DCMedical News: Friday, July 26, 2019
DCMedical News-DCMN
Washington, D.C.
Friday, July 26, 2019
DCMedical News is published every day both the House and the Senate are in session. The House adjourns for the August recess today, the Senate August 2. The next day on which both the House and the Senate are in session is September 9, when DCMN will resume publication. Subscription information below.
THE BIG STORY IN HEALTH CARE
Senate Finance Committee Drug Pricing Proposal Passed by Committee, Big Amendments Rejected
The Senate Finance Committee on Thursday approved the proposal (here), still in non-legislative language, by a vote of 19-9. Rejected as amendments: an attempt to remove the Part D price-above-inflation penalties was rejected on a tie 14-14 vote, Senator Menendez of pharmaceutical state New Jersey joining all of the Republican Committee members; efforts to compel Medicare to negotiate drug prices directly with manufacturers failed 12-16; also rejected on a 14-14 vote was an attempt to block an administration proposal that would link some Medicare drug reimbursements to lower prices paid by other countries (“reference pricing”).
The bill has the potential to compromise other revenues, including hospital Part B charges. STAT+ reported that starting in 2021, Medicare Part B's 6% add-on fee for hospital outpatient departments, ambulatory surgical centers and physician offices would be capped at $1,000 per drug per day. Starting in 2029, this cap could start increasing at the rate of inflation. Also, the “site neutrality” of Part B administrative fees changes; beginning in 2021, the "grandfathered" off-campus hospital outpatient departments that since 2015 get higher payments for administering Part B drugs would lose their special status.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Private Equity Takeover of Dermatology Practices
A study in JAMA this week (here) reports that PE-backed groups acquired 184 practices between May 1, 2012, and May 22, 2018. “These acquired practices accounted for an estimated 381 dermatology clinics as of mid-2018 . . . Practice acquisitions increased each year, from 5 in 2012 to 59 in 2017. An additional 34 acquisitions took place from January 1 to May 31, 2018 . . . Clinics associated with acquired practices spanned at least 30 states, with 138 of 381 clinics (36%) located in Texas and Florida.” An editorial (here) notes that “Some might claim that the rapid takeover of the private practice of dermatology by private equity will prove beneficial for dermatology and the American public. The more compelling case today, however, is that the basic approach and incentives of private equity are not aligned with health and value in dermatology. By focusing on short-term revenue opportunities, private equity acquisitions will likely add to the immense cost and stark inequality of our health care system, with the added risks of unnecessary treatments and significant disruptions in care.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
U.S. Birth Rate Declines 2% in One Year
The CDC’s National Center for Health Statistics reports (here) that “The U.S. general fertility rate (births per 1,000 women aged 15–44) declined 2% between 2017 and 2018 . . . The teen birth rate declined 7% from 2017 to 2018 to 17.4 births per 1,000 females aged 15–19 . . . The percentage of vaginal births after previous cesarean (VBAC) rose to 13.3% in 2018 . . . Percentages of births delivered preterm and early term increased from 2017 to 2018, whereas full-term and late- and post-term deliveries declined.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Bill-of-the-Month
The Kaiser Health News bill-of-the-month (here) was $540,842 for 14 weeks of dialysis. The insurer paid $16,242. The patient was billed $524,600. Rick Louie investigates actual prices paid to hospitals for dialysis in the same state (Montana) and finds that “[D]ialysis chain providers, notably Fresenius Medical Care and Dialysis Clinic Inc., are charging up to 25 times higher than the non-chain providers. For example, Fresenius charges $6,291 for this hemodialysis treatment, compared to $248 at St. Peters Community Hospital Dialysis Clinic.”
Association Health Plans Appeal
A decision in March (here) striking down Administration plans to expand association health plans was correct, according to former Labor Department officials filing a brief on appeal (brief here). The Administration says the plans, which are not subject to the requirements that they cover “Essential Health Benefits,” would give smaller groups, banding together, the same leverage enjoyed by larger corporations. The group of former Labor Department officials contend that the AHPs will provide skimpy or inadequate coverage.
DRUGS AND DEVICES
U.S. Spending on Drugs Spurned by Cost-Effectiveness Assessment Agencies in Other Countries
STAT+ reports that “[A] new analysis finds Medicare spent more than $26 billion in recent years on dozens of medicines that were not recommended for coverage in three other wealthy nations because government advisory groups there found the drugs did not have sufficient value to justify the costs. The researchers identified a total of 134 medicines that were approved by the Food and Drug Administration prior to 2016 but were not endorsed by agencies in Australia, Canada, and the U.K. that conduct so-called health technology assessments, according to the study in the Journal of General Internal Medicine.” The study said “The United States (US) spends more on prescription medications than any other country. Many countries have created a central health technology assessment (HTA) agency to analyze available evidence on clinical safety and efficacy, as well as cost-effectiveness, of approved medical products and then recommend whether they should be covered by their respective national health program, including Australia (Pharmaceutical Benefits Advisory Committee [PBAC]), Canada (Canadian Agency for Drugs and Technologies in Health [CADTH]), and England (National Institute for Health and Care Excellence [NICE]). In contrast, the US has no single national health program and HTA is fragmented across several uncoordinated public and private initiatives. The Centers for Medicare and Medicaid Services (CMS), which administers Medicare, the US’ largest publicly funded health insurance program, makes both local and national coverage determinations but is statutorily prohibited from considering” cost effectiveness.
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
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.