DCMedical News: Tuesday, September 10, 2019
DCMedical News-DCMN
Washington, D.C.
Tuesday, September 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
Not-so-Nifty 250 in Cross Hairs for Demo Drug Plan
Bloomberg reports that a Democratic drug price control plan sponsored by Speaker Pelosi (H.R. 3, here) would target the 250 most expensive drugs each year. “Every year, the Secretary would identify the 250 brand-name drugs that lack price competition with the greatest total cost to Medicare and the whole U.S. health system. The Secretary would use data provided by Medicare, Medicaid, as well as commercial insurance to make the determination about aggregate cost.” Then, according to Bloomberg, “Negotiation with the Department of Health and Human Services would be required for those drugs that are the most expensive to Medicare and lack competition from at least two other generic drugs, biologics, or biosimilars, and would include insulin. The plan would also cap the prices of the drugs at 1.2 times the average international price of Australia, Canada, France, Germany, Japan, and the United Kingdom, an idea President Donald Trump has also proposed (“Global Freeloading:), although the Speaker’s proposal would also set prices for drugs administered in a doctor’s office or purchased at a pharmacy.
Maternal Health Hearing in the House
Today at 10 a.m. in room 2123 of the Rayburn House Office Building, the Subcommittee on Health will hold a hearing entitled, “Improving Maternal Health: Legislation to Advance Prevention Efforts and Access to Care.”
A background memo from the Chairman is here, further information, list of witnesses and their testimony may be found at https://energycommerce.house.gov/committee-activity/hearings/hearing-on-improving-maternal-health-legislation-to-advance-prevention?utm_source=&utm_medium=email&utm_campaign=24614.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
“Incidentalomas” and Other Indicators of Low Value Medical Care
JAMA Internal Medicine this week (here) has a report surveying 2018 findings on low value medical care. From the summary: “Incidentalomas are present in 22% to 38% of common magnetic resonance imaging or computed tomography studies; 9% of women dying of stage IV cancer are still screened with mammography; and computed tomography lung cancer screening offers stable benefit and higher rates of harm for patients at lower risk . . .urgent care clinics commonly overprescribe antibiotics (in 39% of all visits, patients received antibiotics) and [that] treatment of subclinical hypothyroidism had no effect on clinical outcomes. Three studies highlighted services that should be questioned, including using opioids for chronic noncancer pain (meta-analysis found no clinically significant benefit), stress ulcer prophylaxis for intensive care unit patients (mortality, 31.1% with pantoprazole vs 30.4% with placebo), and supplemental oxygen for patients with normal oxygen levels.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
MedPAC Medicare “Context” Presentation Augers Insolvency, Major Medicare Change, or Both
Meeting September 5th and 6th in Washington, the Medicare Payment Advisory Commission discussed a “context for Medicare payment policy” (here, see also DCMN 9-9), which implies insolvency (funds necessary for the delivery of services to health insurance beneficiaries exceeds income, there being no actual “trust fund” of deposits), major change in the program, or both. In our previous story, we noted growth in health spending, growth in per beneficiary Medicare spending, growth in the 2013-2018 period following a brief hiatus in the rate of growth, projections by both the Medicare trustees and the Congressional Budget Office that spending will double during the next decade, and that Medicare enrollment will increase during that period to over 80 million, with the number of workers per health insurance beneficiary declining from 4.5 (in 1970) and 4 (in 1990) to 2.5 in 2030.
The staff presentation, discussed by MedPAC, shows that general revenue is paying for a growing share of Medicare spending. (Spending is funded from payroll taxes, tax on benefits, premiums, state transfers and drug fees, general revenue transfers and a periodic deficit in Part A). General revenue transfers (subject to year-to-year Congressional action) now outstrip payroll taxes and premiums as the major sources of funding for Medicare spending. More poignantly for the prospect of major change, the staff presentation indicates that Medicare, other health programs, Social Security and net interest will exceed total federal revenues by 2041 (basically, two decades).
For the beneficiary, this year Part B and Part D premiums and cost-sharing will take almost a quarter of the average Social Security benefit, up from 7% in 1980, growing to almost a third by 2039. The average premium for individual coverage was up nearly 50%, for family coverage more than 50%, but median household income was up 22% during that period. The premiums for employer-sponsored insurance have grown twice as fast as Medicare costs during the same period.
With regard to solutions, the staff noted that “Medicare [is] just one payer in the overall, multi-payer health care system,” a statement which ignores the stage setting and template development role of Medicare, for example, with Diagnosis-Related Group payment for inpatient services (vs. cost-based), Resource-Based Relative Value Scale (for physician services), etc.
Crowdfunding for Cancer Care: Underinsured Patients Prominent
A study this week in JAMA Internal Medicine (here) of more than 37,000 on-line “crowd-funding” campaigns (more than 1000 of which were studied in detail) for patients receiving expensive cancer therapy noted that “Campaigns with underinsured patients made up 26.2% of the population . . . Posters received approximately a quarter of their requested goal, independent of insurance status . . .The underinsured, compared with those not mentioning insurance, reported unstable employment . . . There were no significant differences in patient age, sex, type of cancer, or insurance status with regard to donation totals.” The study noted these effects of expensive cancer care on patients and their families: “Patients with cancer often borrow money, avoid leisure activities, decrease food spending, sell possessions, go into debt, and/or declare bankruptcy, and they are at greater risk for disability or unemployment.”
DRUGS AND DEVICES
UnitedHealth Gives Advice to Other Insurers on Site-of-Administration of Specialty Drugs
UnitedHealth Group has published an “infographic report” (here) on lowering the cost of specialty drugs by having those drugs administered in physician offices or at home, rather than in a hospital clinic or emergency department. The report notes that growth in per capita spending on administered specialty drugs since 2013 has averaged 14% per year. “Compared to independent physician offices, hospitals charge more for specialty drugs and their administration, whether treatment occurs in a hospital or in a hospital-owned physician practice.” The “Savings Opportunity by Condition” claims that “Administering specialty drugs in physician offices and patients’ homes instead of hospital outpatient settings offers the following savings opportunities per privately insured patient per year: Multiple Sclerosis: $37,000 savings for four months of treatment; Immune Deficiency: $32,000 savings for six months of treatment; Rheumatoid Arthritis: $28,000 savings for five months of treatment; Inflammatory Bowel Disease: $21,000 savings for five months of treatment; Cancer (Chemotherapy): $16,000 savings for four months of treatment.”
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.
Committees and Members at https://www.senate.gov/committees
House and Senate 2019 Calendar of Regularly Scheduled Sessions, here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
September publication dates: 11, 12, 17, 18, 19, 20, 23, 24, 25, 26, 27
October publication dates: 15, 16, 17, 18, 21, 22, 23, 24, 28, 29, 30, 31
November publication dates: 12, 13, 14, 15, 18, 19, 20, 21
December 3, 4, 5, 6, 9, 10, 11, 12
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.