DCMedical News: Monday, September 27, 2021
DCMedical News-DCMN
Washington, D.C.
Monday, September 27, 2021
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY
Rationing Hospital (and Other Health) Care
The Hill (here) summarizes news from around the nation, as unvaccinated patients with COVID-19 crowd out other hospital admissions: “More hospitals forced to ration amid delta surge.” The story, “As of Friday, the ICUs in Alabama, Georgia, Idaho, Kentucky and Texas all exceeded 90 percent capacity. The ICUs in Alaska and Montana, meanwhile, were 84 percent and 77 percent full, respectively, according to federal data.”
And the cost: a note in JAMA Health Forum (here) summarizes the avoidable cost of hospitalizing unvaccinated patients: the “cost of these largely preventable hospitalizations for the months of June, July, and August soared to more than $5 billion . . . As of early September, one-quarter of adults aged 18 or older were still unvaccinated, even as COVID-19 cases, hospitalizations, and deaths surged, fueled by the spread of the more infectious Delta variant . . . the vast majority (98.6%) of people hospitalized with COVID-19 in June through August were not vaccinated . . . This translated to 32 000 preventable COVID-19 hospitalizations among unvaccinated US adults in June, 68 000 in July, and 187 000 in August, for a total of 287 000 hospitalizations over the 3-month period.”
Hospital Staff Shortages, Deadline Today in New York for Employee Vaccination
The New York Times (here) reports that “New York Hospitals Face Possible Mass Firings as Workers Spurn Vaccines,” and that “With a Monday deadline looming, thousands of health care workers in the state are risking their jobs by not getting a coronavirus vaccine . . . As of Sept. 22, state data shows, around 84 percent of New York’s 450,000 hospital workers and 83 percent of its 145,400 nursing home employees had been fully vaccinated. But tens of thousands of people are estimated not to have gotten a shot despite being threatened with losing their jobs. The holdouts say they fear potential side effects from the vaccines, have natural immunity or believe that the mandate violates their personal freedom. On Thursday, Gov. Kathy Hochul said that the Monday deadline was firm and that her administration was developing emergency plans to cover for those who are laid off, going so far as to look into recruiting temporary workers from the Philippines or Ireland.”
USA Today reports (here) “Hospitals across the country are both overrun and understaffed” and that “As of Sept. 2, more than 78% of inpatient beds nationwide are occupied, nearly 14% of which are in use for COVID-19, according to data from the U.S. Department of Health and Human Services. That's more than 101,807 beds taken by COVID-19 patients . . . Intensive care unit beds were even harder to come by, with more than 80% in use nationwide as of Sept. 2, about 31% of which are occupied by COVID-19 patients. ICU beds are measured by the total number of staffed beds in use.”
Meanwhile, in Congress . . .
A big week. Sample summary here, from today’s Financial Times: “Democrats in crunch talks to save Biden’s $1.2 trillion infrastructure bill, Progressives cling to $3.5 trillion promise, Federal shutdown looms, Budget plans in danger.”
DOCTORS, NURSES AND OTHER HEALTH CARE PROFESSIONALS
Booster Vaccination Advice
From the CDC, Friday (here), and from the attending physician to Congress, in a letter addressed to Members of Congress, here. And what is the current measure of population immunity in the U.S.? A study in the Annals of Internal Medicine (here) estimates that “as of 15 July 2021, 114.9 million persons had been infected with SARS-CoV-2 in the United States.”
Survey Recruiting Incentives for Physicians, NPs, APRNs, CRNAs Reveal Changing Patterns of Practice
Merritt-Hawkins reports (here) its annual survey of such incentives. Among the findings: “Nurse practitioners (NPs) topped the list of Merritt-Hawkins’ most requested search engagements for the first time, underscoring the accelerating demand for these professionals. In 27 previous years, the top position has always been held by physicians . . . Average starting salaries for NPs showed strong growth, increasing 12% year-over-year, from $125,000 to $140,000 . . . Average starting salaries for PAs also showed strong growth, increasing by 14% year-over-year, from $112,000 to $128,000 . . . 18% of Merritt Hawkins’ search assignments were for advanced practitioners, including NPs, physician assistants (PAs) and certified registered nurse anesthetists (CRNAs), up from 13% the previous year. This is the highest percentage in the 28 years the Review has been conducted.”
In physician recruitment, “Only 18% of Merritt Hawkins’ search engagements were for primary care physicians, down from 20% in 2020 and 22% in 2019, signaling a relative decline in demand for primary care doctors. . . Psychiatrists placed fourth on the list of most requested search engagements, signaling a continued strong demand for mental health professionals that is likely to be accelerated by COVID-19.” Also, “Interventional cardiologists are offered the highest average starting salaries of physicians tracked in the Review at $611,000, followed by orthopedic surgeons at $546,000… Pediatricians are offered the lowest average starting salaries of physicians tracked in the Review at $236,000.”
“Only 3% of Merritt Hawkins’ search engagements were for solo practice or partnership settings, underscoring the decline of physician private practice.”
DRUGS & DEVICES
COVID-19 Testing and Price Gouging
Sarah Kliff in The Upshot, (The New York Times, here), describes how a “startup” lab company is (mostly successfully) charging $380 for coronavirus testing. “When Congress tried to ensure that Americans wouldn’t have to pay for coronavirus testing, it required insurers to pay certain laboratories whatever ‘cash price’ they listed online for the tests, with no limit on what that might be. GS Labs’ high prices and growing presence — it has performed a half-million rapid tests since the pandemic’s start, and still runs thousands daily — show how the government’s longstanding reluctance to play a role in health prices has hampered its attempt to protect consumers.”
The lab pays “approximately $20” for the rapid test itself, and “says the high price reflects the ‘premium service’ they provide patients, as well as the $37 million in start-up costs associated with building their laboratory network in less than a year.” According to the lab company, “You can book 15 minutes out with us on any given day, and get your results in 15 to 20 minutes . . . We have a nursing hotline where you can get your results interpreted. Our pricing is one of the most expensive in the nation because we have the best service in the nation.”
READINGS & REFERENCES
While You Were Away, Part 5
The grand-person of all Medicare program prospective payment rules, the hospital inpatient prospective payment system for discharges on and after this Friday, October 1, was published (2,295 pages!) in the Federal Register on August 13, 2021 (final rule here, CMS “fact sheet” here, 179-page summary from the Healthcare Financial Management Association, here).
In the aggregate, the final rule will increase payments to hospitals by $2.3 billion in FY 2022, assuming that the hospitals report “quality data” and “meaningful use” of electronic health records. Price transparency requirements which would have revealed payments by Medicare Advantage organizations to hospitals are gone. Disproportionate Share Hospital (DSH) payments decrease by $1.1 billion from FY 2021, to $7.2 billion nationwide. The “add-on payment” for COVID-19 treatment will continue through the end of the fiscal year in which the “public health emergency” ends. Five new requirements are added to the “Inpatient Quality Reporting Program” including vaccination rates among hospital personnel, a measure targeting maternal morbidity and two medication adverse event measures. Also, during the PHE, CMS will suppress most payment “adjustments” (reductions) association with hospital “value-based” payment programs.
Select Coronavirus Public Health Resources and References may be found here.
2021 CQ Congressional Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
September 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.