DCMedical News: Wednesday, October 16, 2019
DCMedical News-DCMN
Washington, D.C.
Wednesday, October 16, 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
Democratic Presidential Candidates Debate in Ohio
Joshua Sharfstein posts in JAMA Forum (here) a commentary on the three year trend of declining life expectancy in the U.S. He writes, “There are major disparities in how long US citizens live, based on race, class, geography, and education, with the result that many children will not live as long as their parents. One might imagine that these demoralizing statistics would be a key focus for candidates seeking the presidency. This is not the case. Not a single candidate, Democrat or Republican, has posted a comprehensive plan for reversing the trends in life expectancy.” Considerable discussion took place in last night’s debate, however, about Medicare-for-all, Medicare-for-all-who-want it, the tax burden of a public program on the middle class (and whether it would be offset by savings in health insurance costs, etc.).
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
A State Solution to Balance Billing
The Washington (State) Medical Commission explains (here) the provisions of that State’s prohibition on balance or “surprise” billing. From the bulletin, “The new law requires that an insurer must cover emergency services provided by an out-of-network hospital emergency department. An out-of-network provider or facility may not balance bill a patient for emergency services. Additionally, they may not balance bill a patient for non-emergency services provided at an in-network hospital or an in-network ambulatory surgical facility if the services are provided by an out-of-network provider and involve surgical or ancillary (anesthesiology, pathology, radiology, lab, or hospitalist) services. Additionally, an insurer may not seek reimbursement from a patient due to balance billing when the emergency services are provided by an out-of-network hospital in Oregon or Idaho.”
It Depends on What You Mean by “Myocardial Infarction”
MedScape reports (here) that “A noted cardiothoracic surgeon who is an early member of the EXCEL trial's executive committee took a conference podium to charge that trialists ‘manipulated’ data in a way that tilted the results in favor of percutaneous coronary intervention, compared to coronary artery bypass grafts . . . The EXCEL trial's 5-year follow-up analysis, recently published [here] in the New England Journal of Medicine (NEJM), yielded no significant difference in the primary endpoint of death from any cause.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
UnitedHealth 3rd Quarter
In its 8-K report (here) UnitedHealth reported that nearly 50 million enrolled (flat) produced $60 billion in revenue (up nearly 7% Q3 to Q3) with operating earnings of $5 billion (up 9%), Earnings Per Share (EPS) growth of 17% year-to-date, an 82.4% medical loss ratio (up 1.4%, “health insurance tax deferral driving the 140 basis point year-over-year increase”) with 13% growth for Optum (in “care delivery” and “behavioral health”) and overall Return on Equity of 26%. Earnings call transcript from Seeking Alpha here.
Women in the Workforce with Health Insurance
The Agency for Healthcare Research and Quality (AHRQ) published a study from the Medical Expenditure Panel Survey (here) showing that employer-sponsored health insurance premiums in the U.S. were higher for single, employee-plus-one and family coverage in companies where women made up 75% or more of the workforce.
DRUGS AND DEVICES
Double Dipping in 340B?
STAT+ reports on a Manatt survey (reported as an infographic, here) on means through which states attempt to avoid “double dipping” in the 340B drug discount pool. “Currently, drug makers that participate in the Medicaid program must pay rebates to states for medicines dispensed to Medicaid patients. However, federal law says that a drug purchased by a 340B hospital or clinic is not eligible for both a Medicaid rebate and a 340B discount. As a result, a 340B hospital or clinic may not use drugs covered under the 340B discount program for Medicaid patients, unless a state Medicaid program has a mechanism to identify and exclude medicines that would otherwise be eligible for a rebate from a drug maker. In order to avoid duplicate discounts, 340B hospitals and clinics must notify HRSA if they purchase drugs under the 340B discount program. The hospitals and clinics are then listed in a so-called Medicaid exclusion filed maintained by the HRSA . . . there are concerns about the accuracy of the Medicaid exclusion file. . . . the survey found 12 state Medicaid Programs continue to rely solely on exclusion lists. By contrast, 22 states rely on specific claims-level identification data for submitting claims to Medicaid for 340B drugs, so that the state Medicaid program can exclude those drugs from its rebate requests. The rest of the states use both approaches, according to Manatt.” More than 2000 hospitals now participate in the 340B program.
READINGS AND REFERENCES
Census Bureau Highlights Hispanic Population in the United States
At the end of Hispanic Heritage Month (9/15-10/15), the Census Bureau published a set of tables and population profiles (https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?src=bkmk) noting that the Hispanic population of the United States as of July 1, 2018 was almost 60 million, making people of Hispanic origin the nation’s largest ethnic or racial minority. Hispanics constituted 18.3% of the nation’s total population. Ten states have a population of 1 million or more Hispanic residents, including Arizona, California, Colorado, Florida, Georgia, Illinois, New Jersey, New Mexico, New York and Texas. Tables from 2009-2018 at the link have detailed information, including health insurance and health care.
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
October publication dates: 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.