DCMedical News: Wednesday, July 28, 2021
DCMedical News-DCMN
Washington, D.C.
Wednesday, July 28, 2021
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY
Doctors, Hospitals Doing Better (See Below), as Fourth COVID-19 Wave Approaches
DOCTORS, NURSES AND OTHER HEALTH CARE PROFESSIONALS
How Are Physicians Doing? KaufmanHall “Flash” Report for First Half of 2021
The report (here) examined 100,000 physicians in 100 specialties and found “Physician productivity, revenues, and compensation all were up compared to the first quarter of last year as patient volumes continued to recover, while the average investment required to supplement physician revenues decreased slightly,” but with private practice physicians at a disadvantage, specifically “While private physician practices have reported concerns about worsening finances, this report focuses on employed physician practices, which have seen compensation return to pre-COVID levels.”
“Net Revenue per Physician FTE (including advanced practice providers or APPs) was $575,113 in the first quarter, up just 1% from the fourth quarter of last year.” But with expenses of employed physicians and staff growing, the figure KaufmanHall calls the “median investment/Subsidy per Physician Full-Time equivalent”--that is, the amount of money a health system has to put into the compensation of employed physicians--was $239,502 for the quarter.”
Telehealth Popular With Providers and Patients
Some 430 provider groups (letter here) urged Congress to make permanent or to further extend the Medicare telehealth benefits from the Public Health Emergency (PHE). “Many of the telehealth flexibilities are temporary and limited to the duration of the COVID-19 public health emergency. Without action from Congress, Medicare beneficiaries will abruptly lose access to nearly all recently expanded coverage of telehealth when the COVID-19 PHE ends.” The group touts high utilization (one in four Medicare beneficiaries), patient satisfaction, lower no-show rates (7.5% vs. 30%) and the role of telehealth in eliminating or minimizing service inequities which otherwise take place secondary to patient and provider location.
RAND (here) reported on claims data and interviews with telehealth providers and patients, noting “providers revealed that they pivoted to telehealth out of necessity, not only to protect themselves and their patients from spreading the virus, but also to quickly offset losses from reduced in-person visit volume. Post-pandemic policies, particularly on reimbursement, will play a large role in whether these providers will continue to offer telehealth services after the public health emergency ends.” RAND also noted the effect of telehealth availability on health services inequities, including improved use by mental health professionals, in opioid use disorder treatment, for mothers of newborns, in rural areas and in management of chronic disease.
HOSPITALS AND OTHER HEALTH CARE FACILITIES
PCI Decline, Shift to Outpatient Services
MedPage Today reported (here) on a study in JAMA Cardiology (here) that “Percutaneous coronary intervention (PCI) rates held steady after a COURAGE trial-related dip but have increasingly moved to the outpatient setting, population-based data from several states showed.” The sole driver of a 10%+ decline in PCI from 2010 to 2017 “was a 34.4% drop in elective PCI (from 165.3 to 123.6 per 100,000), which largely occurred in the early part of the study period from 2010 to 2013. That early shift likely reflected ongoing impact of the 2007 publication of the COURAGE trial, which emphasized the role of medical therapy in managing stable ischemic heart disease by showing that PCI had no outcome advantage.” The outpatient shift: “More notable were the near doubling in outpatient PCI procedures (from 33.8 to 66.7 per 100,000), while inpatient PCI declined a relative 26.6%.”
Follow Up Costs Unaffected in Swiss Study Mandating Move to Outpatient from Inpatient Surgery
A study in Health Policy (here) of Swiss cantonal legislation mandating more outpatient utilization found “steeper decreases in healthcare costs of index procedures in cantons with a legislation, with no impact on length of hospital stays. The legislation also had no impact on outpatient costs or hospitalizations during follow-up.”
Post-COVID-19 Clinics Reassure Patients, Generate Revenue From Related Services
A survey article in Modern Healthcare (here) found that “Health systems across the country are opening post-COVID-19 clinics to care for people who have a wide range of symptoms and are desperate for reassurance that they're not going nuts . . . Up to one-fifth of COVID-19 patients will develop long-haul symptoms . . . caring for those people involves a long string of lab and diagnostic testing, detailed intake histories and referrals to all kinds of specialists. All that work generates money, said Dr. William Lago, a family medicine physician at the Cleveland Clinic who was involved in the creation of its reCOVer Clinics for people who had contracted the virus.”
How Are Hospitals Doing? Not As Bad
Becker’s reports (here) on a KaufmanHall “flash” report for hospitals (here), indicating that “The average hospital operating margin rose 95.2 percent in the first five months of 2021, compared to the first five months of 2020 . . . Gross operating revenue increased 18.6 percent from January to May of this year . . . Outpatient revenue saw the biggest revenue boost, jumping 25.1 percent in the first five months of 2021, compared to last year's levels. Inpatient revenue also was up 13.1percent in the same period versus January to May of 2020.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Joint Replacement Alternative Payment Study Shows Changing Goalposts, No Consistent Savings
A study (here) in JAMA Internal Medicine examined Medicare’s Comprehensive Care for Joint Replacement (CJR) model, initiated in 2016, “a national episode-based payment model for lower-extremity joint replacement (LEJR) . . . In the third year of the program, Medicare made hospital participation voluntary in half of the MSAs and enabled LEJRs for knees to be performed in the outpatient setting without being subject to episode-based payment.” Results show that “savings observed in the second year of CJR largely dissipated by the fourth year owing to a combination of responses among hospitals to changes in the program. These results suggest a need for caution regarding the design of new alternative payment models.”
Surprise for Retroactive ED Payment Denial
Becker’s Hospital Review reports (here) that “CMS' proposed surprise-billing rule prohibits insurers from retroactively denying emergency department claims. The ban is buried in CMS' 411-page rule, which was unveiled July 2, and is the first in a series of rules aimed at shielding patients from surprise billing . . . CMS said in the rule that it is aware that some plans currently deny coverage provided in hospital EDs if the claim is considered nonemergent based ‘solely on final diagnostic codes.’ CMS said the practice is inconsistent with the emergency services requirements of the No Surprises Act and the ACA." United Healthcare had announced a retroactive denial policy to have been effective July 1, but subsequently retracted it.
READINGS & REFERENCES
Select Coronavirus Public Health Resources and References (alphabetical):
AMA resource page for physicians here.
AMA Video Guide to COVID-19, here.
CDC information page for professionals here.
CMS (Centers for Medicare & Medicaid Services) Current Emergencies website, here.
HHS Protect Public Data Hub, here.
JAMA Network’s COVID-19 resource center here.
2021 CQ Congressional Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
July 29, 30
August - none
September 20, 21, 22, 23, 24, 27, 28, 29, 30
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.