DCMedical News: Thursday, September 23, 2021
DCMedical News-DCMN
Washington, D.C.
Thursday, September 23, 2021
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY
More on the Traffic Jam
The Hill reports that (1) “House Democratic leaders are racing ahead with their plans to vote Monday on a bipartisan infrastructure package, brushing aside threats of opposition from both Republicans and liberals in their own caucus in a bid to fulfill a big chunk of President Biden’s domestic agenda”; (2) “The $1.2 trillion infrastructure bill has widespread support in both parties, sailing through the Senate by a vote of 69-30. But it’s been caught up in the broader debate over Biden’s economic agenda and the massive $3.5 trillion social benefits package. A number of liberals, distrustful of the centrists’ commitment to the larger social spending bill, are demanding that the $3.5 trillion package be passed before they’ll support the more popular infrastructure plan”; (3) “Republicans, meanwhile, oppose the $3.5 trillion package unanimously, and they’re lining up to oppose the bipartisan infrastructure proposal — not because they reject the policy, but to curb any momentum behind the larger bill”; and (4) we’re headed for another debt ceiling show-down, “No, sir, I’m not going to pay those bills.”
DOCTORS, NURSES AND OTHER HEALTH CARE PROFESSIONALS
Physician Prescribing of Opioids Down, Overdoses and Deaths Up
The AMA reports (here) that physicians have prescribed 44% fewer opioids over past decade, but overdoses have continued to climb. The report says there was a 44.4% decrease in opioid prescriptions between 2011 and 2020, with a 6.9% reduction between 2019 and last year, with more physicians using prescription drug monitoring programs. CDC data revealed that more than 93,000 people died of drug overdoses in 2020, including about 69,000 from opioid overdoses, a 30% increase in overall fatal overdoses from 2019.
HOSPITALS AND OTHER HEALTH CARE FACILITIES
Emergency Room Prescription Errors at 16.5% in Academic Medical Center
A study published in the American Journal of Emergency Medicine (here), examined the reasons for ER/ED error in prescriptions given to discharged patients. Among them, “The Emergency Department (ED) is known for its high rates of medication errors secondary to many characteristics such as unfamiliar patients, lack of continuity of care, increasing patient volumes, reliance on verbal orders, and fewer safety mechanisms.” The results: “This review identified a 16.5% error rate among all prescriptions provided to patients upon ED discharge that varied among different subcategories of medications. This is consistent with the limited literature that is currently available on the topic.” The error rate for anaphylaxis agents, antiarrhythmic agents, antidiabetic and lipid lowering prescriptions were all over 50% of those sampled.
$54 Billion in COVID-19 Losses Predicted for Hospitals During 2021
KaufmanHall has reported (here), in a survey sponsored by the American Hospital Association, that delayed care and higher expenses for supplies, labor and drugs will cause hospital losses of $54 billion in net income this year, even after taking into account relief provided under the CARES (Coronavirus Aid, Relief and Economic Security) Act. Without CARES funds, losses would reach $94 billion. More than a third of hospitals are projected to have negative margins at the end of 2021. This is notwithstanding heroic charges for COVID-19 patients reported by FAIR Health (here). The FAIR Health report (based on claims data) shows that the average billed charge for a COVID-19 hospitalization with complexities is $317,810, with the average in-network provider plan (with patient copayments) paying $98,139. For a general non-complex COVID-19 hospitalization the average billed charge is $74,591 and the average payment $33,525.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Health Disparities: I Read It In The Newspaper
A study in the Milbank Quarterly (here) “assessed whether the magnitude of income-based life expectancy disparity within a city was associated with the opinions of that city’s mayoral official (i.e., mayor or deputy mayor) about health disparities in their city.” The association of Mayoral opinion and disparities was not affected, according to this study, by ideology or politics; rather, “Highly visible and publicized information about mortality disparities, such as that related to COVID-19 disparities, has potential to elevate elected officials’ perceptions of the severity of health disparities and influence their opinions about the issue.” Also, “A 1-year-larger income-based life expectancy disparity in a city was associated with 25% higher odds that the city’s mayoral official would “strongly agree” that health disparities existed.”
Tenancy Support for the Homeless Under Medicaid Waivers: Easier Said Than Done
Another Milbank Quarterly report (here) examined “implementation of Medicaid’s Section 1115 demonstration waivers to test strategies to finance tenancy support services for persons experiencing or at risk of homelessness.” Among the challenges: “resolving the housing supply and NIMBY, removing silos between healthcare and homeless services providers, enrolling and retaining the target populations in Medicaid, contracting with and paying tenancy support providers, recruiting and retaining key workers, ensuring Medicaid’s waiver durability, and reducing administrative crowd-out and waiver burden.” Notwithstanding, “three of the four states [in the study] have made significant progress in launching their initiatives.”
DRUGS & DEVICES
Worth Repeating
Drug Channels’ original reporting, on pharma subjects of import which are rarely explored in depth, is startling even when in rerun. Attached is a (previously published) summary of the organization’s FOI-assisted examination of the 340B program, finding that (1) “Discounted purchases under the program reached at least $38 billion in 2020. That figure is an astonishing 27% higher than its 2019 counterpart—and more than quadruple the value of discounted purchases in 2014,” and (2) “The 340B program's size now exceeds the Medicaid program's outpatient drug sales—and accounts for nearly 20% of the total rebates and discounts that manufacturers provide for brand-name drugs. Alas, many elements of the 340B program—including its controversial contract pharmacy component—lack a comprehensive regulatory infrastructure.”
READINGS & REFERENCES
Medical Education Edition of JAMA
The annual summary of American medical schools (here) includes “data derived from the 2020-2021 Liaison Committee on Medical Education (LCME) Annual Medical School Questionnaire-Part II. The questionnaire was sent to the 155 LCME-accredited medical schools with students enrolled in at least 1 year of the curriculum. There was a 100% response rate.”
The summary of graduate medical education (residency and fellowship programs, here) is a “National GME Census through GMETrack, an internet-based AAMC product, a jointly maintained database of information on training programs accredited by the Accreditation Council for Graduate Medical Education (ACGME) and of the residents and fellows in them.”
While Your Were Away, Part 3
On July 29 CMS issued a final rule updating payment policies and rates for facilities covered by the Inpatient Rehabilitation Facility (IRF) Prospective Payment System (PPS), effective October 1. Says the agency, “CMS is updating the IRF PPS payment rates by 1.9% based on the IRF specific market basket estimate of 2.6%, less a 0.7 percentage point productivity adjustment. In addition, the final rule contains an adjustment to the outlier threshold to maintain outlier payments at 3.0% of total payments. This adjustment will result in a 0.4 percentage point decrease in outlier payments. We estimate that the overall IRF payments for FY 2022 would increase 1.5% (or $130 million), relative to payments in FY 2021.” CMS will require inpatient rehabilitation facilities to report employees' COVID-19 vaccination statuses with public reporting beginning with the September 2022 CareCompare exercise, based on data collected for the fourth quarter of 2021. 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 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.