DCMedical News: Friday, October 18, 2019
DCMedical News-DCMN
Washington, D.C.
Friday, October 18, 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
Focus
The lobby for commercial health insurance plans urges Congress to focus. In a letter to House and Senate leaders (here), AHIP (America’s Health Insurance Plans) writes “As you return for the final weeks of the 2019 work period, we urge you to enact bipartisan legislation in three critical policy areas: (1) surprise medical bills; (2) prescription drug prices and costs; and (3) health care taxes that undermine affordability and access.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Global Burden of Cancer
JAMA Oncology publishes here a survey of the global burden of cancer, surveying 29 cancer groups in 95 countries, from 1990 to 2017. In sum, “Cancer is now widely recognized as a global problem that unfortunately lacks a global solution.” The most common causes of cancer deaths for men were TBL [tracheal, bronchus, lung] cancer (1.3 million deaths) liver cancer (572 000 deaths) and stomach cancer (542 000 deaths). For women in 2017, the leading causes of cancer deaths were breast cancer (601 000 deaths), TBL cancer (596 000 deaths), and colorectal cancer (414 000 deaths).
Cancer and Health Insurance Coverage
A new National Bureau of Economic Research study (here) affirms the importance of Medicare (and, inferentially, of health insurance coverage generally) in detecting and treating cancer: “Our analysis focused on the three tumor sites with recommended screening before and after age 65: breast, colorectal, and lung cancer. At age 65, cancer detection increased by 72 per 100,000 population among women and 33 per 100,000 population among men; cancer mortality also decreased by 9 per 100,000 population for women but did not significantly change for men. In a placebo check, we found no comparable changes at age 65 in Canada. This study provides the first evidence to our knowledge that near-universal access to Medicare at age 65 is associated with improvements in population-level cancer mortality, and provides new evidence on the differences in the impact of health insurance by gender.” [Italics added.]
High Cost Cancer Drugs
An article in press in Value in Health (abstract here) reports on expensive new cancer drugs “Although drug costs have been rising more rapidly than median survival gains, they have been rising at about the same rate as mean survival gains. This suggests that when accounting for longer-term survival gains, the benefits of new drugs are roughly keeping pace with their costs, despite rapid cost growth.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Prior Authorization, Denials, Appeals, Spanners in the Works
UnitedHealthcare has announced that it plans to impose “prior authorization” on surgical procedures which, it feels, might better be performed in an ambulatory surgery center than in a hospital. CMS has announced similar steps (see DCMN 10-17 re OPPS rules for 2020). Kaiser Family Foundation explores the impact on hospitals, here. Modern Healthcare reports on the United move and its implications for hospitals, physicians and patients here.
TJC Revises Total Hip and Total Knee Program Accreditation Requirements
Accreditation requirement revisions proposed (here) are open for comment to The Joint Commission through November 8.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Had Enough M-f-All?
Kaiser Health News volunteers (here) to referee the discussion. The Atlantic (here, among other publications) features the “eye-popping” cost.
DRUGS AND DEVICES
H.R. 3 (Pelosi Drug Bill) Progresses in the House
H.R. 3 (bill here, early draft here, Education and Labor substitute bill here) which would require CMS to directly negotiate high-cost drug prices was approved by the House Education and Labor Committee on a party line vote. Direct negotiation would be enforced by the prospect of additional taxes on non-compliant pharmaceutical companies. Also taking place: the Energy & Commerce Committee moving its own bill, the Ways & Means Committee considering a bill next week, both in the House, where a vote is expected during the last week of October. Changes in HR 3 include increasing over time the number of drugs subject to negotiation, and including newly launched drugs in the negotiation process. CQ reports that “The upper limit of the negotiated prices would be based off of what other wealthy countries pay. The bill would also impose a $2,000 out-of-pocket spending maximum for beneficiaries in Medicare's prescription drug program, Part D.”
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
October publication dates: 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.