DCMedical News: Wednesday, February 2, 2022
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY Wednesday, February 2, 2022
Cumulative Deaths from Omicron Variant in U.S. Surpass Deaths From Delta, as Well as Deaths in Most Other Nations
The New York Times reports (here) that "Two years into the pandemic, the coronavirus is killing Americans at far higher rates than people in other wealthy nations . . . Cumulative U.S. Covid-19 deaths per capita are highest among other large, high-income countries."
"Despite having one of the world’s most powerful arsenals of vaccines, the country has failed to vaccinate as many people as other large, wealthy nations. Crucially, vaccination rates in older people also lag behind certain European nations."
"The United States has fallen even further behind in administering booster shots, leaving large numbers of vulnerable people with fading protection as Omicron sweeps across the country . . . The resulting American death toll has set the country apart — and by wider margins than has been broadly recognized. Since Dec. 1, when health officials announced the first Omicron case in the United States, the share of Americans who have been killed by the coronavirus is at least 63 percent higher than in any of these other large, wealthy nations."
"Hospital admissions in the U.S. swelled to much higher rates than in Western Europe, leaving some states struggling to provide care. Americans are now dying from Covid at nearly double the daily rate of Britons and four times the rate of Germans . . . Record numbers of Americans with the highly contagious variant have filled up hospitals in recent weeks and the average death toll is still around 2,500 a day."
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
ACO Footprint Fading, Groups Moving on to the "Next Thing," Direct Contracting
A report in MedPage Today (here) says "ACO Groups Disappointed With Results for Medicare 'Shared Savings' Program," with the number of "accountable care organizations" dropping by 34 from 2020. The report notes that "One possible reason that interest in the MSSP [Medicare Shared Savings Program] is flagging may be that ACOs and other entities are more interested in a new model called Direct Contracting . . . The Direct Contracting demonstration program offers three different types of direct contracting models, including both capitated and partially capitated population-based payments that move away from traditional fee-for-service." CMS "fact sheet" on direct contracting, here.
Medical Care and Productivity Growth—Is the Investment Worth It?
David Cutler and colleagues propose a satellite account ("a framework of presentation for the economic data of a particular area in relation to the overall economic analysis") for the U.S. health sector in the American Economic Review (here). They measure productivity growth in health care for the elderly population between 1999 and 2012, and "measure the change in medical spending and health outcomes for a comprehensive set of 80 conditions." Results: "Medical care has positive productivity growth over the time period, with aggregate productivity growth of 1.5 percent per year. However, there is significant heterogeneity in productivity growth. Care for cardiovascular disease has had very high productivity growth. In contrast, care for people with musculoskeletal conditions has been costly but has not led to improved outcomes."
Knowledge, Skills and Abilities (KSA): Maintaining Readiness and Military Surgeons
A study in JAMA Surgery (here) found that "The number of KSA metric points and procedural volume in military hospitals has been decreasing since 2015, whereas both measures have increased in civilian facilities. The findings suggest that loss of surgical workload has resulted in further decreases in military surgeon readiness and may require substantial changes in patient care flow in the MHS to reverse the change."
A commentary in the same edition (here) said "Low surgical volume has been associated with worse outcomes following complex operations. . . Beyond clinical outcomes, low surgical volumes also may affect surgeon job satisfaction, retention, and preparation for entering the civilian workforce after separation or retirement. The authors propose 2 strategies for improving the expeditionary readiness of military surgeons: embedding surgeons in trauma centers, as has been done through military civilian partnerships, and restoring cases shifting to the civilian setting."
HOSPITALS AND OTHER HEALTH CARE FACILITIES
KaufmanHall January 2022 "Flash Report" Chronicles Continued Financial Pressure on Hospitals
The report, here, notes that "Hospitals are struggling financially, as the costs of the COVID-19 patients they’re treating remain extremely high, and staffing issues persist . . . Actual hospital margins remained thin, but above 2020 levels. The median Kaufman Hall Operating Margin Index for the year was 2.5% versus -0.9% for 2020, not including federal . . . (CARES) Act funding. With the aid, it was 4.0% in 2021 compared to 2.8% in 2020."
"Tight competition for healthcare workers pushed expenses up despite lower staffing levels. Total Expense per Adjusted Discharge was up 20.1% for the year versus 2019 and Labor Expense per Adjusted Discharge was up 19.1% over the same period." Nurse staffing challenges in smaller community hospitals is profiled in The New York Times, here. "The exodus of medical workers during the pandemic has been especially brutal for the small, nonprofit safety-net hospitals where millions of Americans seek care."
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
"Single Payer" Dies in California
The Los Angeles Times reports (here) that "Lawmakers declined to vote on a high-profile effort to overhaul California’s healthcare system on Monday, putting an end to a proposal that would have guaranteed medical coverage to every resident by levying billions in new taxes. . . Instead of forcing a vote that could be politically damaging for some of his Democratic colleagues [the sponsor] opted to let the bill die, angering the California Nurses Assn., which has championed single-payer for years."
"AB 1400 would have created a publicly financed healthcare system called CalCare, which could cost between $314 billion and $391 billion in state and federal funds, according to a legislative analysis. But supporters said residents in the state would ultimately have saved money when compared with paying for insurance, co-pays and deductibles . . . It’s the second time in the last five years that a single-payer bill has died in the Assembly."
AMA Faults Insurers for Limits on Coverage for Mental Health Services
The Senate Health, Education, Labor and Pension (HELP) Committee received a broadside from the AMA (here), chastising insurers for uneven coverage of mental health services, fifteen years after passage of the Mental Health Parity and Addiction Equity Act (MHPAEA). The AMA says a new report on the Act "found that insurers’ parity violations have continued and become worse since the MHPAEA was enacted in 2008." They added, "The AMA is incredulous that insurers’ policies and practices continue to violate federal law . . . This report underscores two simple facts: insurers will not change their behaviors without increased enforcement and accountability, and patients will continue to suffer until that happens." The AMA specifically noted the impact on patients with autism, substance abuse and eating disorders.
READINGS & REFERENCES
Dually Eligible Data Book
The Medicare Payment Advisory Commission (MedPAC) and Medicaid and CHIP Payment and Access Commission (MACPAC) jointly publish Beneficiaries Dually Eligible for Medicare and Medicaid, (here), the sixth edition of a reference which describes the dually eligible population’s composition, service use, and spending in 2019.
Select Coronavirus Public Health Resources and References may be found here.
2022 CQ Congressional Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
February 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