DCMedical News: Tuesday, February 1, 2022
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY Tuesday, February 1, 2022
Congress is Back
CQ reports that "Congress is back in town this week and several health care hearings are on the agenda. Democrats are coming back eager to make progress on some version of Biden's social spending bill, but it's still unclear what, if any, health policies might survive."
The week's agenda:
Today (Tuesday), the Senate HELP Committee will discuss mental health and substance use disorders.
Wednesday, the Energy and Commerce Consumer Protection and Commerce Subcommittee holds a hearing on pandemic profiteering and price gouging for respirators, hand sanitizer, personal protective gear and other medical supplies.
Wednesday, the Senate Finance Committee Subcommittee on Fiscal Responsibility and Economic Growth will hold a hearing on the future of Medicare financing and the hospital insurance trust fund.
Wednesday, the House Ways and Means Committee will discuss America's growing mental health crisis.
Thursday, the Ways and Means Health Subcommittee examines health equity gaps for people with disabilities and chronic conditions.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
British Researchers Find No Evidence to Support Many Common Orthopedic Procedures
A study in BMJ (here) notes that "The National Institute for Health and Care Excellence, NHS, and British Orthopaedic Association produce national clinical guidelines recommending common elective orthopaedic interventions. These recommendations often lack strong supporting evidence, particularly in the form of randomised controlled trials." The study found "Most common elective orthopaedic interventions are not backed up by readily available high quality evidence, mostly owing to a lack of definitive randomized controlled trials."
This study evaluated evidence (or lack thereof) for "Ten of the most common elective orthopaedic procedures—arthroscopic anterior cruciate ligament reconstruction, arthroscopic meniscal repair of the knee, arthroscopic partial meniscectomy of the knee, arthroscopic rotator cuff repair, arthroscopic subacromial decompression, carpal tunnel decompression, lumbar spine decompression, lumbar spine fusion, total hip replacement, and total knee replacement."
HOSPITALS AND OTHER HEALTH CARE FACILITIES
Health Care Loses Half a Million Workers
Burn out has caused half a million health care workers to leave the field, according to the Bureau of Labor Statistics, cited in a Wall Street Journal profile (here) of exhausted Pittsburgh hospital workers. "More than 1,000 hospitals have been reporting daily critical staffing shortages in recent weeks, according to federal data. The healthcare sector has lost nearly 500,000 workers since February 2020, according to estimates from the Bureau of Labor Statistics." NYT coverage here.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Record Number of Obama-Policies Sold in Just-Concluded Open Enrollment Period
HHS announced (here) that "A record-breaking 14.5 million people have signed up for 2022 health care coverage through the Marketplaces during the historic Marketplace Open Enrollment Period (OEP) from November 1, 2021 through January 15, 2022 – including 5.8 million people who have newly gained coverage . . . HealthCare.govconsumers saw their average monthly premium fall by 23%, compared to the 2021 enrollment period. "
Cost of Cancer Care an Increasing Problem in High Deductible Health Plans (HDHPs)
Researchers affiliated with Stanford, the VA and the Mayo Clinic published (here) a study showing that "Patients with cancer and private insurance experienced sharp increases in OOPCs [out of pocket costs] compared with those without cancer, which was amplified among those with HDHPs. These findings illustrate the degree to which HDHPs offer poorer protection than traditional insurance against unexpected health care expenses." The researchers pointed to this anomaly: "The financial burden of a cancer diagnosis is increasing rapidly with advances in cancer care. Simultaneously, more individuals are enrolling in high-deductible health plans (HDHPs) vs traditional insurance than ever before."
Florida Managed Care Companies Return $275 Million in Excess Profits to the State
Florida Politics reports (here) that "Medicaid managed care and managed dental plans returned $274.8 million in excessive profits to the state in 2020, according to the state Agency for Health Care Administration." The newsletter explained that "The Florida Legislature passed a sweeping rewrite of its Medicaid laws in 2011, which included a requirement for most Medicaid beneficiaries to enroll in a managed care plan. Included in the Medicaid rewrite was the 'achieved savings rebate' program meant to ensure that the plans weren’t making too much profit." The law allows managed care plans to keep all profits from the program up to 5% of their revenue; half of the profit above that and up to 10% of revenue is split between the plan and the state; plans must return to the state all profits beyond 10%. MACPAC publishes (here) a study of Medical Loss Ratios in Medicaid Managed Care.
CBO Finds Commercial Health Insurance Payments Much Higher Than Medicare
CBO examined (here) potential reasons that the prices paid by commercial health insurers for hospitals’ and physicians’ services are higher, rise more quickly, and vary more by area than the prices paid by the Medicare fee-for-service program.
DRUGS & DEVICES
More Drugs at Hospital Discharge = Danger
An analysis of patients with acute decompensated heart failure (HF) revealed that excessive polypharmacy at hospital discharge is associated with an increased risk of mortality after 1 year. In The Journal of Cardiovascular Nursing, excessive polypharmacy (≥ 12 medications) was associated with a higher risk of mortality and rehospitalizations.
CAR-T Charges Excessive in Hospitals, Say Analysts
Adam Fein's Drug Channels (here) reports on who is making money from CAR-T. "Chimeric antigen receptor (CAR) T-cell therapy has produced amazing therapeutic breakthroughs." Analysts at Sanford C. Bernstein examined who is making money. "They examined the reimbursements that commercial health plans paid to hospitals for three CAR-T products: Kymriah, Yescarta, and Tecartus . . . The study examined the Wholesale Acquisition Cost (WAC) list price, which is set by the manufacturer, the hospital’s chargemaster list price, which is set by the hospital, and the negotiated average payment, which is established in agreements between a hospital and a commercial health plan."
Results: "Hospitals mark up the list price by 300% or more. For instance, the average chargemaster price for Yescarta is $1,275,000—equal to 320% of the manufacturer’s list price of $399,000. Commercial plans pay hospitals more than twice the list price . . . Hospitals absorb two-thirds or more of the funds that health plans pay for CAR-T."
READINGS & REFERENCES
The United Health Foundation and the American Public Health Association publish "America's Health Rankings" (here) and individual state profiles from those rankings (here), the 2021 edition of the "longest running state-by-state analysis of the nation’s health," first published in 1990.
Select Coronavirus Public Health Resources and References may be found here.
2022 CQ Congressional Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
February 2, 3, 4, 7, 8, 9, 28
March 1, 2, 3, 7, 8, 9, 10, 15, 16, 17, 18, 28, 29, 30, 31
April 1, 4, 5, 6, 7, 26, 27, 28, 29
Notes to Fred Hyde, MD, JD, MBA, news@dcmedicalnews.org