DCMedical News: Friday, February 4, 2022
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY Friday, February 4, 2022
Vaccination Edge Lost, Resulting in Doubled Hospitalization Rates in U.S.
An analysis in The Financial Times (here) contends that "Almost half of the US Covid-19 hospitalisations this winter could have been averted if the country had matched the vaccination coverage of leading European countries, according to a Financial Times analysis of the Omicron variant’s impact on either side of the Atlantic."
"The data show large pockets of unvaccinated or partially vaccinated people in the US have placed more pressure on hospitals during the Omicron wave than in European nations with higher immunisation rates. The analysis supports the findings of scientists and accounts of frontline medics who say lower vaccination levels are perpetuating the pandemic in the US."
Medicare Advantage, Part D Revenues to Increase 8% in 2023
The Centers for Medicare & Medicaid Services (CMS) released the "Calendar Year (CY) 2023 Advance Notice of Methodological Changes for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies" (notice here, news release "fact sheet" here), providing an 8% revenue increase for the MA plans, a little less than half from growth in "risk adjustments." The "Better Medicare Alliance" expressed its "appreciation to CMS for issuing an Advance Notice that “protects coverage choices, advances health equity, and preserves affordability for beneficiaries”
CQ reports (here) that "The rule followed a Senate Finance Fiscal Responsibility and Economic Growth Subcommittee hearing on Medicare solvency, where Chair Elizabeth Warren, D-Mass., accused Medicare Advantage plans of gaming the system on issues like quality benchmarks and risk adjustment. A recent Kaiser Family Foundation analysis found that Medicare Advantage enrollees cost $7 billion more in 2019 than they would have under traditional Medicare."
Comments on the proposals are due Friday, March 4, 2022. The final 2023 Rate Announcement will be published April 4, 2022.
HOSPITALS AND OTHER HEALTH CARE FACILITIES
How Many Ambulatory Surgery Centers Do We Need?
A table in Becker's (here) shows the number of ASCs per 100,000 population, with Maryland having the most, at 5.67, Vermont the fewest, at .31, and Florida at 2.25, California at 2.10, Texas at 1.6, and New York at .82.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Medicare Patient Telehealth Use Shoots Up
A report from the HHS Assistant Secretary for Planning and Evaluation (here) found that "the number of Medicare fee-for-service (FFS) beneficiary telehealth visits increased 63-fold in 2020, from approximately 840,000 in 2019 to nearly 52.7 million in 2020. However, and despite the increase in telehealth visits during the pandemic, total utilization of all Medicare FFS Part B clinician visits declined 11% in 2020, compared to levels in 2019."
"Most beneficiaries (92%) received telehealth visits from their homes, which was not permissible in Medicare prior to the pandemic . . . Telehealth increased to 8% of primary care visits, while specialty care had smallest shift towards telehealth (3% of specialist visits)."
Also, visits to behavioral health specialists showed the largest increase in telehealth in 2020, comprising a third of total visits to behavioral health specialists. "Black and rural beneficiaries had lower use of telehealth compared with White and urban beneficiaries, respectively. Telehealth use varied by state, with higher use in the Northeast and West, and lower in the Midwest and South."
Dual Eligible Patient Outcome Disparities—Can Hospitals Do Better?
Researchers publishing in the JAMA Health Forum (here) note that "Low-income older adults who are dually eligible (DE) for Medicare and Medicaid often experience worse outcomes following hospitalization. Among other federal policies aimed at improving health for DE patients, Medicare has recently begun reporting disparities in hospital readmissions. The degree to which disparities for DE patients are owing to differences in community-level factors or, conversely, are amenable to hospital quality improvement, remains heavily debated." They note that "remaining variation in these disparities should be the focus of hospital efforts to improve the quality of care transitions at discharge for DE patients in
efforts to advance equity."
Telehealth Deductible Relief Disappears
Bloomberg Health & Law (here) reports that "Employers and health-care organizations are pushing Congress and the IRS to waive deductible requirements for telehealth services for 32 million people with some employer-sponsored plans. An emergency Covid-19 policy expired Dec. 31 that enabled people with high-deductible plans and health savings accounts (HSAs) to get telehealth coverage without first having to meet annual deductibles."
"Some people who had been receiving care at little or no cost by computer or telephone are now receiving bills . . . The now expired provision in the Coronavirus Aid, Relief, and Economic Security (CARES) Act of 2020 (P.L. 116-136) waived a requirement that people who have high-deductible plans coupled with tax-friendly health savings accounts must meet their minimum out-of-pocket payment threshold before their insurance can cover telehealth."
DRUGS & DEVICES
CBO Models New Drug Development and Drug Price Controls
Staff from the Congressional Budget Office have published (here) CBO’s "Model of New Drug Development." They explain that "under current law the Secretary of HHS is not allowed to negotiate prices for drugs purchased by Medicare; that Medicare Part D provides prescription drug coverage for seniors, with prices negotiated between manufacturers and insurers; and that the federal government reimburses insurers.
"Changes proposed under Build Back Better (November 2021): Prices would be negotiated for Medicare only; an inflation rebate would apply to drug purchases covered by Medicare and commercial insurers." CBO’s previous finding was that "Allowing price negotiations would not, in and of itself, lead to lower prices."
Under more recent (Cummings) proposals, "CBO estimates that: New (expensive) drugs would be priced at 80% of the price that would have been set under current law [and that] global pharmaceutical revenues would be reduced by 19%."
ICER Reports on Drug Treatment for COVID-19
In a draft report (here), the Institute for Clinical and Economic Review says "ICER is presenting a full evaluation of clinical and economic outcomes of four treatments for mild-to-moderate COVID-19 among outpatients at high risk of progression to severe disease: sotrovimab, molnupiravir, Paxlovid™, and fluvoxamine."
The highly qualified results: "Studies of all four therapies were conducted in overlapping timeframes but with potentially important differences in location (US vs. overseas), in the spectrum of SARS-CoV-2 variants, and their prevalence within the population. None of the clinical trials were performed at a time when the Omicron variant was present. Within this context, high-quality evidence demonstrated that if given within a limited number of days following initial symptoms of COVID-19, all four drugs of interest were superior to placebo in reducing hospitalization related to the acute infection."
READINGS & REFERENCES
Select Coronavirus Public Health Resources and References may be found here.
2022 CQ Congressional Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
February 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