Today's News and Commentary

About health insurance

Who is writing 2020 Democrats' health plans? We found out: This article from the Washington Post provides background about who is advising the Democratic candidates on their healthcare plans.

Mystery Solved: Private-Equity-Backed Firms Are Behind Ad Blitz on ‘Surprise Billing’: Ever wonder who is opposing the proposals against surprise billing? This NY Times article is a great story about a non-profit called Doctor Patient Unity, whose two largest contributors are “TeamHealth and Envision Healthcare, private-equity-backed companies that own physician practices and staff emergency rooms around the country.”

Rebates for Brand-Name Drugs in Part D Substantially Reduced the Growth in Spending from 2011 to 2015: Despite the dates, this report was just issued by the Office of the Inspector General of HHS. The “bottom line” is : “total Part D reimbursement for brand-name drugs increased by 19 percent from 2011 to 2015, versus a 4-percent increase in rebate-adjusted reimbursement for these drugs over the 5 years reviewed.” That is, rebates are falling way behind drug price increases.

Report: Billing manipulation leads to higher health care spending: In this study of Massachusetts hospitals: “Volume at the top five largest health systems has increased 18 percentage points between 2010 and 2017, versus a 16 percent decline in volume going to independent community hospitals, the report says. 

Hospitals have responded by changing how they bill for care, according to the report, using billing codes reserved for more severe treatments than in the past. Statewide, the percentage of discharges that were billed using ‘high acuity’ codes rose to 62 percent in 2017 from 56 percent in 2010.”

This case is the perfect example of increasing intensity (upcoding) as the volume decreases in order to maintain revenue.

Surge in U.S. health insurance prices exposes quirks in data: Does the healthcare Consumer Price Index really reflect the prices consumers pay? Actually, no, “it’s an indirect measure based on retained earnings, or what insurers have after paying out claims. And unlike other prices in the CPI that are obtained each month, the department takes data collected annually and spreads the change equally over 12 months.” This calculation leads to some conclusions about price increases that do not always reflect what is happening in the market. Read this article for further explanation.

About pharma

OxyContin maker Purdue Pharma files for bankruptcy protection: The headline is the message. The question now is whether the company will be able to meet is liability obligations.

Amazon's battle for pharmacy business is fought over phone, fax: This article is a good case study about the perverse power of competition. Amazon bought PillPack, a distributer of prepackaged medications that have accompanying instructions on each dose when to take it. Before the acquisition, pharmacies cooperated with PillPack’s requests to transfer prescriptions. After Amazon took over, many requests are going unanswered.

About the public’s health

NC Using Real-Time Data to Address Social Determinants of Health: “The North Carolina Department of Health and Human Services (NC DHHS) is partnering with Phreesia, a patient intake platform, to address individuals’ social determinants of health using real-time data and screening questions.”