Axios Vitals

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July 03, 2019

Good morning. If you live in D.C. and took any tank pics last night, make sure you tweet them.

Today's word count is 840 words, ~3 minutes.

1 big thing: Medicare for All's winners and losers

Adapted from Zirui Song, 2019, "The Pricing of Care Under Medicare for AllImplications and Policy Choices"; Chart: Andrew Witherspoon/Axios
Adapted from Zirui Song, 2019, "The Pricing of Care Under Medicare for AllImplications and Policy Choices"; Chart: Andrew Witherspoon/Axios

Medicare for All would result in payment cuts for most providers, and a recent analysis in JAMA by Harvard's Zirui Song takes a look at just how steep those cuts would be.

  • Many specialties would still take a pay cut even under versions of "Medicare for All" that aren't as full-throated as what Sen. Bernie Sanders has proposed.

Details: This is a feature, not a bug, of Medicare for All. Part of the point is to spend less on health care — through steep cuts in how much many doctors and hospitals get paid.

Yes, but: The figures above represent the change in how much doctors would get paid for patients who currently have private insurance — not the total pay change across all of their patients.

  • Doctors are already receiving Medicare's lower rates for their patients who are on Medicare, and are in many cases getting paid less than that for Medicaid patients.

What they're saying: "The assumption that physicians and hospitals would not react as their commercial prices are reduced substantially to Medicare levels is likely unrealistic," Song writes.

  • Doctors and hospitals would likely to try to boost their reimbursements under a single-payer system using some of the same tools they lean on now: Performing more procedures, steering patients toward more profitable services, and consolidating independent doctors' practices within hospitals, which get paid more.
  • And without patient cost-sharing, people may demand more care.

The bottom line: Setting rates above Medicare levels would be less disruptive, as would phasing in the changes over time, Song argues.

Go deeper: Hospitals that treat poor patients aren't opposing Medicare for All

2. Facebook fighting sensational health claims

Facebook announced yesterday that it is changing its algorithm to weed out misleading information about health conditions, my colleague Sara Fischer reports.

  • The announcement was made following a Wall Street Journal report detailing posts that promoted spammy or misleading cures.

Why it matters: Experts cite online misinformation on Facebook and other platforms as creating real-world health problems.

  • Most recently, platforms like Facebook have been blamed for harboring anti-vaccination content.
  • Facebook said last month it made two updates to the way it ranks content in its News Feed to downplay posts with exaggerated or sensational health claims and posts attempting to sell products or services based on health-related claims.

Between the lines: YouTube has also been taking some action against bad health care content by cutting off advertising for bogus cancer-treatment channels, according to the Wall Street Journal.

  • Facebook and YouTube tell the Journal they're taking specific action against cancer-related content after the Journal presented the companies with examples of promotional and spammy posts it found on their platforms that promised miracle cures or bogus health services.

The big picture: Facebook has mostly figured out how to weed out scam posts that have been uploaded by bots, but it's had a much harder time filtering out content uploaded by humans that doesn't explicitly violate its rules.

Go deeper: Anti-vaccination content haunts Big Tech

3. The case for biosimilars

It's too soon to throw in the towel on biosimilars, especially because there's evidence that they're lowering the net costs of biologics, Alex Brill and Benedic Ippolito of the American Enterprise Institute argue in a Health Affairs blog.

What they're saying: The number of biosimilars in development is increasing, and 2 biologics facing biosimilar competition — Neupogen and Remicade — have begun offering bigger discounts to stay competitive, even though their list prices haven't come down.

The bottom line: "Although prices likely will not reach close to marginal costs...this does not imply that biologics, writ large, are natural monopolies in any traditional sense of the concept," Brill and Ippolito write.

  • The big question going forward, Ippolito told me, is how low biologic prices will go.

4. The "confession" of a nursing home operator

Health care researchers have been warring recently over whether "accountable care organizations" have been successful. Nursing homes have a particularly dim view of that care model, Axios' Bob Herman writes.

The intrigue: Skilled Nursing News spoke with an anonymous nursing-home operator who argued hospitals and doctors have cut referrals to nursing homes to save money for their ACOs, and instead have routed patients to their own home care companies.

  • But some patients aren't getting any healthier because they are getting readmitted and "ping-ponged around the system."
  • ACOs "have been a disaster" for nursing homes, the operator said.

The bottom line: The latest evidence is very mixed. Some of these care models can save modest amounts of money and keep people healthy, but spending is higher for the millions of people who have been "ping-ponging" in and out of ACOs.

5. Medicare wades into acupuncture debate

Medical staff performs acupuncture.
Photo: Aytug Can Sencar/Anadolu Agency/Getty Images

Medicare is considering paying for acupuncture — which would be a controversial move, the Washington Post reports.

  • The change would be part of a push to provide alternative, non-pharmacologic ways to address chronic pain amid the opioid crisis. Coverage would be only for chronic low-back pain.
  • Acupuncture proponents note its safety and say that it's worth covering even if it only works for some people.

Yes, but: There's research showing that in many cases, acupuncture isn't much more effective than a placebo.

  • "The whole thing is a big scam," Steven Novella, an assistant professor at the Yale School of Medicine, told the Post.

Have a great 4th of July. Vitals will be off tomorrow and Friday, but will be back in your inbox on Monday.