DCMedical News: Wednesday, January 12, 2022
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY Wednesday, January 12, 2022
National Health Expenditures Report
CMS has reported on national health expenditures for 2020 (highlights here, links to supporting data and documents here, pie charts showing sources and uses of funds here). From the report, “U.S. health care spending increased 9.7 percent to reach $4.1 trillion in 2020, a much faster rate than the 4.3 percent increase experienced in 2019. Gross Domestic Product (GDP) declined 2.2 percent in 2020, leading to a sharp increase in the share of the overall economy related to health care spending—from 17.6 percent in 2019 to 19.7 percent in 2020.”
Further, “The acceleration in national health spending in 2020 was primarily due to a 36.0 percent increase in federal expenditures for health care that occurred largely in response to the COVID-19 pandemic. In 2020, most of the faster growth was not directly linked to patient care events. Rather, spending growth was driven by federal financial assistance to health care providers through the Provider Relief Fund and Paycheck Protection Program loans, increased federal public health activity, as well as increased federal Medicaid funding. The increase in federal funding among medical care providers far outweighed negative or slow growth in private health insurance and out-of-pocket spending, particularly for hospitals, physicians, and nursing homes.”
Hospital care, at 31% of the total, increased 6.4% in 2020; physician services at 20% of the total increased by 5.4%; retail prescription drugs at 8% increased 3%; nursing care and CCRCs at 5% increased by 13% in 2020; home health care at 3% increased by 9.5%
Jaime King in September of 2020 on the drivers of U.S. health care spending (56 slides, here).
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
A Good Bet to Lose Income
Researchers from academe, RAND and Doximity, report in Health Affairs (here) that physicians selling their practices to hospitals are placing a losing bet, at least on income.
“We combined national survey data on physician practice ownership with data on physician income to examine whether hospital or health system ownership of physician practices was associated with differences in physician income during 2014–18. During the study period, hospital and health system ownership of physician practices increased by 89.2 percent, from 24.1 percent to 45.6 percent of all physicians in our sample. Among physician practices overall, vertical integration with hospitals or health systems was associated with, on average, 0.8 percent lower income compared with independent physicians after multivariable adjustment. In analyses by physician specialty, vertical integration of physician practices with hospitals or health systems was associated with lower income for nonsurgical specialists, no difference in income for primary care physicians, and slightly higher income for surgical specialists. Although vertical integration of physician practices is a rapidly growing trend, physicians might not directly benefit financially.”
The Great Resignation
Researchers publishing in the Mayo Clinic Proceedings (here) analyzed more than 20,000 responses from health care professionals in 124 institutions and found that “Approximately 1 in 3 physicians, APPs, and nurses surveyed intend to reduce work hours. One in 5 physicians and 2 in 5 nurses intend to leave their practice altogether. Reducing burnout and improving a sense of feeling valued may allow health care organizations to better maintain their workforces post pandemic.”
Highest Debt Per Student Found in DO Schools, Lowest in Top Tier MD Programs
U.S. News (report here) grades the medical schools on total debt per graduate, finding that “Of the top 10 highest-debt schools, seven offer doctor of osteopathic medicine (DO) degrees rather than doctor of medicine (MD) degrees. These include the top three.” Average indebtedness of students in these three ranged from $308,000 to $340,000. “On the opposite end of the student debt spectrum . . . are 10 schools whose graduates have significantly less debt. These schools, most of which are MD-only programs, include . . . Stanford, Harvard, and Johns Hopkins universities.” Stanford was least expensive, with average debt less than $90,000. Half of new physicians begin with more than $200,000 in debt, a quarter with more than $300,000, when undergraduate debt is included.
HOSPITALS AND OTHER HEALTH CARE FACILITIES
VA System Superior for Veterans, Compared to Community Hospitals
Researchers in JAMA Surgery (here, MedPage here) report that “In this national cohort study describing more than 4 million operations, VA surgical care was associated with lower perioperative mortality and decreased failure to rescue” [compared to community hospitals]. The MedPage report notes “The findings came from an analysis of about 740,000 noncardiac procedures performed at VHA centers during 2015 to 2018 and recorded in the VA's Surgical Quality Improvement Program (VASQIP), along with some 3.2 million performed in the private sector over the same period and included in the National Surgical Quality Improvement Program (NSQIP), which was modeled on the VA's system.”
A similar result was found in 2020, where researchers reporting in the Journal of the American College of Cardiology (here) following veterans having PCI found “Patients treated at community hospitals had a higher rate of death compared to similar patients treated within the VA Healthcare System.”
Eat, Walk, Engage
A report in JAMA Internal Medicine (here) addresses “Hospital-associated complications of older people,” which “include delirium, hospital-associated disability, incontinence, pressure injuries, and falls. These complications may be preventable by age-friendly principles of care, including early mobility, good nutrition and hydration, and meaningful cognitive engagement.” But, the results showed “The Eat Walk Engage program did not reduce the composite primary outcome of any HAC-OP or length of stay, but there was a significant reduction in the incidence of delirium.”
Hospital Contract Labor
Becker’s reports on a Definitive Healthcare study (here) on hospital contract labor. The “average hospital contract labor spend more than doubled between 2011 and 2020, from $2.23 million to $4.59 million . . . The annual average increase in spend was about eight percent. In comparison, total hospital operating expenses increased at about four percent year-over-year.” Nine of the top ten hospitals in contract spending, and seventeen of the top twenty, were in California.
DRUGS & DEVICES
CMS Pushes Aduhelm to Clinical Trials, Limited Coverage
CQ reports (here) that “The Centers for Medicare and Medicaid Services on Tuesday proposed limiting coverage of a pricey and controversial Alzheimer’s drug to Medicare patients in certain clinical trials, citing the need for more safety and efficacy data.” The report noted, “A final decision is expected by April 12. The agency has altered proposed coverage decisions in the past, most recently in 2019 when it opted to drop proposed evidence requirements for the cancer gene therapy CAR-T.”
Bloomberg Health and Law reports that “The agency chose one of its most stringent standards for reimbursement, restricting coverage only to people in randomized trials.” Bloomberg added, “The FDA granted Aduhelm accelerated approval in June despite objections from its scientific advisers, who said the evidence didn’t warrant it. Since then, Medicare has been paying for Aduhelm on a case-by-case basis, with local contractors and private health plans that administer the program deciding whether to approve claims.” The CMS Decision Memo (49 pgs.) is here.
READINGS & REFERENCES
Select Coronavirus Public Health Resources and References may be found here.
2022 CQ Congressional Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
January 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