DCMedical News: Wednesday, December 8, 2021
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY Wednesday, December 8, 2021
Congress Working
The House passed legislation Tuesday night (primarily aimed at the debt ceiling) that would also delay scheduled cuts in Medicare and other programs, on a 222-212 vote. The measure is expected to get a Senate vote this week, completing the first of two steps lawmakers have decided will be needed to pass a debt limit bill this time around. CQ had reported (here) that “A bipartisan deal to avert a series of Medicare cuts is dividing Republicans in the House and Senate after Democrats paired the measure with a provision allowing the Senate to raise the debt ceiling on a simple majority vote.”
Outline of the House action: CQ says “The House package would extend a partial suspension of the 2 percent Medicare sequestration, by suspending it in full during the first three months of 2022 and by half in the second three months. The measure would also extend for one year an increase to physician payments under the Medicare Part B outpatient program that was enacted for 2021, although the extension would lower the physicians' boost to 3 percent instead of the original 3.75 percent increase. The package also includes a one-year delay of the next round of cuts to lab services — which aim to better align Medicare rates with private market rates — and another one-year delay of a mandatory payment demonstration for radiation oncologists. The package would be offset by extending the sequester cuts on the back end of the 10-year budget window, and by pulling $64 million from a fund meant for improving traditional Medicare services. The package omits any reprieve for clinical labor data changes, which will cut payments as much as 20 percent for device-heavy specialties in order to boost wages for clinical staff. But lobbyists will have another opportunity to reverse the changes when government funding runs out again in February.”
Calls to Action
InsideHealthPolicy (here) reports that “Vice President Kamala Harris issued a call-to-action Tuesday to address the country’s high maternal mortality rate while CMS announced plans to create a ‘Birthing-Friendly’ hospital quality designation and HHS said an estimated 720,000 Americans would gain coverage if every state would extend Medicaid postpartum coverage to one year. The Biden administration and Congress have both been encouraging states to extend their Medicaid and CHIP postpartum coverage from 60 days to one year. The country’s maternal mortality rates have increased over the past 20 years, and the United States now has the highest maternal mortality rate of any wealthy nation.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Racial and Ethnic Representation in US Clinical Trials of New Drugs and Biologics, 2015-2019
A report (here) in JAMA notes that “Concerns have been raised over racial and ethnic representation in clinical trials. In 2015, the US Food and Drug Administration (FDA) launched the Drug Trials Snapshots program, a transparency initiative highlighting demographics in the pivotal clinical trials that supported FDA approval of new molecular entities or original biologics. Recently, the FDA published a summary report of aggregated global demographic data from the trials that were the basis for snapshots published between 2015 and 2019. Using that database, we reviewed the participation of racial and ethnic populations at US sites to understand the extent to which US trial participation represents the diversity of the US population.”
The results: “The underrepresentation of racial and ethnic minority populations in clinical trials is commonly based on comparisons with US Census data. In this study, the mean and yearly participation rates were at or above the US Census level for Black or African American populations but not for other racial or ethnic minority groups.”
Two Hypotheses Without Support
Modern Healthcare (here) reports that critical access hospitals were not more stable financially or better for patient care in states with expanded Medicaid coverage, compared to those not expanding.
November 29 was the six-year “milestone” of the CMS experiment know as Independence at Home (CMS website here, sixth year report here, report appendices here, report highlights here). The six-year report card shows that primary care at home did not save money for Medicare, although patients enjoyed the experience. “The incentive paid to participating providers didn't impact hospital admissions, emergency department visits, potentially avoidable hospital use, mortality rate or the probability of entering institutional long-term care in 2019 . . . Many practices also didn't meet the standards for all six quality measures connected to payment.”
HOSPITALS AND OTHER HEALTH CARE FACILITIES
Telehealth Hospitals, Top 25
Hospital Pricing Specialists’ Rick Louie reports (here) on the top 25 hospitals providing telehealth/telemedicine services during the year from the second quarter of 2020 to the first quarter of 2021. Some 72% of U.S. adults who have used telehealth said they have accessed virtual care through their regular provider or health plan, according to results of a poll of 2,201 adults conducted Oct. 21-23. The study, of outpatient telehealth visits billed to Medicare by quarter, shows the University of Michigan in top place, with more than 62,000 visits Q2 2020--Q1 2021.
Abusive Billing and Collection Efforts, Continued
A study in Health Affairs and a report on the study in The Wall Street Journal (here) finds that “Hospitals in Wisconsin have sued patients over medical debt at a rate that amounts to one out of every 1,000 residents a year, especially people in low-income areas and who are Black, a new study found. The study, published Monday in the health-policy journal Health Affairs, found some hospitals were more likely than others to take patients to court and low-income and Black patients were disproportionately sued.”
READINGS & REFERENCES
MACPAC on Accessing Care
MACPAC Access Brief: Adults’ Experiences in Accessing Medical Care
MACPAC, the Medicaid and CHIP Payment and Access Commission, (report here) compares the demographics, health status, and difficulties accessing care for adults with Medicaid coverage vs. adults with private insurance vs. the uninsured. Their results showed that Medicaid covered adults were significantly more likely to have a usual source of care in the last 12 months than their uninsured counterparts. However, privately insured adults were significantly more likely to report a usual source of care than their Medicaid insured counterparts.
MACPAC Access Brief: Children’s Experiences in Accessing Medical Care
MACPAC compares (report here) the demographics, health status, and difficulties accessing care for children with Medicaid coverage vs. children with private insurance vs. the uninsured. Their results showed that Medicaid covered children were just as likely in the past 12 months to have seen a doctor, had a well child visit, and have had a dental exam as privately insured children.
Final Report to Congress to Improve Patient Safety Outlines Strategies to Speed Progress
A final report (here) on strategies to improve patient safety and reduce medical errors has been delivered to Congress, as required by the Patient Safety Act of 2005 (here), encouraging the use of patient safety strategies outlined in the National Action Plan by the National Steering Committee for Patient Safety (here).
Select Coronavirus Public Health Resources and References may be found here.
2021 CQ Congressional Calendar here.
2022 CQ House of Representatives Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
December 9, 10
January 10, 11, 12, 13, 18, 19, 20, 21
February 1, 2, 3, 4, 7, 8, 9, 28
Notes to Fred Hyde, MD, JD, MBA, news@dcmedicalnews.org