DCMedical News: Thursday, January 13, 2022
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY Thursday, January 13, 2022
Is the Public Health Emergency Over?
InsideHealthPolicy (here) reports that “Hospitals and nursing homes are urging the administration to renew the public health emergency declaration before it expires on Saturday (Jan. 16) and ends COVID-19 waivers that loosened restrictions around telehealth services, nursing home staff training, three-day hospital stays and Medicaid eligibility.” The public health emergency declaration has been in effect for nearly two years.
“The emergency declarations have proven critical in equipping hospitals and health systems with the tools and resources necessary to manage the recent COVID-19 surges and ensure high-quality care in this unprecedented environment,” the American Hospital Association says in a letter to President Joe Biden and Becerra on Tuesday (Jan. 11).”
IHP notes that “Several key COVID-19 flexibilities are in effect only as long as the public health emergency declaration is in place. Aside from expanding telehealth services, this includes waiving the 75-hour training requirement for nursing home staff and the policy that a Medicare patient must stay three days in a hospital before CMS will cover their costs at a skilled nursing facility.” Said IHP, “State Medicaid directors have also been anxious about the public health emergency’s end, which marks when they will have to restart Medicaid beneficiary eligibility renewals. Officials say they need time to update their technology and to train staff on a renewal process that hasn’t been done in nearly two years.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Medicare Patients See More Specialists, Increasing Coordination Challenge
A study in the Annals of Internal Medicine (here) found that “Outpatient care for Medicare beneficiaries has shifted toward more specialist care received from more physicians without increased primary care contact. This represents a substantial expansion of the coordination burden faced by PCPs.”
Details: “The mean annual number of primary care office visits per beneficiary also changed little from 2000 to 2019 (2.99 to 3.00), although the mean number of PCPs seen increased from 0.89 to 1.21 (36.0% increase). In contrast, the mean annual number of visits to specialists increased 20% from 4.05 to 4.87, whereas the mean number of unique specialists seen increased 34.2% from 1.63 to 2.18. The proportion of beneficiaries seeing 5 or more physicians annually increased from 17.5% to 30.1%. In 2000, a PCP's Medicare patient panel saw a median of 52 other physicians. . . increasing to 95 . . . in 2019.”
Slow Walk to Creation of New Residency Positions
Bloomberg Health and Law reports (here) that the 1,000 new Medicare-funding physician residency slots will be phased in over eight years, with the first 200 such positions to be phased in over five years, to be announced January 31, 2023, and to be available July 1, 2023. “The Biden administration will commit $1.8 billion over eight years to create 1,000 new Medicare-funded physician residency slots at qualifying hospitals in rural and underserved areas. The Fiscal Year 2022 Inpatient Prospective Payment System final rule. . . will provide the largest increase in Medicare-funded residency positions in more than 25 years. Hospitals with training programs in areas with a proven shortage of primary, dental, or mental health-care providers will be prioritized in the allocation of residency slots.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Med-PAC Meetings Virtually, Focus on Payment Adequacy
The Medicare Payment Advisory Commission will meet virtually today (January 13) and tomorrow (agenda here). The Thursday session will include discussion of “Assessing payment adequacy and updating payments: Hospital inpatient and outpatient services”; “Mandated report on Bipartisan Budget Act of 2018 changes to the low-volume hospital payment adjustment”; “Assessing payment adequacy and updating payments: Physician and other health professional services”; “Assessing payment adequacy and updating payments: Ambulatory surgical center services; outpatient dialysis services; hospice services”; “Assessing payment adequacy and updating payments: Skilled nursing facility services; home health agency services; inpatient rehabilitation facility services; long-term care hospital services;” and a “Mandated report: Designing a value incentive program for post-acute care.”
The Friday program will include “Developing a multi-track population-based payment model with administratively updated benchmarks;” “The Medicare Advantage program: Status report and mandated report on dual-eligible special needs plans;” and “The Medicare prescription drug program (Part D): Status report. The next meeting of the group will be March 3-4.
AMA Finds Health Insurance Markets Highly Concentrated
The American Medical Association’s 2020 update (here) of its long-running studies of health insurance markets found, overall, even more market concentration. In the 19th edition of the study, the AMA’s Division of Economic and Health Policy Research found: “74% of MSA- [Metropolitan Statistical Area] level markets were highly concentrated . . . in 92% of MSA-level markets, at least one insurer had a commercial market share of 30% or greater, and in 48% of markets, a single insurer’s share was at least 50% . . . Despite a small decrease in 2019, we found an upward trend in concentration over this period [2014-2019]. On net, markets are more concentrated than they were five years ago. The share of markets that are highly concentrated increased from 71% to 74% . . . We found evidence of increases in concentration in markets that were already highly concentrated in 2014 as well as in those that were not. More than half (52%) of the markets that were highly concentrated in 2014 became even more concentrated by 2019 . . . High concentration levels in health insurance markets are largely the result of consolidation (i.e., mergers and acquisitions), which can lead to the exercise of market power and, in turn, harm to consumers and providers of care.”
Graphic from AMA report showing market share of largest insurer in each state, here.
Medicaid and Maternity
The Administration published its plan to grapple with maternal and infant morbidity and mortality challenges (here), while CMS admonished the States (here) to do likewise. Says CMS, “The American Rescue Plan Act of 2021 give[s] states a new option to provide 12 months of extended postpartum coverage to pregnant individuals enrolled in Medicaid and CHIP beginning April 1, 2022 . . . The newly extended postpartum coverage option offers states an opportunity to provide care that can reduce pregnancy-related deaths and severe maternal morbidity and improve continuity of care for chronic conditions such as diabetes, hypertension, cardiac conditions, substance use disorder, and depression. More than half of pregnancy-related deaths occur in the 12-month postpartum period, and 12 percent occur after six weeks postpartum.”
READINGS & REFERENCES
MACPAC Medicaid Stats—Portrait of Medicaid in the Nation
The Medicaid and CHIP Payment and Access Commission has released its 2021 edition of MACStats (here). From the press release (here), “MACStats, published annually in December and updated regularly on macpac.gov, brings together the range of Medicaid and CHIP statistics—including eligibility and enrollment, benefits, service use, and access to care, and state and federal spending—that are often difficult to find across multiple sources.”
Key findings: From July 2020 to May 2021, enrollment in Medicaid and CHIP increased by about 8.9 percent, driven in large part by the economic downturn created by the COVID-19 pandemic; Medicaid and CHIP covered more than one quarter of the U.S. population in 2019, with 83 million enrolled in Medicaid and 9.7 million enrolled in CHIP at some point during the year; Enrollment increased in all states and the District of Columbia. The growth in enrollment ranged from 5.8 percent in the District of Columbia to 24.1 percent in Nebraska; Total Medicaid spending was $688.0 billion in FY 2020. Spending for CHIP was $19.8 billion; Over 40 percent of individuals enrolled in Medicaid or CHIP in 2019 had family incomes below 100 percent of the federal poverty level; adults newly eligible for Medicaid under the Patient Protection and Affordable Care Act (ACA) and some adults who were previously eligible in states that expanded Medicaid prior to the ACA, accounted for 24 percent of enrollees and 18 percent of spending in FY 2019.
Select Coronavirus Public Health Resources and References may be found here.
2022 CQ Congressional Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
January 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