DCMedical News: Friday, December 10, 2021
DCMedical News is published every day both the House and the Senate are scheduled to be in session. The House and/or the Senate is now in recess; publication of DCMN will resume January 10, 2022, when both houses are back in session.
THE BIG STORY Friday, December 10, 2021
New Hospital Requirements; Guidelines for Hospital Prices and Estimates
January 1 brings new responsibilities for U.S. hospitals to publish payment information, provide a notice of the availability of such information, and make Good Faith Efforts (GFE) to provide estimates of total payments due from patients for shoppable services. Notice and Consent must be given by providers or facilities furnishing out of network services to patients post stabilization or for non-emergent services in the timeframe outlined. Also, the new transparency and surprise billing laws include prohibitions on balance billing for certain items and services. More in the New Year.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Surgical Site Infections
A review in the International Journal of Surgery (here) studied the worldwide incidence of surgical site infections in general surgical patients, a review and meta-analysis of 488,594 patients. The conclusion: 11 out of 100 general surgical patients are likely to develop an infection 30 days after surgery.
HOSPITALS AND OTHER HEALTH CARE FACILITIES
City of Hope Expands With Acquisition of Cancer Treatment Centers of America
City of Hope, an NCI-designated comprehensive cancer research and treatment organization, in Duarte, California, has agreed to acquire Cancer Treatment Centers of America (CTCA), a network of oncology hospitals and outpatient care centers, and convert CTCA to a non-profit. CTCA currently has three hospitals (in Atlanta, Chicago and Phoenix) and five outpatient centers (in downtown Chicago; Gilbert, Arizona; Gurnee, Illinois; North Phoenix, Arizona; and Scottsdale, Arizona). (Story from Fiercehealthcare here, joint news release here.)
Mergers at 2x Historical Level, FTC Promotes Post-Merger Review
Polsinelli law firm members of the Antitrust Practice Group of the American Health Law Association (AHLA) write (here) that “An Overworked FTC Puts the Burden on Merging Parties to Identify and Fix Antitrust Problems Themselves.” The “Federal Trade Commission (FTC) reports that merger filings in 2021 have grown to ‘astounding’ levels. In the first nine months of 2021, 2,795 transactions were reported to federal antitrust enforcers under the Hart-Scott-Rodino (HSR) Act. At this rate, nearly 4,000 transactions will be reported to enforcers by the end of the year—twice the average annual number in the prior five years.” [Italics added. The authors note further that “The FTC believes it has spent ‘far too many of our enforcement dollars and limited staff hours investigating transactions that should never have been proposed in the first place. In response to these workload challenges, the FTC has made a series of significant changes to its merger-review practices and procedures. Together, the changes put the burden on parties to identify and resolve antitrust problems themselves or risk giving the FTC veto power over future transactions.”
In a blog post August 3 the FTC announced [here] that it would begin sending warning letters to merging parties indicating that, while the FTC will allow a merger to close, the agency’s investigation would remain open and may result in a post-closing challenge.
The authors of the AHLA essay note that “Although the FTC and the Department of Justice (DOJ) have always retained the authority to reopen or continue merger investigations after the expiration of the HSR waiting period, they have almost never done so. Thus, merging parties have looked to the expiration of the waiting period as a strong indication that enforcers will not challenge the transaction down the road. Now, however, many transactions are being allowed to close [and] the expiration of the waiting period ‘should not be construed as a determination regarding the lawfulness of the transaction.
British Hospital Wait List Climbs to 6 Million
The Financial Times reports (here) that “The number waiting for non-emergency NHS hospital treatment has risen to 6m, the highest since records began almost 15 years ago, underlining the health service’s fragility as it braces for the consequences of the new Omicron coronavirus variant. Official data from NHS England published on Thursday showed a large jump in the backlog in October, with about 35 per cent of patients waiting more than 18 weeks to start treatment, against a target of just 8 per cent. The Institute for Fiscal Studies said the latest figures amounted to 140,000 people being added to the queue in just one month and 1.55m more than in February 2020 before Covid-19 struck. The waiting list includes 312,665 patients who have been waiting more than a year.” (The equivalent waiting list in the U.S., estimating the population of Great Britain at 67 million, and the U.S. at 330 million, would be approximately 30 million people.)
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Long Term All-Cause Mortality and Medicaid Expansion
“After 4 years of implementation, Medicaid expansion remains associated with significant reductions in all-cause mortality, but reductions are variable by state characteristics,” according to a study (here) in The Lancet Public Health. The study included 31 expansion states and the District of Columbia, and 17 non-expansion states.
“At baseline in 2010, expansion states had smaller proportions of people from minority racial and ethnic groups, smaller rural populations, and fewer uninsured adults than non-expansion states. Between baseline and the end of the study period in 2018, the decrease in the proportion of uninsured adults was greater in expansion states (–10.5% absolute change; –51.9% relative change) than in non-expansion states (–7.7% absolute change; –30.3% relative change). Baseline age-adjusted all-cause mortality was 311.2 per 100 000 adults in expansion states versus 365.2 per 100 000 adults in non-expansion states.” Linking reduction in mortality to insurance coverage, the study concludes “the magnitude of change in the proportion of people who are uninsured is associated with the magnitude of improvement in overall mortality attributable to Medicaid expansion.”
MedPAC Moves on to 2023
The Medicare Payment Advisory Commission gave initial reactions Thursday to proposals for hospital and physician payments under Medicare in 2023. According to CQ, (here), the group tentatively agreed Thursday to keep hospital payments in line with current law for 2023 (a 2% increase); received a report showing federal aid largely counteracted the impacts of the COVID-19 pandemic; and expressed significant concerns about a similar recommendation for physician payments, scheduled to remain flat in 2023.
All of the draft recommendations will be formally voted on at the group’s January meeting, and will then be sent to Congress and the Department of Health and Human Services in March.
Also in the Thursday report, “The number of hospital closures declined to 10 in 2021, down from a peak of 46 in 2019. All-payer margins for rural hospitals reached near record highs in 2020.” The panel also estimated that doctors received a combined $35 billion from COVID-19 aid from the Health and Human Services Provider Relief Fund and forgiven loans under the Paycheck Protection Program.”
READINGS & REFERENCES
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
January 10, 11, 12, 13, 18, 19, 20, 21
February 1, 2, 3, 4, 7, 8, 9, 28
March 1, 2, 3, 7, 8, 9, 10, 15, 16, 17, 18, 28, 29, 30, 31
Notes to Fred Hyde, MD, JD, MBA, news@dcmedicalnews.org