DCMedical News: Thursday, September 26, 2019
DCMedical News-DCMN
Washington, D.C.
Thursday, September 26, 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
Hospital and Medical Price Rage
Network news continues (CBS, ABC) features on hospital and medical bill outrage, while the Kaiser Family Foundation (KFF) issues its annual report (report here, summary here, Health Affairs article on the report here) on the cost of employer-sponsored health insurance. Summary of the (238 pg.) KFF report: companies paying $15,000 plus, employees paying $5,000 plus, for family coverage, the premium having increased nearly 5% since 2018. Company-sponsored health insurance covers 153 million people, with the combined employer + employee payments increasing 54% during the past decade.
Hospital pricing specialist Rick Louie reports (here) that “CBS News recently launched ‘Medical Price Roulette’ where they encourage their audience to share patient bills. Each provider they attack as having high prices has their reputation tarnished. Here's the stories covered by CBS News in just the last 2 days: Medical bills jump from $220 to $4,000 a month – for a treatment her life depends on, and After her miscarriage, she received two rounds of ultrasounds. Why did one cost 10 times more? In addition, earlier this week ABC News compared the prices of ‘common medical procedures’ in the Omaha market, including colonoscopies.” Louie noted that his firm analyzed its national pricing database to compare colonoscopy prices among all Nebraska hospitals. CHI Health in Omaha had the highest colonoscopy price at $5,995, while the Thayer County Health Services had a colonoscopy price of $977.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Lower Rates of Increase in CT and MRI Imaging
How much lower? JAMA Network publishes an infographic, here. The (approximately) 10% increase in CT imaging per year during the period 2000-2006 has dropped to .8% for children, 4-5% for adults during the period 2013-2016. The 11% annual increase in MRI use during the period 2000-2005 dropped to 1-2% in the period 2005-2016. There are new codes for imaging and the full range of Common Procedural Terminologies as the AMA releases the 2020 CPT® book, here. And speaking of coding, a group of researchers spells out (here, from JAMA Surgery) the numerous ways clinical research can go wrong if the researchers handle carelessly the International Classifications of Diseases, Tenth Revision, Clinical Modification and Procedure Classification System (ICD-10-CM/PCS, whew!).
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
DSH Reduction Final Rule Published in Federal Register
The “final rule” reducing Medicaid supplemental payments known as Disproportionate Hospital Share were published in Wednesday’s Federal Register, here. Barring legislative action to extend the life of the DSH reduction deferral, the rule will become effective November 25. An explanatory note from the published rule: “In the 2013 DSH allotment reduction final rule, we finalized a DSH Health Reform Methodology (DHRM), as required by statute, to implement annual allotment reductions that would have been in place only for FY 2014 and FY 2015. Prior to the implementation of allotment reductions, legislation was signed into law delaying the start of the reductions. Subsequent legislation delayed the start of these reductions, modified the reduction amounts, and extended the fiscal years subject to reductions. Under current law, annual allotment reductions start in FY 2020 and run through FY 2025.”
Eligible for Overtime? You May Be Soon
January 1, 2020 will see 1.3 million more eligible for overtime (time-and-a-half pay for more than 40 hours work per week), raising the threshold (unchanged from 2004) from $23,660 to the new figure of $35,568. The Wall Street Journal (here) notes that some states have standards exceeding the federal level; in California, for example, where workers earning less than $49,920 are now eligible, the January 1 standard will be $62,400. Most of those affected will be in service industries, including healthcare and nonprofit organizations.
Liver Donation Policy on Ice
Bloomberg reports that the U.S. Court of Appeals for the Eleventh Circuit (decision here) said a district court must look at whether the Health and Human Services Secretary legally had to refer the new policy to the Advisory Committee on Organ Transplantation, and also offer it public comment in the Federal Register before implementing it. “Four patients and more than a dozen hospitals are challenging the new policy, which would expand that geographic region for eligible recipients. Liver donations would be offered to patients with the highest medical urgency registered at a transplant hospital within a 500-mile radius. Under the current policy, donated livers are offered first to people with the highest medical urgency registered at a transplant hospital within the donor’s region.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
What is TrumpCare?
Larry Levitt tries his hand at describing the TrumpCare, in JAMA Forum, here.
DRUGS AND DEVICES
The Price of Drugs
The Wall Street Journal chronicles pharma dismay at the potential loss of pricing power (here), while CQ has an essay, “Political tensions escalate as drug pricing bills move forward,” here. The CQ piece is useful for organizing the various efforts, as well as the persiflage.
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: 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.