DCMedical News: Monday, November 15, 2021
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY Monday, November 15, 2021
Pregnancy complications and maternal morbidity cost the U.S. billions in health expenses
The Commonwealth Fund reports (here) that health conditions resulting from pregnancy and delivery cost the United States tens of billions of dollars each year, totaling $32.3 billion in 2019. “Incidences of maternal morbidity doubled between 1998 and 2014 from 74 to 140 cases per 100,000 hospitalizations. Seventy-four percent of maternal morbidity costs come from children's outcomes rather than maternal outcomes, and two-thirds of these costs accrue in the first year of a child's life. The most expensive child outcomes include preterm birth, developmental disorders, and respiratory distress. The costliest maternal health outcomes include lost productivity, cesarean section delivery and extra hospital stays before or after childbirth.”
At 17.4 deaths per 100,000 live births, the U.S. rate is double that of other high-income countries. Most morbidity occurs after leaving the hospital.
CMS Issues Regulation Mandating Vaccination for Health Workers
November 5 CMS issue its anticipated emergency regulation mandating that staff working at a healthcare facility be vaccinated for COVID-19 as a condition of Medicare and Medicaid participation. The rule will affect more than 17 million healthcare workers across the country. The interim final rule requires eligible employees to have a first vaccination by December 5 and full vaccination by Jan. 4, 2022.
COVID-19 Drugs Begin to Arrive
The Financial Times reports (here) that “High-risk patients will soon have two new drugs that could transform their care without them even leaving home. Late stage trials have shown the Pfizer pill, called Paxlovid, cuts the risk of hospitalisation and death by almost 90 per cent and a drug developed by Merck/MSD and Ridgeback Biotherapeutics cut the risk of hospitalisation in half. Merck’s drug, called molnupiravir, has received its first approval, in the UK.”
The report notes, “The oral antivirals will be an important tool for ailing healthcare systems eager to reduce the burden of a potential influx of Covid-19 patients this winter. Doctors have so far had to rely on the expensive and hard-to-administer antiviral remdesivir plus antibody treatments, or drugs such as steroids that quell the immune system’s overreaction later in the disease.” However, notes Bloomberg Health Law and Business, (here), they won’t end the pandemic.
DOCTORS, NURSES AND OTHER HEALTH CARE PROFESSIONALS
Alternative Payment Model for Oncology Produces No Net Savings Or Other Improvement for Patients
A report in JAMA (here) finds that the three year CMS experiment, begun in 2016, produced no net savings, compared to traditional payments, and that “There were no statistically significant differences for most utilization, quality, and patient experience outcomes.”
Urban Institute Study Finds Physician Payment Rate Mark-Up Highly Variable Among Specialties
The study (here) noted that “Private insurers generally pay physicians substantially higher rates than Medicare does for the same service. Policy proposals to reduce commercial prices and curb health care spending by benchmarking private payment rates to Medicare prices could therefore significantly affect physician payments, but the effects will likely vary considerably by specialty.” Using Fair Health data, Berenson and colleagues analyzed bills which include “40 percent of total professional spending.” They found: “Family medicine, obstetrics and gynecology, dermatology, ophthalmology, and psychiatry had the lowest commercial markups relative to Medicare prices, averaging about 110 percent of Medicare rates or less. Nine specialties received commercial payments between 120 and 150 percent of Medicare rates, on average. These included gastroenterology, cardiology, general surgery, and orthopedics. Radiology and neurosurgery received commercial payment rates of 180 and 220 percent of Medicare rates, whereas emergency department and critical care specialties received commercial payment rates of 250 percent of Medicare rates. Anesthesia received the highest markup at 330 percent of Medicare rates.”
“How Much Will This Drug Cost Me, Doc?” Study Says Patients Should Ask Someone Else
A study in JAMA Network Open (here) challenged physicians to “estimate a patient’s out-of-pocket expenses if they are given all the necessary information about a drug’s price and the patient’s insurance plan.” The findings: “In this survey study of 371 primary care physicians, gastroenterologists, and rheumatologists, only 21% could accurately estimate out-of-pocket drug costs using information about the drug’s price and an insurance plan’s cost sharing mechanisms, including deductibles, copays, coinsurance, and out-of-pocket maximums.” The authors write “few physicians are able to estimate out-of-pocket costs accurately enough to have informed conversations about financial trade-offs with their patients.”
HOSPITALS AND OTHER HEALTH CARE FACILITIES
Nursing Shortages Continue, Grow, Especially in Rural Hospitals
VoxCare reports (here) that “America’s hospitals are still experiencing a staffing crisis that is putting critical care for patients in jeopardy. Hospitals all over the country are struggling, especially those in lower-population areas.” Vox reports on a Chartis Group survey, which found “Nearly 99 percent of rural hospitals surveyed said they were experiencing a staffing shortage; 96 percent of them said they were having the most difficulty finding nurses. Almost half of the hospitals in the survey said staffing problems had prevented them from accepting new patients in the past 60 days. One in four hospitals said that a lack of nurses had forced them to suspend certain services, including . . . newborn delivery, chemotherapy, and colonoscopies.” A study in Health Services Research (here) found that “In areas previously served by a rural hospital, there is a higher probability of new FQHC service-delivery sites post closure.”
Kaiser Health News reports (here) that “Enrollment in nursing programs across the U.S. increased nearly 6% in 2020 from the year before, according to the American Association of Colleges of Nursing.”
Nursing Sensitive Patient Outcomes: Not All Indicators Studied Are of Equal Strength
A study (here) in Health Services Research sought to develop “a comprehensive list of nursing-sensitive patient outcomes (NSPOs) from published research on nurse staffing levels and from expert opinion.” The researchers identified “22 unique NSPOs . . . and ranked these in a systematic fashion according to the strength of evidence existing for their association with nurse staffing.” Results: “Of the 22 NSPOs discussed in the 15 included literature reviews, we rated the strength of evidence for four as high, for five as moderate, and for 13 outcomes as low. Four additional NSPOs that have not been considered in literature were identified through expert interviews . . . central venous catheter occlusion, infection of vascular access site, poor discharge status, and mycosis.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Premiums Increase for Medicare Part B, Inpatient Expenses for Medicare Part A
CMS announced an increase in Medicare premiums and deductibles November 11 (here), noting that impact of the pandemic and uncertainty over how much CMS may pay for Aduhelm, the controversial new Alzheimer's drug. The 14.5% increase in Part B premiums will increase monthly payments for those in the lowest income bracket from $148.50 a month in 2021 to $170.10 in 2022. In August, the Medicare trustees estimated that the monthly premium for 2022 would be $158.50. Aduhelm is estimated to cost $56,000 a year. Traditional Medicare enrollees would be responsible for 20% of the cost of most Part B medications, or about $11,500 in out-of-pocket costs for those prescribed Aduhelm.
For part A (hospital expenses, here), “For CY 2022, the inpatient hospital deductible will be $1,556. The daily coinsurance amounts for CY 2022 will be: $389 for the 61st through 90th day of hospitalization in a benefit period; $778 for lifetime reserve days; and $194.50 for the 21st through 100th day of extended care services in a skilled nursing facility in a benefit period.” The notices will appear in this Wednesday’s Federal Register.
READINGS & REFERENCES
Select Coronavirus Public Health Resources and References may be found here.
2021 CQ Congressional Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
November 16, 17, 18, 30
December 1, 2, 3, 6, 7, 8, 9, 10
Notes to Fred Hyde, MD, JD, MBA, news@dcmedicalnews.org