DCMedical News: Thursday, July 25, 2019
DCMedical News-DCMN
Washington, D.C.
Thursday, July 25, 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
Senate Finance Committee to Vote Today on Major Drug Pricing Package
The proposal (here) will compel pharmaceutical manufacturers to reimburse the government if drug list prices are too high, cap out-of-pocket costs for Medicare patients, address conflict of interest in government payment decision-making, and, in general, according to STAT+, “[H]as the potential to change Medicare more dramatically than almost any piece of health policy in the last 20 years.” Some 111 amendments have been filed (here) in advance of the mark-up session. The CBO report (here) projects $100 billion in savings over a decade, most of it from a provision (the subject of strong objections by Republican members of the Committee) which would force drug makers to rebate money to Medicare if they raised prices faster than inflation.
Lower Health Care Costs Act
Senator Lamar Alexander reports to his constituents (here) that “A recent Gallup poll found that the cost of health care was the biggest financial problem facing American families, so it is my hope that the Senate will pass this bill and lower the cost of what Tennesseans pay for health care.” However, neither the Senate nor the House will act on “surprise bills,” both chambers facing stiff opposition from physicians and hospitals favoring arbitration over index payments.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Persistent Antigen and Lyme Arthritis: Chronic Lyme Disease Possibility?
A major component of the cell wall is identified (here) in Proceedings of the National Academy of Science which may be “an immunogen likely to contribute to inflammation during infection and in cases of postinfectious Lyme arthritis.”
Physician Pay Grows as Hospitals Acquire Practices
Modern Healthcare reports (here) a growth in physician compensation of 2% in 2018, for an overall mean of $400,686. Much of the growth came in non-invasive cardiology and plastic surgery, and followed an overall “relatively flat 2017.” Orthopedic surgeons had the highest average annual salary among the 26 specialties surveyed with a mean of $594,928. Lowest paid were pediatricians, at $245,043. The Modern Healthcare survey brings together results from 10 different commercial surveys, whose constituency, financial support and methodology are described in the article.
Wellness for the Corporation or the Employee?
Employee penalties for wellness programs are the subject of a lawsuit at Yale (here) by the AARP against Yale University, whose “Health Expectation Program” fined employees up to $1,300 annually for failure to participate in an employee wellness program. The suit alleges that “The rapid expansion in employee wellness programs has come at a price for employees, however, with a contingent of employers imposing financial penalties on employees who do not participate in these programs, despite growing evidence that imposing penalties does not improve programs’ effectiveness.”
The AARP suit against Yale cites a Kaiser Foundation 2018 employee benefit survey indicating that nearly 5% of large employers impose fines for non-participation in wellness programs which exceed $1,000 per year. A JAMA study (here) of workplace wellness programs found “no significant differences in clinical measures of health, health care spending and utilization.” The study notes that “these findings may temper expectations about the financial return on investment that wellness programs can deliver [to patients] in the short term.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Community Health Center Renewal, Size, Growth
Modern Healthcare reports on the growth of community health centers (here, infographic), showing coverage (smaller percentage uninsured as Medicaid has expanded), grants flat compared to revenue, capital improvement or development grants disappearing. Also (pgs. 2-3), Congressional action to support the 1,400 community health centers which, according to the story, “seem to indicate their [Congress] intention to avoid going over the fiscal cliff again.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
DSH Payment Delays in Race Between Regulation and Statutory Change
Bloomberg’s Sam McQuillan reports that OMB has received a “final rule” on the proposal to reschedule Medicaid DSH (Disproportionate Payment Hospitals) cutbacks established under the Patient Protection and Affordable Care Act. The reductions could cost hospitals $43 billion in payments between 2022 and 2025. The theory of PPACA was that expansion of Medicaid (and, to a lesser extent, exchange-based health insurance) would reduce or eliminate bad debt experienced by hospitals caring for uninsured patients. The DSH payments have been pushed back each year since 2014 and never implemented. The rule proposed rescheduling payment reductions for FY2020 to FY2025. In the House, the Energy and Commerce Committee has approved H.R.2328 which would delay the cuts for two years and halve them to $4 billion in 2022.
DRUGS AND DEVICES
Uncontrolled Experiments on the Public
The Milwaukee Journal Sentinel reports (here) that “A drug’s most dangerous side effects often aren’t discovered until it’s on the market.” The focus of this story is on biologics whose problems (infections, side effects) “emerged only after the U.S. Food and Drug Administration deemed the drugs safe and effective treatments and allowed them on the market.” The drugs were the subject of 25 warnings since the year 2000, with more than 60% of the 21 separate drugs involved receiving a “black box” warning, most after problems identified with drugs already on the market. A larger 2017 study in JAMA found that of 222 drugs making it to the market between 2001 and 2010, 27% later received a black box warning. An earlier Journal Sentinel analysis (here) of FDA data had found more than 500,000 serious side effects since the year 2004 with biologic drugs, leading to more than 34,000 deaths.
READINGS AND REFERENCES
Health care spending in the Medicare program, the Medicare Payment Advisory Commission (MedPAC) Databook for June 2019 (206 pgs), here.
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: 26
August publications dates: None
September publication dates: 9, 10, 11, 12, 17, 18, 19, 20, 23, 24, 25, 26, 27
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.