DCMedical News: Tuesday, October 19, 2021
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY Tuesday, October 19, 2021
Congress Moving This Way, or That
InsideHealthPolicy reports (here) that as the end-of-October deadline for “reconciliation” approaches, pending cutbacks in physician and hospital payments in 2022 are attracting increasing Congressional attention. “More than half the House recently signed a letter urging leadership to alleviate certain Medicare pay cuts set for 2022,” while in the Senate, Majority Leader Chuck Schumer (D-NY) “said it’s time for legislators to focus on President Biden’s Build Back Better agenda -- but he didn’t mention health care when touting various aspects of the fledgling reconciliation package.”
DOCTORS, NURSES AND OTHER HEALTH CARE PROFESSIONALS
Wave of Physicians Retiring: “Yes,” Say Surveys, “No” Says Medicare Claims Data
Through the pandemic, surveys of practicing physicians have projected a large number of retirements (see, e.g., Medscape, here, summarizing survey reports). A study by Chernew and Neprash of 2019 and 2020 Medicare claims data by physicians, however, in JAMA (here), examined how many physicians with Medicare patients had stopped filing claims for a period during those 2 years. As summarized by Medscape, “If a doctor had ceased submitting claims and then resumed filing them within 6 months after the last billing month, the lapse in filing was defined as ‘interruption with return.’ If a physician stopped filing claims to Medicare and did not resume within 6 months, the gap in filing was called ‘interruption without return.’ In April 2020, 6.9% of physicians billing Medicare had a practice interruption, compared to 1.4% in 2019. But only 1.1% of physicians stopped practice in April 2020 and did not return, compared with 0.33% in 2019.” The study’s authors conclude, “Practice interruptions in the treatment of Medicare patients during 2020 exceeded those in 2019 and were concentrated in April—coinciding with the nadir of outpatient clinical volume due to the COVID-19 pandemic. Most practice interruptions were temporary, though not all.”
Slow-walking-doctoring may be another issue in physician availability, however. Reports Medscape, “In the summer of 2020, there was a major drop in physician recruitment by hospitals and health systems, partly because of fewer patient visits and procedures. But demand for doctors has bounced back over the past year . . . Another reason is that some employed doctors — particularly older physicians — have slowed down. Many doctors prefer to work remotely 1 or 2 days a week, providing telehealth visits to patients.”
Competition, IMGs, Diversity, Education, Vaccination—AMA on Physician Concerns in 2021
A report (here, summary here) from the summer House of Delegates meetings reflects on these and other concerns of the practicing physician members of the American Medical Association.
HOSPITALS AND OTHER HEALTH CARE FACILITIES
70 Million UnitedHealthcare Members Directed to Outpatient Imaging and Surgery Facilities
A report in Radiology Business (here) says “The nation’s largest commercial health insurer wants its members to receive at least 55% of their radiology services at freestanding imaging centers by 2030 . . . The Minnetonka, Minnesota-based health giant also wants 55% of outpatient surgeries delivered outside of hospitals by the end of the 2020s.” The insurer said it is “equipping referring physicians with shared decision-making tools to help patients select the best site for imaging services.” Says Radiology Business, “This is just the latest in a series of maneuvers by UnitedHealthcare and its parent UnitedHealth Group to reduce radiologist pay. Other actions include cutting health systems and doc groups out of its network, steering patients toward certain tests, and adding new prior authorization processes.”
AHLA Attempts to Bring Clarity to CARES Act Funding and Reporting
The American Health Law Association’s Regulation, Accreditation and Payment Practice Group has provided (here) a summary of the “continually evolving” distribution and reporting requirements of the CARES Act’s Provider Relief Fund, with links to the legislation, related legislation, appropriations bills and Health Resources and Services Administration (HRSA) guidance documents. The AHLA authors note, “From shifting administrative guidance on required attestations and reporting, to approving new funding distributions every few weeks, the federal government continuously issued reporting guidance and then changed course in response to industry feedback—all while ramping up its PRF monitoring and penalties to combat potential misuse of PRF distributions.”
Enthusiasm Lacking for Rural Hospital Aid Which Would Close Rural Hospital Inpatient Services
“The Biden administration must prioritize and make use of a new measure to aid struggling rural hospitals before more close, Senators Charles Grassley and Amy Klobuchar said,” according to a report (here) in Bloomberg. The Senators sent a letter asking CMS to prioritize implementation of a new Rural Emergency Hospital designation. “The measure sponsored by Grassley and buried in the almost 6,000-page stimulus act signed late last year has garnered little attention so far. But it provides a potential lifeline for rural hospitals . . . The measure calls for small rural hospitals to shutter their in-patient operations.” The new Medicare funding category, effective in 2023, was also subject of a CQ report earlier in 2021 (here). “The designation [Rural Emergency Hospital] allows hospitals with fewer than 50 beds to convert to stand alone emergency departments, while still offering outpatient services, observation stays, ambulance services and telehealth . . . Converted hospitals will receive a 5 percent increase to base payments through Medicare’s outpatient system, in addition to a monthly facility fee. Hospitals will also still be allowed to operate a skilled nursing facility.”
Major Hospital Systems “Recovered” in 2020
Modern Healthcare reports (here) that, in a survey of 300 health systems, “While the pandemic dealt a severe financial blow to systems early in 2020, median operating income in the fourth quarter was about 10% higher than the same period in 2019 for 301 not-for-profit systems reporting results.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Medicaid Enrollment Grew Dramatically Under the Pandemic’s Public Health Emergency Provisions
A Kaiser Family Foundation report (here) finds that “Medicaid, once considered the ugly duckling compared with the politically powerful and popular Medicare program, now covers nearly 1 in 4 Americans. The pandemic-caused recession and a federal requirement that states keep Medicaid beneficiaries enrolled until the national emergency ends swelled the pool of people in the program by more than 9 million over the past year . . . Medicaid enrollment grew from 71.3 million in February 2020, when the pandemic was beginning in the U.S., to 80.5 million in January . . . That's up from about 56 million in 2013, just before many states expanded Medicaid . . . And it's double the 40 million enrolled in 2001.”
Does Medicare Measure Cost Effectiveness in its “Quality” Measures. In General, “No.”
A study in Value in Health (here) finds that, in examining 23 measures used by Medicare, “The majority of these measures (15 of 23) were based on subjective ratings or outcome measures without specifying an intervention or process, posing a challenge in identifying supporting economic evidence . . . Most of the current quality measures are not specific enough to assess the economic value of the practice.”
DRUGS & DEVICES
Public Equity
STAT reports (here) that one-third of all state legislators received campaign or other funds in 2020 from drug companies, their executives and lobbyists. “In Louisiana . . . 84% of lawmakers accepted funding from pharmaceutical companies. In California, it was 82%, and in Illinois, 76% of legislators cashed a check.” The STAT study found “Drug companies were adept at picking winners. Of the more than $9 million the pharmaceutical industry spent on state legislative races, less than $500,000 went to candidates who lost.”
READINGS & REFERENCES
Select Coronavirus Public Health Resources and References may be found here.
2021 CQ Congressional Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
October 20, 21, 22, 25, 26, 27, 28
November 1, 2, 3, 4, 5, 15, 16, 17, 18, 30
December 1, 2, 3, 6, 7, 8, 9, 10
Notes to Fred Hyde, MD, JD, MBA, news@dcmedicalnews.org