DCMedical News: Wednesday, September 22, 2021
DCMedical News-DCMN
Washington, D.C.
Wednesday, September 22, 2021
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY
Death Comes More Often in Rural Areas of the U.S.
A new study from CDC’s National Center for Health Statistics (here) finds “From 1999 through 2019, age-adjusted death rates in urban areas declined from 865.1 per 100,000 to 693.4, whereas rates in rural areas initially declined from 1999 (923.8) through 2010 (837.6) and then stabilized through 2019 (834.0). Death rates for both males and females were higher in rural than in urban areas from 1999 through 2019, and the differences in rates widened over the period. In 2019, rates for the 10 leading causes of death were higher in rural areas than in urban areas, with the greatest difference in rates for deaths due to heart disease (189.1 compared with 156.3), cancer (164.1 compared with 142.8), and chronic lower respiratory disease (CLRD) (52.5 compared with 35.4). Differences between rural and urban death rates for heart disease, cancer, and CLRD widened from 1999 through 2019.”
Traffic Jam and Health Legislation, Continued
Says InsideHealthPolicy, “Democratic leaders now plan to move reconciliation separately from a vote on the bipartisan infrastructure bill . . . House Democratic leaders from both sides of Capitol Hill confirmed Tuesday they won’t delay a vote on the infrastructure bill beyond next week even though reconciliation is unlikely to be ready for floor action by then.”
“The Senate has yet to unveil its reconciliation legislation despite a Sept. 15 caucus deadline, leading to speculation the final package will be scaled back to appease moderates . . . But House Speaker Nancy Pelosi (D-CA) and key House Democrats are still pushing for the bill to stay around $3.5 trillion, a number negotiated earlier with progressives who had wanted a much larger package. Pelosi also is urging the Senate to include Medicare, Medicaid and Affordable Care Act policy changes in the package.”
“There are indications the Senate is moving in a different direction than the House on drug pricing and the other health reforms. Senate Democrats hope to add benefits to Medicare that are more generous and kick in sooner than those marked up by House committees -- and the Senate’s emerging plan could be even more generous than Senate Budget Chair Bernie Sanders’ (I-VT) initial proposal, caucus documents indicate. But Senate Democrats might not be as generous as the House on Medicaid and ACA reforms.”
DOCTORS, NURSES AND OTHER HEALTH CARE PROFESSIONALS
Telehealth a Pandemic-Era Winner for Doctors and Patients
A study in Telehealth and Medicine Today (here) reviewed 2 billion claims from 50 states, half of all private health insurer activity, from January 2019 to December 2020, as well as a provider and a patient survey. Among the findings: three out of four providers said telehealth enabled them to provide quality care to patients, a sentiment echoed by 84% of patients. Usage range widely by state, with Massachusetts peaking at 75% during the study period, Mississippi at 25%. Most use took place with chronic disease management, care coordination, medication reconciliation and preventive care, much less for procedures and acute care. The biggest barrier? Diagnostic instruments (smartphone for photos, blood pressure cuffs, scales), then low reimbursement.
“Commentaries” in Medical Journals and Financial Conflicts of Interest
A study in JAMA Internal Medicine (here) examined “The financial associations between authors of commentaries on randomized clinical trials (RCTs) of invasive cardiovascular interventions and trial sponsors, and whether the financial associations were disclosed.” An important tool for disclosure is the CMS Open Payments website which does not record payments to non-U.S. based authors, some 60% of the authors of commentaries. Notwithstanding that limitation, “15% of authors of editorial commentaries accompanying RCTs on invasive cardiovascular interventions published from 2013 to 2019 reported financial associations with trial sponsors. Many of the authors with general payments or research funding reported on Open Payments did not disclose all of these financial associations in the commentary nor the accompanying
disclosure forms.”
Physician Pay Up, Productivity Down in AMGA 2020 Compensation Survey, May Affect Contract Practices
The American Medical Group Association (AMGA, here) reports that “In 2020, physician compensation increased 0.12%. That compares to a 3.79% increase in 2019. However, productivity fell 10.17% in 2020 compared to the previous year. In 2019, productivity rose 0.56% per year. The compensation per work RVU (wRVU) ratio increased to 10.82% [in 2020], up from 2.14% observed in 2019. Productivity likely decreased, in part, because healthcare organizations and patients put routine care and elective procedures on hold throughout much of 2020.”
AMGA’s President said “Medical groups paid a steep price to retain their physician talent, even though productivity steeply declined. COVID-19 highlighted the need for medical groups and health systems to reconsider their compensation plans so that they rely less on obligatory annual pay increases and more on incentivizing productivity that rewards valuable outcomes.”
HOSPITALS AND OTHER HEALTH CARE FACILITIES
Antitrust: a State Matter, Also, Increasing Resources and Refining Focus on Anticompetitive Mergers
Milbank publishes (here) an essay on state-level antitrust enforcement in the health field. The study says “The Federal Trade Commission (FTC) and the Department of Justice (DOJ) receive notice only of transactions over $92 million as required by the 2021 Hart-Scott-Rodino Antitrust Improvements Act (HSR). Therefore, smaller health care provider transactions, such as acquisitions of physician groups by hospitals, are rarely reported and ultimately escape federal review. As a result, these smaller transactions and other forms of consolidation not challenged by federal antitrust enforcers have increased substantially.”
“Second, federal antitrust enforcers have limited resources and have struggled to analyze the ever-increasing number of reported mergers. In sum, few health care transactions rise to federal attention, and those that do are often met with limited resources to challenge them.” The authors, from The Source for Healthcare Price and Competition, include a bibliography of recent studies and state legislation, and a web site with state by state and related resources, here.
READINGS & REFERENCES
While You Were Away, Final Rules from CMS, Part 2
MLN Connects (the Medicare Learning Network) reports that “On July 29, CMS issued a final rule that updates Medicare hospice payments . . . Under the final rule, the hospices would see a 2.0 percent increase ($480 million) in their payments for FY 2022 relative to FY 2021. This is a result of the 2.7 percent market basket percentage increase reduced by a 0.7 percentage point productivity adjustment. Hospices that fail to meet quality reporting requirements receive a 2-percentage point reduction to the annual hospice payment update percentage increase for the year.
The FY 2022 hospice payment updates also include an update to the statutory aggregate cap amount, which limits the overall payments per patient that are made to a hospice annually. The cap amount for FY 2022 is $31,297.61 (FY 2021 cap amount of $30,683.93 increased by 2.0 percent).” CMS Fact Sheet here, final rule here.
Select Coronavirus Public Health Resources and References may be found here.
2021 CQ Congressional Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
September 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.