Subject: POLITICO Pulse, presented by PhRMA: Topic A for lawmakers: What happens next with Part B? — CRFB breaks down Clinton's health care proposals — Health Affairs cheat sheet
From: POLITICO Pulse <[email-masked]>
To: <[email-masked]>
Date: Tue, 3 May 2016 08:02:04 -0600

By Dan Diamond | 05/03/2016 10:00 AM EDT

Hillary Clinton's economic policies get graded, and Health Affairs gets the PULSE cheat sheet treatment. But first: The fight over Medicare's Part B demo is getting messy.

TOPIC A ON THE POLICY AGENDA: WHAT HAPPENS NEXT WITH PART B - Several House Democrats broke from the White House on Monday and joined hundreds of Republicans in calling for Medicare's controversial Part B demo to be nixed - a move that launched a war of words and competing comment letters.

- What's at stake. Medicare spent around $22 billion on drugs last year, and the demo would test a lower reimbursement rate for high-cost drugs administered under Part B. CMS also has proposed piloting value-based payment models - like reference pricing and outcomes-based pricing - for certain drugs.

- Why Monday's news was notable. While Senate Finance Committee Democrats last week called for changes to the demo, Monday was the first time that Democrats have publicly demanded an end to the project. 

Lawmakers also are in the home stretch: Comments are due to Medicare by next Monday, and a slew of negative letters could affect how fast CMS can turn around a final rule and get the project off the ground.

- Why four House Democrats - and 238 House Republicans - are opposed. The representatives maintain that the demo would hurt patient care and affect nearly 75 percent of seniors, a "deeply troubling" scope for a pilot project. 

"Under CMS's Medicare drug experiment, numerous physicians would face acquisition costs that exceed the Medicare payment amount for certain drugs," the letter to HHS Secretary Sylvia Mathews Burwell and CMS acting administrator Andy Slavitt reads. "This policy will make it harder for patients to receive the drugs they depend upon."

Read the House letter: http://go.politicoemail.com/?qs=77c27f81a7de1e5cc003cf0daeca9d3c1c2ae4405b2c2ea63a00f56d1a29f8eb

It's also worth noting that of the four dissenting House Democrats, three - Reps. Brad Ashford, Collin Peterson and Kyrsten Sinema - are top targets for Republicans in the 2016 election. (Maryland Rep. Dutch Ruppersberger is thought to occupy a safe seat.)

- Why 25 organizations are in favor. Within minutes of the House letter's release, a bevy of groups - led by AARP and including AFL-CIO, the Center for American Progress and Kaiser Permanente - fired off a competing comment to Burwell and Slavitt, applauding the initiative as a necessary move toward value-driven care.

"We do not believe that the model's proposed changes to Medicare Part B prescription drug payment will adversely impact beneficiary access to needed care or a provider's ability to make care decisions in the best interest of their patient," the groups write.

"We also support CMS' proposal to test the feasibility of value-based pricing strategies that have shown promise in the private insurance market."

Read the letter: http://go.politicoemail.com/?qs=a734c313258e807f21093f61166094f4729da12664557e48c44caa8eabbee72d

Washington Post editorial board endorses CMS' proposal. According to the Post, the medical industry is trying to submarine the proposal in order to protect its profits.

"The executive branch is on the side of consumers and taxpayers this time," the Post's unsigned editorial reads. "We hope it doesn't back down."

THIS IS TUESDAY PULSE - Where practice may not make perfect, but it makes meaning. Tips to [email-masked] or @ddiamond on Twitter.

With help from Brett Norman (@BrettNorman).

HEALTH AFFAIRS CHEAT SHEET - The latest issue of Health Affairs is out, and Pulse and the Pro health care team round up some of the most interesting studies.

1) Increased competition may not help rein in the increasing costs of cancer drugs. That's according to research published on Monday in Health Affairs that appears to contradict a common drug industry argument. 

The findings were released concurrently with another Health Affairs study that showed the United States gets low value for its spending on cancer drugs. The U.S. consistently outspent other developed nations on cancer drugs between 2004 and 2014, but had one of the smallest improvements in cancer-related outcomes. More for Pros from Sarah Karlin-Smith.

2) Insurers increasingly pick up the tab for rising opioid problem. While deaths from prescription pain killers quadrupled between 1999 and 2013, insurers covered a growing share of the tab for the drugs, according to one study. Out-of-pocket spending fell from $4.40 for a standard measure of opioids to $0.90 from 2001 and 2012. Medicare was the largest payer for the drugs, covering 20 percent to 30 percent of the cost. 

A second paper found that hospitalizations due to opioid abuse climbed from about 302,000 in 2002 to 520,000 in 2012, with inpatient charges for treatment reaching almost $15 billion in 2012. Medicaid was the most common payer over that period. 

3) States that spent more on social services saw healthier residents. That's according to a study that found a possible link between addressing social determinants of health and outcomes. Residents of states that had relatively higher ratios of social to health spending also had improved health across seven measures, including adult obesity, acute myocardial infarction and type 2 diabetes.

4) Acute care drug shortages are hanging around. The FDA user fee law passed in 2012 included provisions to stem a surge of shortages in critical drugs. They appear to have helped, according to this study, as the total numbers of active and new drug shortages have come down from peaks in 2012. That's not been the case with drugs used in emergency departments and other acute care environments, however. Shortages with those drugs have increased and grown longer compared to non-acute medicines.

5) Some not-for-profit hospitals continue to report massive profits. While only forty-five percent of hospitals were profitable in 2013, seven of the nation's ten most profitable hospitals were not-for-profit. And all of them reported more than $163 million from patient care services alone, according to a new study. The key factor: Their market power allowed them to exact price increases from insurers.

More coverage of the latest issue of Health Affairs
. Medicare is paying bonuses to hundreds of lower-quality hospitals because they're treating less expensive patients, Jordan Rau writes at Kaiser Health News.
. California's Obamacare exchange is helping to keep premiums in check, Lisa Aliferis writes at KQED's "State of Health." 

HOW DO CLINTON'S HEALTH CARE PROPOSALS STACK UP? - The bipartisan Center for a Responsible Federal Budget is out with a review of Hillary Clinton's economic proposals, finding that they nearly pay for themselves. (Overall, the Democratic front-runner would offset much of her new economic spending by hiking taxes on high earners.)

Here's CRFB's specific math on Clinton's health care proposals over the next decade.

. Expand the Affordable Care Act: $300 billion in spending.
Clinton plans to expand Medicaid funding, spend more on outreach to the uninsured and establish a new refundable tax credit to cover out-of-pocket health costs 

. Repeal the Cadillac tax on high-cost health plans: $100 billion in spending.
Like a growing number of politicians, Clinton supports repeal of the planned 40 percent excise tax on high-cost health plans. (As PULSE readers know well, the tax already has been delayed until 2020.)

. Reduce prescription drug costs and allow for "public option": $250 billion in savings.
Clinton plans to increase bargaining power for Medicare Part D and encourage states to offer a "public option" in health insurance exchanges

See CRFB's brief: http://go.politicoemail.com/?qs=77c27f81a7de1e5c9df0adb9bf81cc6a695a84cf2bbfac91bf5bcbe1a0a27a38

- CRFB applauds Clinton's specificity. "It is quite encouraging that Secretary Clinton has outlined specific offsets for her new proposals," the organization writes. "By our estimates, these savings would cover nearly all the new costs (and may more than fully cover the costs once the campaign releases specifics for corporate tax reform)." 

It's a striking difference from how CRFB described Bernie Sanders' proposals, which it said last month came up trillions of dollars short. And overall, CRFB's series of presidential scorecards reveals a mild surprise. "The most fiscally conservative presidential contender left standing is ... Hillary Clinton," Catherine Rampell writes in the Washington Post.

- Clinton holding substance abuse event today. The Democratic front-runner's in West Virginia and scheduled to hold a 10:30 a.m. event in Charleston that focuses on residents' struggle with addiction, particularly because of opioid abuse.

** A message from PhRMA: Developing innovative medicines is not possible without the people who volunteer to participate in clinical trials. During Clinical Trials Awareness Week, we celebrate clinical trial study volunteers who help inform the drug discovery process. Watch here how clinical trials are playing an important role in making new treatments a reality. **

KAISER POLL: THE OPIOID EPIDEMIC IS PERSONAL, AND NOT ENOUGH IS BEING DONE - About 44 percent of Americans know someone who has been addicted to prescription painkillers, including one in five who say a family member has been hooked. 

That's according to a new Kaiser Family Foundation poll out this morning, which found more than 80 percent of respondents said more pain management training for providers, expanded access to addiction treatment and monitoring doctors' prescribing of painkillers would be effective strategies to address with the epidemic. About two-thirds said federal and state governments weren't doing enough to fight the increase in prescription drug addiction. 

 - Where Americans stand on mental health care. One in five respondents said they or someone in their immediate family has needed mental health treatment but did not get it. Eighty-seven percent said lack of access to mental health care was a problem. And only about 40 percent knew that insurers had to provide mental health benefits comparable to traditional medical coverage. 

See the poll: http://go.politicoemail.com/?qs=77c27f81a7de1e5c324577717103037384b4b77e66f16d64f5cb9e3ffd421cf7

WORLD ASTHMA DAY IS HERE - And GSK is out with a new survey that quantifies some of the risks of asthma, including a finding that one-fifth of patients with uncontrolled asthma needed to visit the emergency room or urgent care clinic in the past year. http://go.politicoemail.com/?qs=77c27f81a7de1e5ccad061eb20bbb3e17b342998ccc8306ad52ba3c94b929662

BLACKBURN THREATENS 'ALL MEANS NECESSARY' TO GET STEMEXPRESS INFO - A House committee is escalating its battle with StemExpress, the company that previously worked on fetal tissue with Planned Parenthood.

"We have yet to receive accounting, banking and other business documents, for which subpoenas were issued to StemExpress," Rep. Marsha Blackburn, chairman of the Select Investigative Panel established in the wake of the Planned Parenthood sting videos, wrote in a letter to StemExpress CEO Cate Dyer. 

Blackburn warned that she's not going to let the issue go without a fight. More for Pros from Jennifer Haberkorn: http://go.politicoemail.com/?qs=a734c313258e807f0e27c0107b4315cffce08614acbf455268c39e6dcadcb101 

THANKS FOR MAKING 'PULSE CHECK' A SUCCESS - iTunes named our brand-new podcast as one of its featured "New and Noteworthy" podcasts. Listen to our interview with CMS acting administrator Andy Slavitt and subscribe for upcoming episodes. http://go.politicoemail.com/?qs=77c27f81a7de1e5c8e73565678455cf907b19c936863a4bb72c7e861d753e6b6

TECH PRESS TO BLAME FOR THERANOS DEBACLE? - That's what Nick Bilton, a former tech columnist for the New York Times, argues in the pages of Vanity Fair. 

Bilton writes that Theranos - a blood testing company that was valued at $10 billion last year, but has since been plagued by allegations its technology wasn't ready for prime time - was aided and abetted by "one of the more insidious culprits: the Silicon Valley tech press."

"There were no tough questions about whether Theranos's technology actually worked; just praise," Bilton writes. "When it seemed that the tech press had vetted Holmes, she subsequently went mainstream."

Read Bilton's post: http://go.politicoemail.com/?qs=77c27f81a7de1e5c372b1553b325dab461b259d8f6367593b48652a50172e202 

Author's note: Contra Bilton, if the tech press is a "secret culprit," it's an open secret. Many observers - including your Pulse author - wrote similar assessments last fall.

THEY BUILT THE WORLD'S TINIEST ENGINE - From the Financial Times: "Scientists have developed a microscopic engine, the smallest in the world, that they say is the first one capable of driving nanobots, including medical robots that could travel through the body." More.

Two health care stories worth watching on Wall Street today:

TENET LOST MONEY, BUT NOT BECAUSE OF ACA - The for-profit hospital chain announced a first-quarter loss on Monday, mostly related to a whistleblower lawsuit. Overall, the company's seen persistent revenue growth, especially in its ambulatory care segment. 

And according to CEO Trevor Fetter, the ACA "continues to be helpful" by lowering the number of uninsured patients treated by the chain's hospitals. More from the Wall Street Journal: http://go.politicoemail.com/?qs=77c27f81a7de1e5c3dc6e08e7896b21c099efc764b2e59c5dec152df3b74eff6

- Hospital chain doesn't see UnitedHealth exit as concern. The nation's largest health insurer announced plans last month to leave dozens of ACA exchanges. But according to Tenet spokesperson Daniel Waldmann, other health insurers will step in to "pick up that UnitedHealth business," Reuters reports.

Year-over-year Tenet performance, on a same-hospital basis
. 28 percent: Increase in admissions from patients covered by exchange plans
. 46 percent: Increase in outpatient visits from patients covered by exchange plans

FITBIT'S EVOLUTION - The wearable tech company, which has seen its sales soar but its stock stagnate on Wall Street, is seeking to evolve into "a digital monitoring platform to discover and prevent health problems," the New York Times reports.

The company has worked to distribute its devices, which specialize in tracking fitness, to companies like BP, which in turn are using Fitbit to track employee wellness.

"I believe we've tracked more nights of sleep than have ever been tracked in the history of man," Fitbit's Woody Scal told the New York Times. "We can actually now compare it to normative data that we have and we can identify irregularities."

Read the story: http://go.politicoemail.com/?qs=77c27f81a7de1e5c3d572f2fe9ebaa43ed713b4205471a724d33acbe299dc9e3 

Fitbit sales
2014: 10.9 million devices
2015: 21.3 million devices

Meanwhile, around the nation:

FLINT RESIDENTS TO GET EXPANDED MEDICAID COVERAGE NEXT WEEK - That's according to Michigan Gov. Rick Snyder, who said on Monday that another 15,000 children and pregnant women should become eligible next week, after the funding receives final legislative approval.

D.C. DOCTOR SAYS HOSPITAL WON'T LET HER SPEAK OUT ON ABORTION - A ob-gyn at MedStar Washington Hospital Center says the hospital is curtailing her civil rights and filed a complaint.

AROUND TOWN - Carl Thorsen, the former Tom DeLay aide now with Thorsen French Advocacy, has registered to lobby for Cardinal Health on prescription drug abuse and pharmaceutical market value.

NIHCM NAMES AWARD WINNERS - Winners of the foundation's prestigious research and journalism awards include

. The Wall Street Journal's John Carreyrou and Mike Siconolfi for "Testing Theranos"
. xpostfactoid's Andrew Sprung for "When Silver is Worth More Than Gold or Platinum"
. Martin Hackmann, Jonathan Kolstad and Amanda Kowalski for their American Economic Review paper, "Adverse Selection and the Individual Mandate: When Theory Meets Practice"

OPRAH WINFREY TO STAR IN 'IMMORTAL LIFE OF HENRIETTA LACKS' - Winfrey will play Henrietta's daughter Deborah Lacks, and the HBO version of the best-selling book will follow how Deborah learned about the unauthorized harvesting of her mother's cells. http://go.politicoemail.com/?qs=a734c313258e807f6e3986f6dde81ddba7e81a5c9327c4a33b314cffabe3d762

WHAT WE'RE READING by Jennifer Haberkorn

A DOJ investigation has revealed that South Dakota has unnecessarily relied on nursing facilities to serve people with disabilities, which isolated them from their communities, the AP reports. http://go.politicoemail.com/?qs=a734c313258e807f59fdf75a8fb7e2c9848eb6ef89f7fefe2f987c64b81f6118

Zeke Emanuel writes in the Wall Street Journal that the Independence at Home program is saving Medicare money and improving care and should be scaled up. http://go.politicoemail.com/?qs=a734c313258e807f755eb9d8a3f1fa6b807af879aafec0f9a77d1c0be9de503c

Controlling Zika mosquitoes may already be a lost cause, USA Today's Liz Szabo reports. http://go.politicoemail.com/?qs=a734c313258e807f89b6544a9c2913a6d9f4f6aa9b315c2d9f9ba298bfdf1d20

Former Rep. Patrick Kennedy spoke about addiction and mental health parity with David Axelrod on "The Axe Files" podcast. http://go.politicoemail.com/?qs=a734c313258e807f29dea616127dde89688226f625bf85123abf52fdf01e2753

A federal judge allowed Gilead to submit additional evidence in its lawsuit with Merck after Gilead said the former Merck lawyer lied under oath in the case, according to the WSJ. http://go.politicoemail.com/?qs=a734c313258e807f7f26a0d84886306b6b0f7817371be7d15e6b539040e503a7

** A message from PhRMA: A dynamic and collaborative health care ecosystem is crucial to conducting efficient and effective clinical trials, but 2/3 of trials fail to enroll enough participants. Misconceptions and a lack of awareness about this important research often keep people from participating. During Clinical Trials Awareness Week, get the facts about how America's biopharmaceutical companies are designing new ways to conduct clinical trials to increase efficiency and bring medicines to patients faster. Learn more here. **

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