DCMedical News: Friday, July 30, 2021
DCMedical News-DCMN
Washington, D.C.
Friday, July 30, 2021
DCMedical News is published every day both the House and the Senate are scheduled to be in session, and will resume September 20.
THE BIG STORY
Pfizer Efficacy At Six Months: medRxiv posts a pre-print (here) of a study showing “With up to 6 months of follow-up and despite a gradually declining trend in vaccine efficacy, BNT162b2 had a favorable safety profile and was highly efficacious in preventing COVID-19.”
CDC Now Recommends “The Vaccinated Should Get Tested for Covid If Exposed” (here).
Correction: The infrastructure bill will not use Provider Relief Funds as a pay-for, following reaction. Fierce Hospitals reports that “A bipartisan group of senators has come to an agreement on much of the $1 trillion infrastructure package that ensures COVID-19 provider relief funds will not be touched . . . This came after several provider groups pushed back against plans to use the remaining funds as a pay-for.”
The infrastructure will cost hospitals by extending the sequester, however, according to Modern Healthcare (here), which reports “The Senate is slated to vote on an infrastructure bill that would be financed, in part, by extending Medicare payment cuts. The legislation, which includes $550 billion in new spending over five years for roads, bridges and other transportation projects—but nothing for hospital infrastructure—would finance a small fraction of that new spending by continuing the automatic Medicare reimbursement reductions created under budget sequestration in 2013.”
Fitch reports (here) that “In contrast to the Coronavirus Aid, Relief and Economic Security (CARES) Act, which allocated funds directly to hospitals based on size and coronavirus caseload numbers, the ARP [American Rescue Plan] only provides direct aid to rural providers. However, the ARP will help support hospital patient revenues by reducing the number of those who are uninsured, which is a credit positive for hospitals. The most significant measures temporarily subsidize healthcare coverage under the Consolidated Omnibus Budget Reconciliation Act (COBRA), subsidizing the premium at 100% through the end of September; provide additional funding/incentives to expand Medicaid coverage in those states that have not yet done so; and expand Affordable Care Act (ACA) premium subsidies.” Fitch reports that in the Medicaid expansion period 2014-2015 credit upgrades exceeded downgrades by 3:1.
InsideHealthPolicy reports (here) on a study showing that “The American Rescue Plan’s incentives for states to adopt Medicaid expansion could lead to roughly $21.1 billion in additional federal dollars among the 14 states that haven’t yet implemented expansion, and could fully offset state expansion costs for up to six-and-a-half years in some of the states, according to a Manatt Health analysis.”
HOSPITALS AND OTHER HEALTH CARE FACILITIES
Hospital Outpatient Rate Variation Studied in Workers Compensation Claims
The Workers Compensation Research Institute (WCRI) publishes (here) the 10th edition of its compendium of surgery charges by state, including almost 90% of all such claims in 36 cooperating states.
Price Caps for Hospitals and Other Providers
Chernew and Pany make the case in JAMA (here) for price caps. “In 2017, commercial hospital prices for inpatient care were approximately twice Medicare prices nationally and varied widely across states. Within markets, prices for inpatient care frequently vary by more than 300%, and outpatient prices vary by even more.”
RAND explores policy options (study here, summary here) for reducing hospital prices paid by private health plans. MedPage Today editorializes (here) that “We All Agree Hospital Consolidation Needs More Oversight.”
One party not heard from often, nurses: Healthcare Dive (here) summarizes a study in American Economic Review, on hospital consolidation as a factor in wage suppression of nurses.
Hospital at Home (HAH) Studied in the UK
A report in the Annals of Internal Medicine (summary here from the NEJM Journal Watch) found that “The HAH program employed a multidisciplinary team, daily virtual rounds, and geriatrician-led admission avoidance . . . At 6-month follow-up, similar percentages of patients in the HAH and inpatient groups were living at home (80% and 75%); mortality also was similar (17% and 18%). Those in the HAH group were significantly less likely have delirium at 1 month or to require long-term residential care at 6 and 12 months.
No Hospital Left Behind, Critical Access (25-bed) Hospitals’ Stars Fall
Modern Healthcare (here) summarized the first round of hospital “star” ratings with a revised methodology. “It's the first time CMS has applied the new methodology, and 45% of hospitals received the same star rating as before. Nearly a quarter, 22.7% of acute-care hospitals, had worse ratings. CMS' latest formula equally gives weight to each quality and safety measure and groups hospitals by the number of measures they report. The agency formerly used what's known as a latent variable model that used several variables to calculate each measure's weight.”
“Overall, more hospitals scored 4 and 5 stars on the scale; 45 fewer hospitals received 1 star compared to the last update using the latent variable methodology. An additional 59 hospitals received a 5-star rating. Critical-access hospitals saw a more dramatic shift in star ratings. Previously, 94.3% of these hospitals received 3 or more stars. Only 76.3% scored 3 or higher under the new methodology.”
Quality in Safety Net Hospitals Unaffected by Medicaid Expansion
A report in JAMA Internal Medicine (here) found that “Despite reductions in uncompensated care and improvements in operating margins, there appears to be little evidence of quality improvement among SNHs in states that expanded Medicaid compared with those in states that did not.”
Top 10 Hospitals With COVID-19 Admissions, Payments, Outcomes
Hospital Pricing Specialists (HPS, here) reports on “Clinical outcomes differences between covid and non-covid admissions from April 1, 2020 through December 31, 2020. The study involved 4,756 hospitals and 324,788 patient records that had a covid diagnosis code. The overwhelming DRG associated with a covid diagnosis is DRG 177 - Respiratory Infections with Major Complications.”
Five of the top 10 (in volume) hospitals were in New York, four of those in New York City. Comparing payments and outcomes for patients with that DRG and COVID-19 as the diagnosis, to patients without COVID-19 but the same DRG, the payment was 15% higher, charges were 5% lower, length of stay was 1% greater, and mortality was 80% greater.
READINGS & REFERENCES
Becker’sHospitalReview summarizes Kaiser Family Foundation analysis of twenty years’ of data on ER visit rate by state (here, from 45 per thousand per year in New York, to 11,500 per thousand population per year in North Dakota, national average 437), and hospital beds per thousand population by state (here, from 1.7-1.9 in many Western states to 4.4-4.8 in the upper Midwest, national average 2.4).
Enjoy Coffee: NEJM Journal Watch reports (here) that “A large, prospective study suggests that habitual coffee intake isn't associated with excess risk for cardiac arrhythmias.”
Select Coronavirus Public Health Resources and References may be found here.
2021 CQ Congressional Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
September 20, 21, 22, 23, 24, 27, 28, 29, 30
October 1, 19, 20, 21, 22, 25, 26, 27, 28
November 1, 2, 3, 4, 5, 15, 16, 17, 18, 30
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.