DCMedical News: Friday, September 20, 2019
DCMedical News-DCMN
Washington, D.C.
Friday, September 20, 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
Congress Approaches Final Six Legislative Days in FY2019
The House of Representatives passed (301-123) a “stopgap” spending bill (bill here, CBO report here) to continue government funding until November 21. The Senate is expected to follow suit. Congress will adjourn a week from today (Friday the 27th), reconvening October 15.
Health Care a “Cash Engine” Says Axios
The news and information website’s health care profit tracker (here) shows “The health care industry continued to rake in record-level profits in the second quarter, with its year-over-year earnings increasing by 23% . . . Pharmaceutical firms and hospitals, in particular, are reaping some of the largest rewards even amid the sustained public furor over drug prices and surprise medical bills . . . Drug companies collected almost half of all health care profits despite generating less than 20% of industry revenue . . . The combined net profit margin for this sample of hospital systems was 8.6%. That's lower than the extremely profitable first quarter hospitals had, but above average for the entire group . . . 17 of the 55 companies in the analysis that had net margins of at least 10% in Q2 were not-for-profit hospital systems . . .[Profits] allow the industry to amass a war chest to fend off piecemeal reforms and larger-scale overhauls like Medicare for All.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
New York State “Surprise Medical Bill” Dispute Resolution, Report on a Possible National Model
Crain’s New York’s Jonathan LaMantia reports that New York State’s Department of Financial Services released a report (here) showing growth in the state's dispute-resolution process to settle surprise bills. He wrote “Last year was the first in which arbitrators ruled in favor of providers in a greater percentage of cases than they did for health plans since the law went into effect in 2015. LaMantia noted “The law requires health plans to hold consumers harmless when they receive bills for out-of-network emergency care or receive care from an out-of-network doctor at an in-network hospital or surgery center.”
That Variation in Treatment? It May Be Regional
A paper in JAMA Cardiology (here) explores high intensity statin treatment following myocardial infarction. “[R]region was the strongest correlate of high-intensity statin use, with 66% higher use in New England than in the West South Central region.” Also mentioned, larger hospitals, medical school affiliation, male gender and patient receipt of a stent were “associated with greater high-intensity statin use. For-profit hospital ownership, patient age older than 75 years, prior coronary disease, and other comorbidities were associated with lower use.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Ambulatory Surgery Centers Seek More
The ASC Association (here) is pressing the case for HR 4350, a bill which would further expand payment and procedures at ambulatory surgery centers, while also further compromising hospital finances. While already successful in adding orthopedic and cardiac procedures to the ASC list, the proposed legislation “would slow the widening disparity in Medicare payments between ASCs and hospital outpatient departments by making permanent the hospital market basket as the inflationary update factor, adding transparency and accessibility for patients trying to research quality metrics, forcing CMS to disclose the reason procedures are denied reimbursement in the ASC setting and adding an ASC voice to the Advisory Panel on Hospital Outpatient Payment.” Becker’s reports (here) 23 new orthopedic ASCs thus far in 2019.
Patients in For-Profit Dialysis Facilities Referred Less Often for Kidney Transplantation
Research published in JAMA (here) found that patients in for-profit dialysis facilities were less likely than those in not-for-profit to have patients referred for transplantation. “However, only 14% of patients with incident ESKD are placed on the deceased donor kidney transplantation waiting list or receive transplants within 1 year of ESKD diagnosis. The Centers for Medicare & Medicaid Services (CMS) requires dialysis facilities to provide transplant education and help interested patients pursue kidney transplantation. . . Evidence suggests for-profit dialysis facilities have a lower standardized transplantation ratio, and their patients are less likely to be waitlisted compared with nonprofit facilities. Physicians at for-profit dialysis facilities are less likely to have detailed discussions with patients about transplantation or involve families in the discussion. This could lead to limited access to living donor kidney transplantation at for-profit dialysis facilities . . . It has been suggested that for-profit dialysis facilities strive to reduce operating costs by limiting the provision of low-margin services (such as extended transplant discussions with patients and their families) in the interest of increasing returns to investors, and may impede their patients’ access to transplantation.”
An editorial (here) in the same edition asks “Could financial incentives play a role in dialysis facilities’ achievement of transplant outcomes? One explanation for suboptimal rates for placement on transplantation waiting lists is that US facilities and companies that provide dialysis are organized primarily around the provision of dialysis treatment, and they may not be sufficiently motivated to ensure that patients instead receive kidney transplants [and] . . may limit interest in substituting dialysis treatment with transplantation and moving patients off primary revenue sources.” The editorial includes a useful overview of recent CMS and White House initiatives concerning kidney disease. A second editorial (“Transplantation First, Dialysis Last,” here) notes that “Since the establishment of the 1972 Social Security Amendment to cover permanent kidney failure, the population needing dialysis in the United States has grown from an initial estimate of 10 000 beneficiaries to more than 500 000 prevalent patients receiving hemodialysis. . . . The undeniable medical success coupled with the financial profitability of clinics may have overshadowed the intended purpose of dialysis: a rehabilitative therapy designed as a bridge to kidney transplant.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Medicare for All Who Want It
Mayor Pete (Buttigieg)’s Presidential race platform on health care (here, 10 pages, 51 footnotes) includes a public option, limits on medical prices in surprise bills, increased subsidies for private insurance, automatic opt-in for the uninsured in the public option and voluntary opt-in for those with employer-sponsored health insurance and an out-of-pocket spending cap for Medicare beneficiaries.
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: 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.