DCMedical News: Tuesday, November 30, 2021
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY Tuesday, November 30, 2021
They’re Back . . .
InsideHealthPolicy reports (here) that “A busy week is in store for lawmakers, the Supreme Court and the White House: With government funding running out after Dec. 3 [Friday], the House is expected to introduce a stopgap funding bill to keep the government open through mid-January, the Supreme Court heard arguments on Disproportionate Share Hospital Payments on Monday and is set to hear arguments on Part B payment cuts to 340B drugs on Tuesday, and the White House is laser-focused on tackling the new COVID-19 Omicron variant.”
The New COVID-19 Omicron Variant
CQ reports (here) that “The latest strain of the coronavirus, known as omicron, will not bring the United States back to square one in the pandemic, President Joe Biden said during an address on Monday in which he urged Americans to get vaccinated and boosted. Biden and White House public health officials believe the current COVID-19 vaccines available on the market should provide some level of protection against the new virus variant, though it will take up to two weeks to know exactly how much.”
House Passage of Infrastructure Bill
Friday the 19th (Modern Healthcare coverage here) the House of Representatives passed an “infrastructure” bill (H.R. 5376, bill text here, 2468 pages) which is replete with health programs. Chief among the bill’s health elements is extension of ACA subsidies to 2.2 million people in the "coverage gap" because they reside in the 12 states that haven't expanded Medicaid under the Patient Protection and Affordable Care Act. Millions more would be eligible for increased subsidies; those in the coverage gap would become eligible for zero premium policies with minimal cost-sharing from the health insurance exchanges.
Other health elements in the bill include 4,000 new residency slots for medical schools financed by Medicare, the biggest increase since the 1990s; $3.4 billion for the Teaching Health Center Graduate Medical Education and $200 million for GME programs at children's hospitals; $2 billion for the National Health Service Corps and $500 million for the Nurse Corps, which provides scholarships and loan repayments to providers and nurses working in underserved areas; $500 million each for nursing and medical schools in underserved areas; and Medicare coverage of hearing services beginning in 2023, with a new device every five years.
Also, “The package would direct the Health and Human Services Department to negotiate prices with drug companies for a small number of high-cost drugs without generic or biosimilar competitors. Drug manufacturers would be required to pay rebates to the federal government if their price increases exceed inflation. Cost-sharing for insulin products would be limited to no more than $35 under Medicare and private health plans.”
In addition, “Medicaid programs would be required to extend coverage for one-year postpartum in an effort to reduce maternal deaths. States currently only have to offer mothers coverage for 60 days after childbirth. The package also contains about $1 billion in grants for entities addressing maternal mortality and disparities in health outcomes.” IHP reports that the administration has been entering into §1115 waivers to extend Medicaid coverage for a full post-partum year, with Virginia being the fourth such agreement. The states “want to expand their Medicaid postpartum coverage beyond 60 days” and entered into the agreements “shortly before the House passed its Build Back Better legislation that includes mandatory one-year Medicaid coverage for new mothers. CMS estimates 6,000 Virginians will benefit from the most recently approved 1115 waiver, which increases Medicaid postpartum coverage to 12 months for women whose incomes are at or below 200% of the federal poverty level. The Biden administration recently approved a similar waiver for New Jersey and earlier this year approved waivers for Missouri and Illinois to extend their coverage to one-year postpartum. Georgia’s approved waiver extends Medicaid postpartum coverage to six months for new mothers.”
Also, the bill provides $150 billion to expand home and community-based services in Medicaid; extends the Children's Health Insurance Program, which currently needs to be periodically reauthorized by Congress; provides $2 billion for capital projects at community health centers; and authorizes $7 billion for the Centers for Disease Control and Prevention to shore up public health infrastructure.”
HOSPITALS AND OTHER HEALTH CARE FACILITIES
Rural Provider Relief
IHP reports (here) that more than 40,000 providers across the country who serve rural residents will receive $7.5 billion in COVID-19 relief. “HHS has begun receiving applications for the rural provider relief that Congress allocated in March under the American Rescue Plan along with the long-awaited fourth general distribution of $17 billion in COVID-19 relief.” The $7.5 billion in provider relief is for providers serving rural Medicaid, Children's Health Insurance Program and Medicare beneficiaries from Jan. 1, 2019 through Sept. 30, 2020, with another $1 billion in ARP rural provider relief for the approximately 4% of applications that staff are in the process of manually approving, and as needed to potential reconsideration requests. “Payments to providers average about $170,700, and $500 is the minimum. Baptist Healthcare System, Inc in Bardstown, Kentucky, has the highest distribution at about $43 million. There is nearly $44 billion left in the $178 billion provider relief fund before the $17 billion in phase 4 provider relief goes out, although HHS typically says it’s only $24 billion, excluding what’s left over from specific projects. HRSA hasn’t said what it plans to do with unused provider relief, including returned funds.”
British Government Payments for Hospital Relief, Like American, Benefited Wealthy Institutions the Most
A report in The Financial Times (here) notes that “Private hospitals in the UK have received tens of millions of pounds in furlough cash this year despite benefiting from a post-lockdown boom in NHS work and self-paying patients. Nasdaq-listed HCA Healthcare, one of the largest private hospital chains in the UK, received up to £3m in furlough payments from the UK government during the first eight months of 2021, according to official data. The group was paid more than £150m by the NHS to treat patients between March 2020 and the same period this year. Overall the private hospital sector received up to £41m in furlough funding between December 2020 and August this year, according to figures from the Centre for Health and the Public Interest, a think-tank, based on official government data. Furlough payments were introduced by the UK Treasury to support businesses whose operations were affected by Covid-19 by paying up to two-thirds of staff wages.”
NHS Waiting List, New Records
The Financial Times reports (here) that “More than 5.8m people were waiting for NHS hospital care in England in September, a rise of 100,000 in a single month, and a jump of more than 1m in a year . . . a survey by the NHS Confederation, which represents organisations across the healthcare sector, found that nine out of 10 leaders believed the demands on their organisations were “unsustainable”. The Royal College of Surgeons of England highlighted the “shocking milestone” that 12,491 patients had been waiting more than two years for hospital treatment —including hip and knee replacements, gallbladder removals and hernia operations — a 28 per cent increase on the previous month. Fiona Myint, college vice-president, said that on the overall waiting list patients were not just waiting for planned surgery but even for “surgical procedures to treat aneurysms and prevent heart attacks.”
Expenses Up, Revenues Down, Hospital Recovery Uneven
The October KaufmanHall report (here) found that “Hospital revenues increased YTD compared to both 2019 and 2020 for a seventh consecutive month, due in part to yearly rate changes and the continued rise in higher acuity cases. Gross Operating Revenues (not including CARES) jumped 16.6% YTD and 12.3% YOY versus 2020 and 10.4% YTD and 18.2% YOY versus 2019,” while, “Expenses continued to climb. Total Expense per Adjusted Discharge was up 2.6% YTD and 12.9% YOY. Labor expenses rose across all measures even as the number of hospital workers per patient bed declined, reflecting higher pay as hospitals compete for healthcare professionals amid nationwide labor shortages.”
READINGS & REFERENCES
The Atlantic: Why Health Care Workers Are Quitting in Droves
“About one in five health-care workers has left their job since the pandemic started. This is their story” [here].
Select Coronavirus Public Health Resources and References may be found here.
2021 CQ Congressional Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
December 1, 2, 3, 6, 7, 8, 9, 10
Notes to Fred Hyde, MD, JD, MBA, news@dcmedicalnews.org