Cost of Care

Oct. 14-19: Healthcare Costs a Priority for Public, Policymakers

October 11, 2018 4:05 pm

Affordability is increasingly seen as the leading healthcare issue by members of Congress, said a congressional staff member who has been focusing on the issue.

Oct. 11—Healthcare costs are likely to be a major focus in a discussion next week featuring Seema Verma, administrator of the Centers for Medicare & Medicaid (CMS). And heading into the 2018 midterm elections, the cost of health care is a top priority in both public polling and congressional planning.

On Oct. 18, Verma is scheduled to talk about ways to improve Medicare Part D in a discussionat the Brookings Institution in Washington, D.C.

“Lowering the cost of prescription drugs isn’t just something we would like to do; it is something that we must do in order to get better outcomes at a lower cost overall,” Verma said at the FT Pharma Pricing and Value Summit in September.

In addition to encouraging greater use of generics—the administration estimates beneficiaries spend $1.1 billion out of pocket for brand-name drugs that have available generics—CMS changed its policies to treat biosimilars as generic drugs when determining copays in Part D. President Donald Trump’s budget also proposed eliminating cost sharing for generics and biosimilars for low-income beneficiaries.

Public Concern

Healthcare cost was named by 27 percent of registered voters as the issue they most want to hear political candidates discuss, ranking second behind corruption, according a Sept. 5 Kaiser tracking poll of 995 registered voters.

Among a list of six issues, 78 percent of the public said addressing healthcare costs should be the highest priority, according to another national survey by NORC at the University of Chicago and the West Health Institute.

In the Kaiser poll, 89 percent said they are concerned about increases in the amounts that individuals pay for health care. Many were “very concerned” about increases in the amounts that individuals pay (58 percent) and about what the nation spends on health care (49 percent).

Four in ten were “very concerned” about increases in spending on Medicare and Medicaid, compared with three in ten who were “very concerned” about increases in employer spending on employees’ health care.

The blame for those costs fell heaviest on prescription drug companies, with 78 percent citing drug company profits as the “major reason” why healthcare costs were rising. The share was an increase from 62 percent who said that in 2014.

However, hospitals “charging too much” was tied with “fraud and waste in the healthcare system” as the second-leading reason for rising costs (71 percent). Those were followed by insurance companies (70 percent) and new drugs, treatments, and medical technologies (62 percent).

Fewer blamed rising costs on physicians charging too much (49 percent), an aging population (47 percent), or the cost of medical malpractice lawsuits (45 percent).

The Affordable Care Act (ACA) was blamed by 39 percent, while Trump administration actions on health care were blamed by 38 percent.

Congressional Plans

In response to growing public pressure, members of Congress plan a greater focus on costs, said a senior staff member.

“While access is still the number-one issue, affordability has kind of stepped in front of it,” Nick Uehlecke, a staff member for the House Health Subcommittee, said at an Oct. 10 policy event in Washington, D.C.

Uehlecke said congressional leaders are increasingly mulling ways to cut Medicare’s spending on hospital services.

“People talk about drug costs, costs for this, costs for that. Well, a lot of those costs are this kind of tributary of a giant ocean that is [Medicare] Part A spending,” Uehlecke said.

Medicare spent $268 billion on hospital care in 2016—out of $672 billion total—according to a reportby the Office of the Actuary for CMS.

One measure to curtail hospital spending that has gained support is funding for modifications to homes, as is permitted in Medicaid, to reduce risks and allow more care delivery in the home.

“In this century, the fact that falls are still such a large part of the hospitalization process” is concerning, Uehlecke said.

Other considerations by Congress to reduce hospital spending include an expansion of Medicare funding for telehealth services, he said. Fourteen House Republicans have introduced bills to expand the use of telehealth. One such bill, the CONNECT for Health Act, would allow providers to experiment with telehealth in alternative payment models and incentive programs, and expand remote patient-monitoring programs for chronically ill, geographically remote, and underserved populations.

Additionally, a “preliminary and primary goal” is to expedite the reduction of out-of-pocket costs for chronic care drugs, he said.

Uehlecke specifically cited the example of requirements for separate copays for each drug that a patient tries when seeking an effective treatment for cancer.

“That cost-sharing element is the first thing to attack if we’re going to try to lower the cost of drugs for patients individually,” Uehlecke said.

Sunday, Oct. 14

AHIP National Conference on Medicare, Washington, D.C. (through Oct. 16). Learn more.

Monday, Oct. 15

Start of open enrollment for 2019 Medicare Part C and Part D coverage (through Dec. 7). Learn more.

Policy discussion sponsored by Health Affairs titled “Improving Care for Californians.” Learn more.

Webcast by CMS titled “Submitting Your Medicare Part A Cost Report Electronically.” Learn more.

Deadline to identify and report errors in the calculation of clinicians’ 2017 final scores in the Merit-based Incentive Payment System. Learn more.

Webinar by the Nation Institute for Health Care Management Foundation titled “The Health Impact of Loneliness: Emerging Evidence and Interventions.” Learn more.

Webcast from the annual meeting of the National Academy of Medicine in Washington, D.C., titled “Cancers: Can We Beat the Odds?” Learn more.

Behavioral Health Care Congress, Arlington, Va. (through Oct. 17) Learn more.

Webinar by the Federal Emergency Management Agency on planned updates to the National Response Framework. Learn more.

Tuesday, Oct. 16

AHIP National Conference on Duals, Washington, D.C. Learn more.

Comments due on the CMS proposed rule to redesign the Medicare Shared Savings Program. Submit comments.

Webinar by AAMC titled “Strategies to Promote Faculty Vitality in Academic Medicine.” Learn more.

Wednesday, Oct. 17

Webinar by HFMA titled “Transforming the Revenue Cycle Using Automation and AI.” Learn more.

Webcast by CMS titled “Patient Relationship Categories and Codes.” Learn more.

Webinar by CMS titled “Comparative Billing Report on Psychologists.” Learn more.

AHIP National Conference on Medicaid, Washington, D.C. (through Oct. 18). Learn more.

West Coast Real-Time Benefit Check & ePrior Authorization Summit, San Francisco (through Oct. 18). Learn more.

Web conference by the Advisory Board titled “Health Care IT 101.” Learn more

2018 Xtelligent Media Value-Based Care Summit, Boston (through Oct. 19). Learn more.

Webinar by AHA titled “BDO Cyber Threat Insights: 2018 Second Quarter Report.” Learn more.

2018 Annual State Issues Retreat by AHIP, Washington, D.C. (through Oct. 19). Learn more.

Thursday, Oct. 18

Webinar by HFMA titled “How Patient Financing Fits in a Consumer-Driven Healthcare Environment.” Learn more.

Webinar by AHIP titled “Exploring Value-Based Specialty Care—Cancer and Cardio.” Learn more.

Web conference by the Advisory Board titled “How to Meet the Needs of 18 Million (and Counting) Cancer Survivors.” Learn more.

Webinar by AHA titled “The Health of Health Care Employees:  Addressing the Unique Health Challenges for Clinicians.” Learn more.

Friday, Oct. 19

Deadline to respond to a GASB survey titled “Section 457 Deferred Compensation Plans.” Learn more.


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