DCMedical News: Friday, September 24, 2021
DCMedical News-DCMN
Washington, D.C.
Friday, September 24, 2021
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY
CDC Fails to Recommend Booster for Health Care Workers
The Hill reports that “A CDC advisory panel recommended giving booster doses of Pfizer's coronavirus vaccine to older Americans and those in nursing homes, but was divided about people with underlying medical conditions. They did not endorse a booster for people based on their jobs . . . members voted 9 to 6 against recommending a booster dose for people aged 18 to 64 who are at risk of COVID-19 due to their occupation or living situation. This means people like health workers, grocery workers or teachers would not be eligible, though the Food and Drug Administration's emergency use authorization on Wednesday included such populations.” CDC Director Walensky could accept, modify or reject the recommendation.
DOCTORS, NURSES AND OTHER HEALTH CARE PROFESSIONALS
Doctors Figuring Out How to Afford Robots in Ambulatory Surgery Centers
Becker’s (here) discusses “Many spine and orthopedic surgeons have been lauding the advantages of robots in the operating room, but the high cost of these systems has prevented many ASCs from investing in the technology. Surgical robots are more prominent in hospitals, which have significantly more capital and are always looking to grow their market share by showing that they have the latest and greatest technologies.” Medical device companies may be adapting robot prices to a “per click” basis, as they have done with colonoscopes and other expensive equipment, even at the risk of offending their primary customers, hospitals.
HOSPITALS AND OTHER HEALTH CARE FACILITIES
System-Level Interventions for Reduction of Length of Stay: There Aren’t Any
A study commissioned by the Agency for Healthcare Research and Quality, and published in JAMA Network Open (here), aimed “To identify and synthesize evidence regarding potential systems-level strategies to reduce LOS for patients at high risk for prolonged LOS.” In 19 reviews, 8 strategies for reducing LOS in high-risk populations were identified: “discharge planning, geriatric assessment, medication management, clinical pathways, interdisciplinary or multidisciplinary care, case management, hospitalist services, and telehealth. Interventions were most frequently designed for older patients or patients with heart failure and were often associated with inconsistent outcomes in LOS, readmissions, and mortality across populations.”
The overall result: “This systematic review found that across all high-risk populations, there are inconsistent results on the effectiveness associated with interventions to reduce LOS, such as discharge planning, which are often widely used by health systems.” Reduction in length of stay, generally regarded as desirable for patient safety, became an economic imperative for hospitals following the adoption of Diagnosis Related Group reimbursement in 1983; the DRG payment, due on discharge, took the place of cost-based reimbursement, and placed a premium on moving the patient out of the hospital, in order to create an open bed for the next patient, and the next DRG payment. This was inferentially predicted by Johns Hopkins economist Gerard Anderson in 1984 (here), in a paper primarily focused on readmission of Medicare patients discharged prematurely from the hospital. Anderson noted, “The recently enacted prospective-payment legislation, however, creates economic incentives that could increase readmission rates.”
Overview of the National Inpatient Sample (NIS) from (Estimates of) 35 Million Hospitalizations
AHRQ announces, “The Agency for Healthcare Research and Quality (AHRQ) has released the 2019 National Inpatient Sample (NIS). A powerful database that contains data from more than 7 million hospital inpatient records, the NIS is drawn from 48 States and the District of Columbia, covering more than 98 percent of the U.S. population . . . The NIS is the largest publicly available inpatient healthcare database in the United States. It includes all patients, regardless of expected payer for the hospital stay.” The NIS (here) is part of a family of databases and software tools developed for the Healthcare Cost and Utilization Project (HCUP) . . . Unweighted, it contains data from more than 7 million hospital stays each year. Weighted, it estimates more than 35 million hospitalizations nationally.”
Mitigating the Damage from Hospital and Health System Consolidation
Milbank publishes (here) “Mitigating the Price Impacts of Health Care Provider Consolidation” by scholars at The Source (see DCMN 9-22-2021) which “examines how dominant health systems can exert their market power through contracting practices and offers options and best practices to state policymakers seeking to address provider market power, including passing laws to prohibit specific clauses in contracts between health insurers and providers.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
US Health Care Spending by Race and Ethnicity, 2002-2016
A study in JAMA (here) found in examination of 7.3 million health system visits, admissions or prescriptions that “Age-standardized per-person spending was significantly greater for White individuals than the all-population mean for ambulatory care; for Black individuals for emergency department and inpatient care; and for American Indian and Alaska Native individuals for emergency department care. Hispanic and Asian, Native Hawaiian, and Pacific Islander individuals had significantly less per-person spending than did the all-population mean for most types of care, and these differences persisted when controlling for underlying health.”
DRUGS & DEVICES
“Lost Savings: How Prohibiting Medicare Negotiation Has Cost Taxpayers”
A Staff Report of the Committee on Oversight and Reform U.S. House of Representatives September 2021, here.
READINGS & REFERENCES
While You Were Away, Part 4
MLNConnects reports, “On July 29, CMS issued a final rule that updates Medicare payment policies and rates for the Inpatient Psychiatric Facility (IPF) Prospective Payment System (PPS) for Fiscal Year (FY) 2022, which begins October 1, 2021. For FY 2022, CMS is updating the IPF PPS payment rates by 2.0% based on the final IPF market basket estimate of 2.7%, less a 0.7 percentage point productivity adjustment. In addition, the final rule updates the outlier threshold to maintain outlier payments at 2.0% of total payments. This adjustment will result in a 0.1% overall increase to aggregate payments. Total payments to IPFs are estimated to increase by 2.1% or $80 million in FY 2022 relative to IPF payments in FY 2021.”
As part of the rule, CMS finalized a policy to ensure medical residents won't be displaced if their teaching hospital or program closes, aligning the teaching policy for inpatient psychiatric facilities with changes included in the 2021 inpatient prospective payment system for general hospitals. Also, CMS will require inpatient psychiatric facilities to report COVID-19 vaccination status of their employees, and is developing additional follow-up measures to include patients with substance-use disorders. 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 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.