DCMedical News: Tuesday, October 26, 2021
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY Tuesday, October 26, 2021
“Crunch Time” for Reconciliation
InsideHealthPolicy reports (here) that “It’s down to the wire on whether Democrats will realize the major Medicare, Medicaid and Affordable Care Act reforms they have had in their sights for months as they seek to strike a reconciliation deal by Oct. 31, when they hope to also vote on the bipartisan infrastructure bill. Lobbyists are scrambling to secure versions of their priorities while rumors swirl on competing policies in play as the president and Democratic leaders seek support from a handful of wavering Democrats.”
DOCTORS, NURSES AND OTHER HEALTH CARE PROFESSIONALS
In Pre-Natal Care, Number of Guideline-Based Visits Counts, Number of Visits Not So Much
A study in the American Journal of Obstetrics and Gynecology (here) found that in a “commercially insured population, receipt of guideline-based care was not universal, did not increase with the number of prenatal visits, and varied by patient- and area-level characteristics. Measuring guideline-based care is feasible and may capture quality of prenatal care better than visit count or adequacy alone.” The study notes that “Despite the importance of prenatal care, quality measurement efforts have focused on the number of prenatal visits, or prenatal care adequacy, rather than the services received.”
HOSPITALS AND OTHER HEALTH CARE FACILITIES
Hospital “Haves” Received More CARES Funds Than “Have Nots”
Hospitals that were in a strong financial position prior to the pandemic received more money from the CARES Act’s Provider Relief Funds than those with weaker balance sheets according to a study published in JAMA Health Forum (here).
The study says “Payments were dispersed according to a formula set by the Centers for Medicare & Medicaid Services, based on the hospital’s share of fee-for-service Medicare payments out of total Medicare payments in 2019 for the initial disbursement, and a function of the most recent annual gross receipts minus the initial disbursement. These funds were meant to support hospitals particularly hard hit financially by COVID-19 through well-documented decreases in volumes of care. However, it is not clear if historical measures of Medicare payments are the most appropriate indicator for hospital financial assistance need.”
However, the study was limited, as follows: of the $175 billion in Provider Relief Act funding for hospitals, $65 billion was disbursed by May 31, 2020, of which $22 billion was in target distributions for approximately one thousand hospitals in “high-impact” areas. This $22 billion is the subject of the study, done by RAND personnel, funded by Arnold Ventures.
Hospital Data Valuable—to Hospitals
STAT reports (here) that “The biggest health systems have paid billions of dollars for their electronic health records, and mostly accepted the costly strings attached that constrict how they can share data or which apps they can adopt. Now, many of those hospitals are no longer willing to make that tradeoff . . . health systems are forming their own companies that directly compete with products and services provided by the same major electronic health record vendors they’ve been locked in deals with for years, such as Epic Systems and Cerner Corp. Seventeen major hospital networks with operations in 40 states have joined Truveta, a hospital-led company seeking to aggregate de-identified patient data and put it in a standardized format so it can be sold for medical research. A separate cluster of health systems has formed a nonprofit called Graphite Health to create a marketplace that would make it cheaper and easier to plug in novel software applications.”
Maryland Model Yields Reasonable Bills, or Unreasonable Limitations
Elisabeth Rosenthal, recovering from a head injury, had reasonable hospital bills. In an opinion piece in The New York Times (here) she writes “That’s largely because I live in Washington, D.C., and received the majority of my care in next-door Maryland, the one state in the nation that controls what hospitals can charge for services and has a cap on spending growth. Players in the health care world — from hospitals to pharmaceutical manufacturers to doctors’ groups — act as if the sky would fall if health care prices were regulated or spending capped. Instead, health care prices are determined by a dysfunctional market in which providers charge whatever they want and insurers or middlemen like pharmacy benefit managers negotiate them down to slightly less stratospheric levels. But for decades, an independent state commission of health care experts in Maryland, appointed by the governor, has effectively told hospitals what each of them may charge, with a bit of leeway, requiring every insurer to reimburse a hospital at the same rate for a medical intervention in a system called ‘all-payer rate setting.’” The all-payer rate setting become a global hospital budget setting exercise in 2014.
But hospital pricing specialist Rick Louie, no friend of excess, finds (here) the underside: one Johns Hopkins oncologist noted salaries in his institution are half those of competitive academic institutions in other states; that there are “absurd” waiting lists; and salary discrepancies are found “at all ranks.” One strategy the oncologist noted—parallel to the strategies of investor-owned hospitals—is relocation, in the case of Johns Hopkins “to close shop in Maryland and open up for business in DC and Virginia,” buying a hospital (Sibley Memorial) in Washington, D.C., where “reimbursement is better.”
Nursing Turnover Up, a Lot
Healthcare Finance reports (here) on a study (here) by NSI (a commercial recruitment firm) on nursing turnover. In sum, “registered nurses are leaving healthcare, with many retiring early or simply leaving the profession for other pursuits, burdening hospitals with exorbitant turnover costs . . . The 2021 NSI National Health Care Retention & RN Staffing Report found that since 2016, the average hospital has turned over about 83% of its RN staff and 90% of its overall workforce, with the cost of turnover for a bedside RN ranging between $28,400 and $51,700 . . . Hospital turnover increased by 1.7% during the past year and currently stands at 19.5% . . . [and] hospitals are experiencing a higher RN vacancy rate. Currently, this stands at 9.9%, up another point from last year. Less than a quarter of hospitals reported a RN vacancy rate of ‘less than 5%,’ but more than a third (35.8%) reported a vacancy rate exceeding 10%. In total, it takes three months to recruit an experienced RN, the data showed.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
“Final” 2022 Medicare Pay Regulations Not Yet Final
InsideHealthPolicy reports (here) that stakeholders also are watching to see whether CMS will come out with a number of annual pay regulations expected soon, including the final physician fee schedule for 2022 which could include provisions on changes to clinical labor policy. “Some providers could see pay cuts in 2022 due to a variety of policies, from the end of the sequester moratorium to a phase-in of certain cuts tied to changes to evaluation and management pay and changes to clinical labor policies under the proposed 2022 physician fee schedule, among others.”
DRUGS & DEVICES
At-Home COVID Testing With OTC Products
InsideHealthPolicy reports (here) that the “FDA also wants to facilitate development of single-use OTC tests, including by allowing developers of serial tests to seek a single-use indication. To that end, the agency on Monday updated its emergency use authorization template for molecular and antigen at-home tests and its supplemental template for molecular and antigen diagnostic tests for screening with serial testing.” NIH to identify reliable manufacturers: “The National Institutes of Health also will invest $70 million into its new Independent Test Assessment Program (ITAP), which will establish an accelerated pathway to support FDA evaluation of at-home COVID-19 tests that have potential for large-scale manufacturing.”
READINGS AND REFERENCES
Select Coronavirus Public Health Resources and References may be found here.
2021 CQ Congressional Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
October 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