DCMedical News: Tuesday, September 29, 2021
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY
Health Care Personnel
A comprehensive study of vaccination in health care workers reported in the New England Journal of Medicine (here) found that “The BNT162b2 and mRNA-1273 vaccines were highly effective under real-world conditions in preventing symptomatic Covid-19 in health care personnel, including those at risk for severe Covid-19 and those in racial and ethnic groups that have been disproportionately affected by the pandemic.” A survey of 5,000 nurses, reported in the Journal of Nursing Administration (here), found “Pandemic impact was rated high overall and was highest in nurses with 25+ years of experience and in managers/directors. Eleven percent of the total sample indicated they intended to leave their position, and 20% were undecided . . . Of the respondents, less than 2% indicated they were leaving the nursing profession, whereas 8% were undecided” (italics added).
DOCTORS, NURSES AND OTHER HEALTH CARE PROFESSIONALS
AMA’s 2021 Update of Competition in Health Insurance Markets
In a study (here, press release here) the AMA project found that three-fourths of U.S. metropolitan areas lacked a competitive health insurance market, and that shrinking options among payers harmed patients and providers. The 20th annual update found more than half of the markets which qualified (HHI index) as highly concentrated in 2014 became more so by 2020. An additional quarter of the markets reach the “highly concentrated” level. The AMA contends that “Consolidation among insurers leads to lower payments for doctors and higher premiums for policyholders.”
Residency Changes: Leading Educators Propose Reform in the Transition from Undergraduate to Graduate Medical Education, Characterize the Changes Sought as a “Search for Competence.”
A body representing the major education and accreditation organizations in medicine has reported (report here, MedScape summary here) its findings. The group, known as the UGRC (Undergraduate Medical Education-Graduate Medical Education Review Committee), found that “There are identified challenges in the transition between medical school and residency that are negatively impacting the UME-GME transition,” including “Disproportionate attention towards finding and filling residency positions rather than on assuring learner competence and readiness for residency training . . . Inattention to optimizing congruence between the goals of the applicants and the mission of the programs to ensure the highest quality health care for patients and communities; Mistrust between medical school officials and residency program personnel; Overreliance on licensure examination scores in the absence of valid, trustworthy measures of students’ competence and clinical abilities; Lack of transparency to students on how residency selection actually occurs; Increasing financial costs to students as well as opportunity costs to programs associated with skyrocketing application numbers; The presence of individual and systemic bias throughout the transition; and Inequities related to specific types of applicants such as international medical graduates.”
Independently, the Niskanen Center foundation (report here, Becker’s summary here) examined residency programs in the U.S., finding that “Bottlenecks in the physician training and education pipeline are limiting entry for residency and [are] playing a vital role in U.S. physician shortages and care access issues . . . The U.S. has significantly fewer physicians per capita than other high-income countries, with 3.1 primary care physicians per 10,000 people, compared with 7.6 PCPs per 10,000 people in the U.K. and 13 in Canada . . . U.S. physician shortages persist not because of lower interest or less capable citizens . . . but instead because of the remarkable degree to which its physician pipeline filters out entrants into the profession. The shortages then foster a reliance on high-intensity, low-access care."
Private Equity Carves Up Surgical Services
A Research Letter in JAMA Surgery (here) presented the results of two decades of private equity (PE) investment in and acquisition of surgical services. Such services account for more than half of Medicare expenditures. Divided roughly into half surgery centers, half practices, the acquisitions increased in number each year; took place initially in the South, but more recently in all regions; and had an average acquisition cost of $143 million. According to the authors, “Financial involvement of PE firms may result in limited surgeon autonomy if the firm dictates patient-payer mix, may affect how surgical services are offered, and may ultimately lead to promotion of profitable interventions and surgical procedures.”
HOSPITALS AND OTHER HEALTH CARE FACILITIES
Making it Simpler for Customers to Live Healthier
Walmart (news release here) chooses Epic for its system-wide health information. “Epic’s platform will support all of Walmart’s health and wellness lines of businesses as it is rolled out and will first be implemented in four new Walmart Health Centers opening in Florida in early 2022.”
Consolidation-Induced Cost Shifting
Chernew and colleagues publish (in Health Affairs, here) a study contending that “Hospitals with a higher share of Medicare patients had lower and more rapidly declining profits and an increased likelihood of closure or acquisition compared with hospitals that were less reliant on Medicare,” as part of a thesis that “the possibility of ‘consolidation-induced cost shifting,’ which recognizes that changes in public prices for hospital care can affect market structure and, through that mechanism, affect commercial prices.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
End of Medicaid Expansion Under PHE
InsideHealthPolicy (here) explores the concerns of different authorities on the end of Medicaid expansion under the Public Health Emergency. In a letter to state health officials August 13, IHP reports that CMS announced that “States will have 12 months after the end of the COVID-19 public health emergency to resume kicking Medicaid beneficiaries off the rolls. . . Additional background: “A record number of people are enrolled in Medicaid right now with enrollment numbers rising by 11 million people from February 2020 to April 2021, according to the Kaiser Family Foundation. The Urban Institute estimated earlier this month that the number of Medicaid beneficiaries could decline by about 15 million throughout 2022, though many people losing Medicaid coverage will be able to receive coverage through other avenues.”
Sullivan and Kahn study accountable care organizations, find they may raise costs, rather than lower them:
Kip Sullivan and James Kahn, who have previously published stories skeptical of accountable care organizations, have a new study (here) in the Journal of General Internal Medicine. They found that accountable care organizations don’t lower costs, but may actually raise them. They studied the financial performance of four ACO programs from 2005 to 2018, looking at the net costs to CMS, that is, gross savings in medical billings minus payments to the ACOs. Overall, they found that the ACOs broke even, and that subtracting bonuses from the savings resulted in the ACOs either losing or saving a few tenths of a percent. In addition, ACO overhead costs, frequently borne by hospitals or other “sponsoring” organizations, would in turn affect other costs paid by CMS. MedPAC estimates that overall overhead for ACO programs is 2% of Medicare spending, leading to their conclusion that “If ACOs save CMS and providers at most a few percent, this implies that ACOs are actually raising systemwide costs.”
Annual Core Set Data for Medicaid and CHIP
CMS released the Federal Fiscal Year 2020 Medicaid & Children’s Health Insurance Program Child and Adult Core Set data and additional resources (here). “The release this year provides information on 21 frequently reported child measures and 28 frequently reported adult measures voluntarily reported by states.” CMS notes “The Core Sets are comprised of quality measures collected at the state level. To be publicly reported, measures must be reported by 25 or more states and the data must meet internal quality standards. These state level data are then used to calculate national estimates.” Reporting is currently voluntary for the states, but will be mandatory beginning in 2024.
READINGS & REFERENCES
Select Coronavirus Public Health Resources and References may be found here.
2021 CQ Congressional Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
September 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, news@dcmedicalnews.org