DCMedical News: Thursday, February 3, 2022
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY Thursday, February 3, 2022
U.S. Death Toll from COVID-19 Soon to be One Million
The New York Times reports (here) that "Two years into the Covid-19 pandemic, America’s death toll is closing in on one million. Federal authorities estimate that 987,456 more people have died since early 2020 than would have otherwise been expected, based on long-term trends. People killed by coronavirus infections account for the overwhelming majority of cases. Thousands more died from derivative causes, like disruptions in their healthcare and a spike in overdoses. Covid-19 has left the same proportion of the population dead—about 0.3%—as did World War II, and in less time. Unlike the 1918 flu pandemic or major wars, which hit younger people, Covid-19 has been particularly hard on vulnerable seniors. It has also killed thousands of front-line workers and disproportionately affected minority populations."
The story notes "Epidemiologists say higher vaccination rates would have saved many people. Some of the hardest-hit places last year, in excess deaths per 100,000 residents, are Southern states with lower-than-average vaccination rates, federal data show. The U.S. has wide disparities in vaccine adoption, recently ranging from a 52.5% full-vaccination rate among Alabama’s eligible population to 83.2% in Vermont and Rhode Island."
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Employed Doctors' Revenue Up, Expenses Up, in KaufmanHall Report
KaufmanHall, better known for its "flash reports" on hospital financial performance, publishes (here) a report on employed physicians and advanced practice providers. Key points: "Overall physician enterprise productivity is above pre-pandemic levels. . . . Physician investment/subsidy [by the employing hospital] increased from Q3 to Q4 2021, continuing the trend of higher investment/subsidy levels per employed physician compared to pre-pandemic levels . . . The impact of COVID-19 on Q4 [of 2021] physician enterprise performance was negligible."
The report notes that "Labor expenses and shortages are posing significant operational challenges. The number of Clinical and Front Office Support Staff FTEs per 10,000 wRVUs [work Relative Value Units] decreased markedly over the past year while labor costs increased. At least three forces appear to be driving this shift, including increased office visits, increased wRVUs per visit (driven in part by CMS 2020 wRVU changes), and increased staffing challenges and associated costs."
HOSPITALS AND OTHER HEALTH CARE FACILITIES
FAIR Health Reports on COVID-19 Hospitalization Costs
In December, FAIR Health released (here) a report which found that "In a state-by-state analysis of private healthcare claims data from 2020 to 2021, New Jersey emerged as the state with the highest average allowed amount for complex hospitalizations [requiring mechanical ventilation or admission to an ICU] for COVID-19, while Maryland had the lowest. In New Jersey, the average allowed amount for such hospitalizations was $128,650 and in Maryland $49,127 . . . The state with the highest average allowed amount for noncomplex hospitalizations for COVID-19 was Alaska ($44,239), and the state with the highest average allowed amount for outpatient treatment for COVID-19 was Nevada ($1,538). Maryland was the state with the lowest average allowed amounts for noncomplex hospitalizations ($12,531) and outpatient treatment ($580) for COVID-19, as well as for complex hospitalizations."
One-Way Price Transparency
Hospital pricing guru Rick Louie calls attention (here) to the "good for the gander" refrain missing from the implementation of price transparency legislation. "The Biden Administration recently delayed portions of the price transparency rules that impact insurers . . . [which] requires insurers to disclose price and cost-sharing information to participants, beneficiaries, and enrollees, including publishing in-network negotiated rates and allowed amounts for out-of-network providers, as well as pricing details for prescription drugs . . . CMS and the Department of Treasury will delay enforcement of this Rule affecting insurers until a minimum of July 1, 2022, and perhaps longer . . . Pharmaceutical interest groups filed lawsuits arguing the publication of actual pricing information will lead to increased costs and harm market participants."
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
DoJ False Claims Act Settlements and Judgments Exceed $5.6 Billion in Fiscal Year 2021, 90% in the Health Field
The Department of Justice obtained more than $5.6 billion in settlements and judgments from civil cases involving fraud and false claims against the government in the fiscal year ending Sept. 30, 2021, according to a DoJ news release (here), with over $5 billion relating to matters that involved the health care industry. The claims involved drug and medical device manufacturers, managed care providers, hospitals, pharmacies, hospice organizations, laboratories and physicians.
"Health care fraud was once again the leading source of the department’s False Claims Act settlements and judgments this past year." The DoJ news release also discusses unnecessary medical services, procurement and purchasing fraud, COVID-19 related fraud, kickbacks and growing problems with Medicare Advantage plans.
"Another important priority for the department has been investigating and litigating a growing number of matters related to the Medicare Advantage program, also known as Medicare Part C, which is Medicare’s managed care program. Medicare Part C pays a capitated amount to private health insurance carriers for each patient enrolled in their plans, rather than a payment for each distinct patient admission or service. CMS adjusts the payments for various “risk” factors that affect expected healthcare expenditures to ensure that plans are paid more for enrollees who pose a greater risk . . . The department has pursued plans and healthcare providers that manipulated the risk adjustment process by submitting unsupported diagnosis codes to make their patients appear sicker than they actually were."
States Step into Medical Debt Void
A Viewpoint in JAMA (here) discusses medical debt. "Given inadequate protections under federal law, states have stepped in to provide consumer protections against medical debt. A total of 21 states have passed laws that help protect patients from medical debt, including California, Colorado, Connecticut, Illinois, Kansas, Louisiana, Maine, Maryland, Massachusetts, Nevada, New Jersey, New Mexico, New York, North Carolina, North Dakota, Oklahoma, Ohio, Oregon, Rhode Island, South Carolina, and Washington." The article notes "There is much to commend these states’ laws. They offer important consumer protections to patients who have limited financial resources and target hospitals’ most egregious debt collection practices. In turn, these protections could help advance racial and ethnic equity."
DRUGS & DEVICES
FDA Preparing for Point-of-Care 3D Medical Device Printing
The Food and Drug Administration has published (here) a Discussion Paper: 3D Printing Medical Devices at the Point of Care. Medical device shortages have led health facilities to explore and develop 3-dimensional (3D) printing to produce face shields, face mask holders, nasopharyngeal swabs, and ventilator parts from locally available materials.
Says the FDA, "3D printing at the point of care (PoC) may serve an important public health purpose, and may provide for rapid and agile production of devices, including but not limited to patient-matched devices and anatomical models for surgical planning. This technology has the potential to help a healthcare facility (HCF) quickly respond to patient needs, bring personalized care to patients in a timely manner, and lead to new innovations in patient care and treatment."
Concerning device "manufacturing" at health care facilities, "FDA recognizes that HCFs may not have the same level of experience or familiarity with FDA’s regulatory framework for medical devices as traditional manufacturers. An HCF should, however, ensure that any medical devices 3D printed at the PoC will be high-quality, perform as intended, and will not expose patients to unreasonable risk of illness or injury."
The discussion paper is open for public comment until February 8.
READINGS & REFERENCES
Select Coronavirus Public Health Resources and References may be found here.
2022 CQ Congressional Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
February 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