06 May May 6, 2019
New CBO Report on Medicare-for-All Would Be Expensive, But No Price Tag Determined
Both sides in the Medicare for All debate claimed victory with the Congressional Budget Report out last week that was thin on numbers but detailed on possibilities. A change to single-payer, which a substantial number of Democratic presidential candidates and members of Congress have called for, would amount to the largest domestic policy change in decades. It would have broad implications not only for health care and the federal budget, but also for the broader economy. “The magnitude of such responses is difficult to predict because the existing evidence is based on previous changes that were much smaller in scale,” the paper said. A ‘Medicare for All’-style system would “substantially” increase government health care spending but declined to assign a specific price tag, click here. Click here for a NYTimes analysis and here for a Wall Street Journal report.
- Led by Senator Jeff Merkley (D-OR), and 14 Democrat Senators, the Choose Medicare Act was introduced last week to allow people to use federal subsidies to enroll in Medicare instead of in a private plan. The bill also would let employers buy Medicare for their workers. The bill would create a new Medicare Part E that would be fully paid for by premiums and be offered on all state and federal exchanges, and people could use the existing ACA subsidies to help pay for it. For a summary from the bill sponsors, click here, and for the bill itself, click here.
- CMS Chief Seema Verma says Medicare for All is wrong answer. Click here.
Impact on Hospitals, Physicians? States Start Cutting Health Benefits
States across the U.S. are testing how far they can reduce health benefits for current and future retirees as a way of coping with mounting liabilities and balancing budgets. The cuts are a response to dramatic increases in medical costs, budget shortfalls and the introduction of new accounting rules forcing governments to be more public about how much they owe. Officials also face fewer legal hurdles to cutting retiree health benefits than they face with public pensions, which enjoy ironclad legal protections in many states. Click here for the WSJ report.
Congressional Budget Analysis Shows Eliminating Drug Rebates for PBMs Won’t Lower Drug Prices
A new analysis by the Congressional Budget Office shows that the Trump Administration’s proposal to to eliminate manufacturer rebates to pharmacy benefits managers in Medicare and Medicaid would not have the desired effect of lowering drug manufacturers’ list prices. Instead of forcing manufacturers to lower their prices, CBO anticipates that the companies will negotiate discounts upfront with PBMs that would be on average approximately 15-percent lower than their current rebate commitments. In turn, PBMs would use those discounts to determine what they pay pharmacies, and because pharmacies would buy drugs based on list prices, manufacturers would give them a “chargeback” to make up the difference. To view the analysis, click here.
- HHS OIG finds that Medicaid could save millions by excluding authorized generics from average manufacturer price calculations, click here.
Measles Outbreak in U.S. Worst in 25 Years: CDC
The measles outbreak in the U.S. shows no signs of abating, as it topped the 25-year high it set last week with at least 704 cases now in 22 states since the beginning of this year, the Centers for Disease Control and Prevention reported last week. Of those cases, 9% have been hospitalized and 3% had pneumonia, the CDC said. There have been no deaths. The total number of cases is the largest since 1994 and includes 78 cases reported in the past week. Click here for details from the CDC.
Senate Committee to Hold a Hearing Looking at MACRA Implementation
The Senate Finance Committee will hold a hearing on Wednesday entitled, “Medicare Physician Payment Reform After Two Years: Examining MACRA Implementation and the Road Ahead.” The goal, according to the Committee’s press release, is to “assess how well that reform legislation is meeting its goals of improving quality of care and value for taxpayers.” Witnesses include the American Medical Association and other physician groups along with the Brookings Institute. Click here for the press release and here to see the full list of witnesses and view the hearing.
Wide Price Variations for Identical Health Care Service Is Common
It’s one of the most common tests in medicine, and it is performed millions of times a year around the country. Should a metabolic blood panel test cost $11 or $952? Both of these are real, negotiated prices, paid by health insurance companies to laboratories in Jackson, Miss., and El Paso in 2016. New data, analyzing the health insurance claims of 34 million Americans covered by large commercial insurance companies, shows that enormous swings in price for identical services are common in health care. In just one market — Tampa, Fla. — the most expensive blood test costs 40 times as much as the least expensive one. Click here for the report.
Uninsured Will Rise to 35 Million by 2029 Due to the Elimination of Mandatory Coverage
That is according to the Congressional Budget Office who says that next year the number of uninsured will be 32 million, an increase of 2 million people from the current year. In the report released last week, CBO also states that even though more people are going without insurance coverage, net federal subsidies for insured people is estimated to rise from $737 billion in 2019 to $1.3 trillion in 2029 with Medicaid and Medicare accounting for about half those subsidies and ACA insurance subsidies accounting for about 10-percent. Click here for the full report.
- House will vote on a bill (H.R. 986) this week that would block the implementation of Trump Administration guidance that allowed states to ease ACA standards to create their own guidelines for health insurance and subsidize plans that do not adhere to ACA rules, click here.
85 Percent of Large Hospitals Either Use Epic or Cerner for Their EHRs
According to an analysis conducted by KLAS Research, Epic and Cerner dominate the large hospital space, with a combined 85-percent market share, or 58-percent and 27-percent respectively. EHR purchases in 2018 outpaced those of the previous two years, with a total of 445 decisions across the hospital spectrum. As organizations merge however, they often seek to integrate onto one mutual platform which has mostly benefited either Epic or Cerner. Since 2014, a fifth of all EHR switches at acute care hospitals have stemmed from mergers and acquisitions, according to the report. To view the report, click here.
Some Hospitals Trying Cubicles in the ER
Cubicles have arrived in the emergency room. Hospitals across the country, rethinking how they use precious ER space, are creating more compact examination and treatment areas for ER patients with less-acute ills—a move that also frees up space for patients with more serious problems and reduces the expense of building larger ERs. By being smarter about using space, the ERs aim to see more patients, in less time, without having to expand. Click here for the story.
Senators Look to Delay Liver Allocation, Ask GAO to Investigate
Senator Roy Blunt (R-MO), chair of the Labor-HHS Appropriations Subcommittee, and Senator Jerry Moran (R-KS), sent a pair of letters on the changes of how donated livers are distributed to patients in need of a transplant. The Senators sent a letter requesting the Government Accountability Office conduct a review to the process the Organ Procurement and Transplantation Network uses to develop new allocation policies. Additionally, in a letter to HHS Secretary Alex Azar, the Senators asked the department to extend the temporarily delay of the implementation until after the GAO has conducted the review. HHS delayed the implementation, that was supposed to go into effect on May1st, due to a lawsuit that was filed by a number of transplant programs. Click here for the GAO letter, and here for the HHS letter.
HHS Finalizes Rules to Strengthen Protections for Religious Health Workers
HHS has finalized rules to provide conscience protections for health care workers to allow them to refuse to provide care that violates their religious of moral beliefs. While anti-abortion groups and conservative religious groups applauded the move, patient advocates have warned it could make it harder for women to receive emergency abortions or access contraception and lead to health care workers refusing to provide care for LGBTQ patients. For the HHS fact sheet, click here, for the final rule, click here. Click here for the NYTimes report and here for the Washington Post.
Bipartisan Senators Introduce Bill to Ban Online Sales of E-Cigarettes to Children
Senators Dianne Feinstein (D-MI) and John Cornyn (R-TX) last week introduced the Preventing Online Sales of E-Cigarettes to Children Act that would prevent online sales of electronic cigarettes to minors by applying the same safeguards already in place for regular cigarettes and smokeless tobacco products. Under the legislation, online retailers would be required to: verify the age of customers for all purchases; require an adult with ID to be present for delivery; label shipping packages to show they contain tobacco products; and comply with all state and local tobacco tax requirements. A number of organizations quickly added their support to the bill including the American Cancer Society Cancer Action Network, and American Lung Association. Click here to view the bill language.
Overdose Deaths from Cocaine and Psychostimulants Involving Opioids Increase by More Than 30 Percent
According to the Centers for Disease Control and Prevention, Cocaine-related deaths increased by 34-percent between 2016 and 2017 and opioids were involved with nearly three quarters of the 2017 deaths. Psychostimulants-related deaths increased 37 percent over the same time period, with half of them involving opioids in 2017. Of further concern is that opioids were detected in two-thirds of all overdose fatalities in 2017. Leading researchers to state, “The contribution of opioids to increases in stimulant-involved deaths underscores the importance of continued opioid overdose surveillance and prevention measures such as current efforts to expand naloxone availability to people at risk.” Click here for the report.
- The White House Council of Economic Advisers released a report last week that associated federal programs subsidizing the cost of prescription drugs with an increase in opioid overdose deaths, click here.
CMS Releases Draft Guidance Co-Location Compliance
CMS late last week released a draft guidance document for State Survey Agency Directors to clarify how hospitals that share space, staff, or services with another hospital or health care entity will be evaluated for compliance of Medicare conditions of participation. According to the document, “Prior sub-regulatory interpretations prohibited co-location of hospitals with other health care entities,” and states that this “guidance changes that to ensure safety and accountability without being overly prescriptive.” As an example, the guidance clarifies that the entities can share public areas, such as waiting rooms and main hallways. Click here for the document.
- The HHS Office of Civil Rights released a legal interpretation last week that seeks to lower some fines for HIPAA violations including data breaches, inadequate risk assessments, and willful neglect, click here.
Exercise Can Enhance Cognitive Function: Study
Recent studies provide evidence suggesting that exercise effects brain functions in positive ways. The newer experiments demonstrate how adult brains are not functionally fixed, but can change depending on one’s lifestyle. Scientists in Maryland found that regular exercise impacts parts of the brain involved in semantic memory, which focuses on one’s ability to recall general knowledge facts. Semantic memory is usually one of the first to fade with age. However, in this study, exercise was shown to increase neural processes, and activate semantic memory in healthy older adults. To read about the study, click here.