DCMedical News: Wednesday, October 20, 2021
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY Wednesday, October 20, 2021
Congress Will Pass “Framework” for Reconciliation This Week
At least according to this report in CQ : “Democrats hope to reach agreement this week on an updated ‘framework’ for a partisan spending and tax package that their Senate and House majorities can pass through the filibuster-proof reconciliation process, but they offered few new details on how they plan to resolve disputes that have stalled the measure for months.”
Appropriations for FY 2022 Move Forward in the Senate
Spending bills for the fiscal year which began October 1 moved forward in the Senate, CQ reports, “Senate appropriators released a draft fiscal 2022 Labor-HHS Education spending bill on Monday that includes $220.8 billion in discretionary funding to boost federal spending for public health, medical research, and low-income schools.”
Detail: “The bill would provide the Department of Health and Human Services with $117.6 billion, an increase of $20.9 billion from the fiscal 2021 enacted level. It would also provide $47.9 billion for the National Institutes of Health, a boost of $5 billion from the fiscal 2021 enacted level, and more than $9.7 billion for the Centers for Disease Control and Prevention, an increase of nearly $1.9 billion above 2021 enacted levels. It provides $2.4 billion to fund Biden's proposed new agency called the Advanced Research Projects Agency for Health, or ARPA-H.” The bill (200 pages) is here, summary (12 pages) here, “explanatory statement” from the Senate Appropriations Committee (375 pages) is here.
The parallel House Appropriations bill passed in July; the “Continuing Resolution” under which spending continued beyond the October 1 beginning of the fiscal year expires December 3.
DOCTORS, NURSES AND OTHER HEALTH CARE PROFESSIONALS
Three Year Medical Schools Return, Grow
The AAMC reports (here) that efforts to accelerate the training of physicians by compressing four years into three are returning, and growing. “Although it may sound unorthodox, accelerated medical education isn’t new. Two Canadian schools have been graduating physicians in three years for decades. And in the 1970s, the U.S. government urged medical schools to trim a year to help fill looming physician shortages. Approximately 25% did so, but the programs closed when shortages eased and federal funding disappeared. Now, interest in three-year medical school programs is on the rise once again. In 2012, the United States had only two accelerated MD programs. In 2014, the country had eight such programs, and the Consortium of Accelerated Medical Pathway Programs (CAMPP) launched with a Josiah Macy Foundation grant.”
Now, CAMPP counts 30 members that offer a fast-track program or plan to do so. Further information on CAMPP at: (https://www.acceleratedmdpathways.org/).
AMA Reports Score (8-2) for Latest Attempts at Scope of Practice Expansions
The American Medical Association reports (here) that 2021 efforts in state legislatures to expand the scope of practice of advanced practice registered nurses (APRNs) have failed eight times, prevailed in two. The report notes that “Eight proposed scope of practice expansions for APRNs—nurse practitioners, nurse anesthetists, nurse midwives and clinical nurse specialists—have been stopped this year due to the AMA’s collaborative efforts with state medical and osteopathic associations and national specialty societies working with state lawmakers.”
The practice expansion efforts (generally aimed at allowing APRNs to practice independently of physician involvement) were unsuccessful in Florida, Kansas, Kentucky, Louisiana, Maine, Mississippi, Tennessee and Texas, while efforts in Delaware and Utah did succeed in APRN scope of practice expansion.
Without providing a score for 2021, the report also notes that “Similar efforts have taken place involving proposed scope-of-practice expansions for naturopaths, optometrists, pharmacists, physician assistants, psychologists and podiatrists.”
Goldman Sachs Buys 1,100-Primary Care Physician “Concierge” Practice MDVIP
Report (here).
HOSPITALS AND OTHER HEALTH CARE FACILITIES
Kaufman Hall Report Shows Hospitals Continuing to Struggle Financially, With Personnel and With Operations
“More than a year and a half into the COVID-19 pandemic, labor and supply costs are still driving hospitals’ expenses upward as revenues remain lower alongside patient volumes, according to Kaufman Hall’s [October] 2021 State of Healthcare Performance Improvement Report out Monday” (news here, report here).
Patient Volume: “Most respondents indicate suppressed volumes across many of their service lines compared with pre-pandemic levels. Pediatrics has been particularly hard hit; only 22% of respondents say pediatric volumes have recovered to pre-pandemic levels . . . Cardiology and cardiovascular services have had the strongest recovery to full pre-pandemic volumes, but still only 44% of respondents have seen volumes return to pre-pandemic levels.”
Hospital Personnel: All respondents reported increased difficulty in attracting and retaining key personnel, with 88% reporting that they have responded with higher base salaries, 68% with higher signing bonuses and 58% paying more for overtime hours worked.
Remote work: The report survey shows the possibility of continued and even increased remote management: “A strong majority of respondents predict that the pandemic will result in permanent changes to the workforce, with 66% saying that the ratio of administrative staff working remotely will continue at levels reached during the pandemic, and another 11% predicting that the percentage of remote workers will continue to increase. Almost half of respondents say the pandemic has driven their organization to adopt new processes, positions, or departments that will be continued going forward.”
Billing and collecting: “The most common impact is an increased percentage of Medicaid patients, followed closely by an increased rate of denials, a lower percentage of commercially insured patients, and an increase in bad debt and uncompensated care.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Commonwealth Fund Compares “Traditional” Medicare and Medicare “Advantage” Beneficiaries
The Fund published a study (here, charts here) of beneficiary characteristics and access to services because “Enrollment in private Medicare Advantage plans is projected to overtake traditional Medicare enrollment over the next decade,” and found that “Beneficiaries in traditional Medicare and Medicare Advantage have similar demographics, report comparable levels of chronic illness, and experience the same monthlong wait times for medical care.”
Class Action Suit to Compel Coverage for Proton Beam Cancer Therapy Survives
A Florida court (Bloomberg report here, decision here) ruled that Aetna acted in a fiduciary capacity when making coverage decisions. Cancer patients Sharon Prolow and Mark Lemmerman adequately alleged that Aetna acted as a “de facto plan administrator” subject to liability under the Employee Retirement Income Security Act, Judge Kenneth A. Marra of the U.S. District Court for the Southern District of Florida held Wednesday. Aetna exercised decision-making authority for both initial determinations of benefits eligibility and administrative appeal. “This means Aetna is a proper defendant for claims challenging its decision to adopt and renew a clinical policy bulletin that categorically excluded proton beam radiation therapy from coverage.”
READINGS & REFERENCES
Select Coronavirus Public Health Resources and References may be found here.
2021 CQ Congressional Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
October 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