Today's News and Commentary

About health insurance

A New Way Of Paying For Maternity Care Aims To Reduce C-Sections: This article is a nice summary for why we need global payments for pregnancy services. But it is not a new method. On behalf of our capitated medical group, I negotiated global maternity care fees starting about 30 years ago. The one fee included prenatal care, routine ultrasound and labs, one non-stress test, and vaginal or c-section delivery.

Sanders unveils plan to eliminate Americans' medical debt: The Democratic candidates seem to be “one upping” each other on healthcare. Medicare for all and the elimination of private insurance does not go far enough for Sen. Sanders. According to his website the plan is to:

“Eliminate the $81 billion in past-due medical debt.

  • Under this plan, the federal government will negotiate and pay off past-due medical bills in collections that have been reported to credit agencies.

  • End abusive and harassing debt collection practices.

    • Prohibit the collection of debt beyond the statute of limitations.

    • Significantly limit the contact attempts per week a collector can make to an individual through any mode of communication, regardless of how many bills are in collection.

    • Require collectors to ensure information about a debt is fully accurate before attempting to collect.

    • Substantially limit the assets that can be seized and the wages that can be garnished in collection to ensure consumers do not lose their homes, jobs, or primary vehicles and will be able to financially support their families.

  • Instruct the IRS to review the billing and collection practices of the nearly 3,000 non-profit hospitals to ensure they are in line with the charitable care standards for non-profit tax status, and take action against those who are not.”

The process for most of these measures is straightforward. The one calling for governmental negotiation and payment of the $81 billion is still lacking details.

U.S. Voters Support Expanding Medicare but Not Eliminating Private Health Insurance (Wall Street Journal, subscription required): In the latest Wall Street Journal/NBC poll, two-thirds “of registered voters support letting anyone buy into Medicare,” but “56% of registered voters oppose a Medicare for All plan that would replace private insurance…” Only 36% of all registered voters thought the government should provide healthcare to illegal immigrants.

Centene-WellCare merger gets OK from regulators in 17 states: The $17.3 billion merger announced in March is proceeding.

Judge dismisses Oscar's suit against Florida Blue over broker deals: Insurer Oscar sued the Florida Blues plan claiming it's tying up of the insurance broker network was anti-competitive. The courts disagreed and dismissed the case. Consider this decision as a precedent regarding nearly exclusive holds on broker networks. We will need to see how it plays out in other states.

4 major questions on Tennessee's bid to become first state to get a Medicaid block grant: This article is a nice short summary of the questions raised by Tennessee’s announcement last week that the state will apply to CMS for a Medicaid waiver to receive bock grants for that program.

About healthcare professionals

Nurses in Four States Strike to Push for Better Patient Care (NY Times, subscription may be required for this article): “Thousands of nurses across the country went on strike Friday morning, pushing for better patient care by demanding improved work conditions and higher pay. 
About 6,500 National Nurses United members at 12 Tenet Healthcare hospitals in California, Arizona and Florida organized a 24-hour strike, which began at 7 a.m., to protest current nurse-to-patient ratios that they contend are burning out employees and making it difficult to provide the best possible care. 
In Chicago, more than 2,000 nurses walked off the job after contract negotiations between National Nurses United and the University of Chicago Medical Center broke down on Wednesday night.”

The nursing shortage is very uneven around the country and poses an increasing problem as the population ages and hospital acuity increases.

1 in 5 surgeons plans to retire early due to physical toll, survey finds: “Nearly 20% of surgeons in the U.S. think they may need to retire early due to the physical problems that result from performing laparoscopic surgery, a survey commissioned by CMR Surgical finds. CMR Surgical, a British medical device company, has developed a robotic system for laparoscopic or minimal access surgery.

That’s the same percentage as surgeons in the U.K. and similar to the 15% of surgeons surveyed in Germany contemplating early retirement from their chosen profession….A 2018 study published in the journal Surgery estimated that by 2050 there will be a deficit of over 7,000 general surgeons in the U.S.”

This finding is an unintended consequence of improved surgical technique. Better back ergonomics for these devices would go a long way to helping.

About healthcare quality and patient safety

CMS Could More Effectively Ensure Its Quality Measurement Activities Promote Its Objectives:

The Bipartisan Budget Act of 2018 contains a provision for the GAO (government accountability office) to review CMS’s quality measurement activities- both its funding and assessment of the appropriateness of the chosen metrics. In its review, CMS told the GAO that “the information it maintains does not identify all of the funding the agency has obligated for quality measurement activities. Further, it does not identify the extent to which this funding has supported CMS’s quality measurement strategic objectives, such as reducing the reporting burden placed on providers by CMS’s quality measures.”  Further, the GAO found that “CMS lacks assurance that the quality measures it chooses address its quality measurement strategic objectives. This is because CMS does not have procedures to ensure systematic assessments of quality measures under consideration against each of its quality measurement strategic objectives… In addition, CMS has not developed or implemented performance indicators for each of its quality measurement strategic objectives.”  

Give these finding, the GAO recommended “that CMS (1) maintain more complete and detailed information on its funding for quality measurement activities, (2) establish procedures to systematically assess measures under consideration based on CMS’s quality measurement strategic objectives, and (3) develop and use performance indicators to evaluate progress in achieving its objectives. HHS concurred with all three recommendations.”

Health System Leaders Shift Top Focus from Costs to Patient Outcomes: This survey of 140 health system clinicians and executives found some significant changes since last year. For example: “Nearly six-in-ten (57 percent) health system leaders (both executives and clinicians) ranked improving patient outcomes as a key area of focus for 2019, up from 48 percent in 2018. Reducing costs is still a top concern; however, it has decreased in importance for health system leaders in just one year’s time. Seventy-five percent of health system leaders selected reducing costs as a top priority in 2018, and in 2019 that number decreased to 55 percent.” If one were to administer the same questions to the general public, the answers would undoubtedly be very different.

About pharma

Novo prices oral Rybelsus on par with injectable rivals, ending discount fears: As previously reported, the first oral GLP-1 was approved by the FDA on Friday. The pricing was not released until today. The list price of $26 per day, or $772 per 30 tablets across all doses, is comparable with the injectables from that same class. Of course, the injectables incur costs of other supplies, such as needles and syringes. The next step is getting the drug on formularies.