provided as a benchmark for what insurers should pay to out-of-network providers. The bill is similar to one passed by the Senate HELP Committee in June, in that both rely on “benchmark rates” for solving payment disputes. The Senate alternative, sponsored by Senators Cassidy and Hassan, proposes “baseball style” arbitration.
Senator Lamar Alexander Gives an Overview of Bipartisan Drug Legislation Progress
In a floor speech (here), reprinted in a communication to his constituents, the famously bipartisan HELP Committee Chairman—not running for re-election—outlined the drug price control bill passed through his Committee:
“Last month, the Senate health committee passed legislation, by a vote of 20-3, that included fourteen bipartisan provisions to increase prescription drug competition to help more lower-cost generic and biosimilar drugs reach patients.
This includes: The CREATES Act, from Senators Grassley and Leahy, and many others, which will help bring more lower-cost generic drugs to patients by eliminating anti-competitive practices by brand drug makers.
Helping biosimilar companies speed drug development through a transparent . . . patent database. Senators Collins, Kaine, Braun, Hawley, Murkowski, Paul, Portman, Shaheen, and Stabenow worked on this provision.
Improves the Food and Drug Administration’s drug patent database by keeping it more up to date – to help generic drug companies speed product development, a proposal offered by Senators Cassidy and Durbin. Prevents the abuse of citizens’ petitions that can unnecessarily delay drug approvals, from Senators Gardner, Shaheen, Cassidy, Bennet, Cramer, and Braun – and was proposed by the president in his fiscal year 2020 budget.
Clarifies that the makers of brand biological products, such as insulin, are not gaming the system to delay new, lower-cost biosimilars from coming to market, from Senators Smith, Cassidy, and Cramer.
Eliminates exclusivity loopholes that allow drug companies to get exclusivity – and delay patient access to less costly generic drugs – just by making small tweaks to an old drug, a proposal from Senators Roberts, Cassidy, and Smith – which was also proposed by the president in his budget; and
Prevents the blocking of generic drugs by eliminating a loophole that allows a first generic to submit an application to FDA and block other generics from the market – the president also proposed this in his budget.
Prevents delays of biosimilar drugs by excluding biological products from compliance with U.S. Pharmacopeia standards that do not apply to biosimilar drugs and could instead delay patient access – another proposal by the president. Increases transparency on price and quality information by banning gag clauses in contracts between providers and health plans that prevent patients, plan sponsors, or referring physicians from seeing price and quality information.
And bans pharmacy benefit managers from charging more for a drug than it paid for the drug.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Now That’s Value-Based Payment!
CMS announced (here) that 97% of participating physicians qualified for bonus payments in the second year of the Merit-based Incentive Payment System (MIPS). Wrote the agency, “Clinician success in MIPS has continued to rise with 97% exceeding the performance threshold score of 15 points to receive a positive payment adjustment based on performance in 2018. This is an increase from 93% in 2017.” In 2017 CMS had 134,000 more practitioners involved, mainly from smaller practices who complained then about the administrative expense and infrastructure necessary to participate.
“Conscience” Rule Delayed Until November 22
Facing legal challenges (including one from the City of San Francisco), the Department of Health and Human Services has agreed to delay (from July 22 to November 22) the effective date of the “final rule” (here) of regulations intended to offer protection for health care entities and individuals who refuse to provide or to pay for medical services because of their religious or moral believes. A stipulation to that effect was agreed to June 28.
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Florida Hospitals Exploring Expansion of High-End Clinical Services in the Wake of CoN Law Ending
Certificate of Need review is on the way out for Florida hospitals. Many of them are exploring new and expensive services (here) previously disapproved by the Florida Agency for Health Care Administration (AHCA). “The legislation, signed into law by Gov. Ron DeSantis last month, eliminated the certificate-of-need requirement for new general hospitals and ‘tertiary services’ on July 1. It will repeal a certificate-of-need requirement in 2021 for specialty hospitals, such as children’s hospitals. Tertiary services include such things as organ transplants and pediatric open-heart surgery and neonatal intensive-care units. The CON program, though, remains intact for nursing homes, hospices and intermediate care facilities for individuals with developmental disabilities. In lieu of requiring hospitals to show there is a need for a program like bone marrow transplants, the new law will allow hospitals to open the program as long as they meet certain licensure requirements. The new licensure requirements will have to be adopted through rules, a process that could take months. AHCA last week released what agency spokesman Patrick Manderfield called ‘supplemental information’ that the state will ask for until the rules are adopted.”
Debt Burden of Care Homes in UK Puts Focus on Privatization
The Financial Times (here) reports that the burden of debt in British care homes raises the question of how privatization has gone wrong in social and medical services. “Most UK care homes were managed by local authorities until the former British prime minister Margaret Thatcher reformed the system in the 1980s; now just 8 per cent are under state control. All four of Britain’s biggest care-home businesses have been up for sale in the past year and have failed to secure deals, partly due to the financial pressure of a long-term fall in local authority fees.”
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
July publication dates: 16, 17, 18, 23, 24, 25, 26
August publications dates: None
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.