DCMedical News: Tuesday, January 11, 2022
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY Tuesday, January 11, 2022
At-Home COVID Test Coverage Mandated
The administration (16-pg. FAQ here, CMS news release here, NYT COVID coverage here) has published “guidance” for health plans, requiring that they cover at-home COVID-19 tests, at the rate of at least eight tests per consumer each month. “At-home diagnostic tests are now available either by prescription or over-the-counter (OTC) (without either a prescription or individualized clinical assessment by a health care provider), through pharmacies, retail stores, and online retailers. On December 2, 2021, President Biden announced that the Departments would issue guidance by January 15, 2022, to clarify that individuals who purchase OTC COVID-19 diagnostic tests . . . during the public health emergency will be able to seek reimbursement from their plan or issuer.” Moreover, “this coverage must be provided without imposing any cost-sharing requirements, prior authorization, or other medical management requirements.”
The mandated coverage will be effective in five days. “Due to the urgent need to continue to facilitate the nation’s response to the public health emergency posed by COVID-19, the Departments believe that this guidance is a statement of policy not subject to the notice and comment requirements of the Administrative Procedure Act.”
OTHER COVID NEWS
“Omicron explosion spurs nationwide breakdown of services”
Modern Healthcare (here) contends that “The current explosion of omicron-fueled coronavirus infections in the U.S. is causing a breakdown in basic functions and services — the latest illustration of how COVID-19 keeps upending life more than two years into the pandemic.”
Mortality: Mortality rates for US residents 15 years or older increased sharply in 2020, with average US life expectancy at birth declining 2.1 years for males (76.3 years in 2019 to 74.2 in 2020), 1.5 years for females (81.4 years in 2019 to 79.9 years in 2020), according to an NCHS data brief (here), the largest 1-year decline in more than 75 years (historical life tables from National Vital Statistics Reports, here).
Beliefs: A study in JAMA Internal Medicine (here) found that in an analysis of 26 823 adults during the COVID-19 pandemic, “self-reported COVID-19 infection was associated with most persistent physical symptoms, whereas laboratory-confirmed COVID-19 infection was associated only with anosmia [loss of the sense of smell]. Those associations were independent from self-rated health or depressive symptoms.” The authors concluded that “Findings suggest that persistent physical symptoms after COVID-19 infection should not be automatically ascribed to SARS-CoV-2.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Congress Notes Impact of PFS on Health Care Inequalities
Twenty-five Members signed a letter (here) noting that the Medicare Physician Fee Schedule for 2022 has reductions that cut reimbursement for office-based services “which treat diseases disproportionately impacting minority populations — by 20 percent or more. While President Biden’s FY 2022 Budget contained many worthy provisions aimed at addressing health inequity through the elimination of disparities in health care, the 2022 PFS Final Rule threatens to undermine those initiatives in areas throughout the PFS, as exemplified with several examples in the table below.” The table in the group’s letter links specific services, the differential impact on Black and Latino patients. and reductions in payment for the CPT codes covering those services.
The Doctor’s Office Becomes an Assembly Line
An opinion piece in The Wall Street Journal (here) observes that “Consolidation is wiping out private practices and making medical care costlier and worse,” and that groups that might have protected small medicine did not. “For a long time, the AMA and other medical establishments such as the American Association of Medical Colleges [sic] quietly celebrated the turn away from small medicine. They assumed that larger, more consolidated health systems would also be more efficient. On the whole, this has not turned out to be the case.”
HOSPITALS AND OTHER HEALTH CARE FACILITIES
Hospital-Based Surgery Centers See Faster Increase in Some Surgical Spine Procedures, Compared to Free-Standing ASCs
Becker’s (here) reports that “Outpatient cervical and lumbar fusions jumped at hospital-outpatient departments [HOPDs] after CMS approved the procedures for ASCs [ambulatory surgery centers] while the procedure rate had little or no growth in surgery centers.” A report from Optum and the Advisory Board is here. “The researchers found that procedures typically shifted outpatient slowly, and HOPD use increased at a higher rate than ASCs . . . cervical fusions were up 26 percent in HOPDs and 1 percent in ASCs. . . cervical fusions for Medicare beneficiaries were up 13 percent in HOPDs and 1 percent in ASCs between 2014 and 2019.”
Reporting Disconnect—State Reports Differ From Hospital Worker Perceptions
Crain’s Health Pulse reports (here) that “Hospitals across New York City report thousands of available beds, but health care workers on the front lines say they struggle to find beds for a rising tide of Covid and non-Covid patients. . . Still, about 20% of the city's hospital beds are available, according to self-reported data from hospitals that the state publishes online by hospital. Some health care workers say the public data is at odds with their reality—and, at least in some cases, does not match hospitals' internal dashboards that track capacity in real time . . . The result, workers say, is that the state gets a rosier picture than reality.” An economic motive may underlie underreporting to the State: New York’s limitation on elective procedures in hospitals with over 90% occupancy also extends to those hospitals’ surgery centers (announcement here), but not to free-standing ASCs.
English System Enlists Private Sector Providers, Builds Lean-To Hospitals
The Financial Times (here) reports that “NHS England has signed a three-month deal with 10 private healthcare groups, including Spire, Circle Health Group and Nuffield Health, to provide extra support as it deals with rising staff absences and the spread of the Omicron variant of coronavirus. The deal — which will start on Monday and end on March 31 — is aimed at relieving pressure on hospitals in England by encouraging them to refer patients in need of NHS elective surgery or urgent cancer work to private facilities.” Additional capacity may not follow, however: “David Rowland, of the Centre for Health and Public Interest think-tank, said: ‘The private hospital sector can only deliver additional capacity to the NHS by relying on NHS staff, its medical consultants. It is therefore misleading to suggest that this deal provides additional capacity to the NHS when this cannot be delivered without NHS staff, many of whom are off sick due to Omicron.’”
Also, “Hospitals have been asked to identify areas such as gyms and education centres to create ‘super surge’ wards on top of their usual capacity. The government is also in the process of building additional temporary mini-Nightingale facilities on the grounds of some hospitals as part of a move to create up to 4,000 extra beds . . . At the start of the pandemic, the UK had just 2.6 beds per 1,000 population [roughly the same as the U.S.], versus 6.1 in France and 8.1 in Germany, according to data from the King’s Fund.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Quality Bonus Theory in MA Debunked, Again
From Health Affairs (here), Ryan and University of Michigan colleagues report on the quality bonus program, linking financial bonuses to commercial insurers’ quality performance in Medicare Advantage (MA). "Despite large investments in the program, evidence of its effectiveness is limited . . . We analyzed insurance claims from the period 2009–2018 from the nation’s largest MA claims database for 3,753,117 MA beneficiaries (treatment group) and 4,025,179 commercial enrollees (control group) . . . We observed no consistent differential improvement in quality for MA versus commercial enrollees under the quality bonus program . . . these results suggest that the quality bonus program did not produce the intended improvement in overall quality performance of MA plans.”
READINGS & REFERENCES
Select Coronavirus Public Health Resources and References may be found here.
2022 CQ Congressional Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
January 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