DCMedical News: Monday, February 28, 2022
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY Monday, February 28, 2022
Returning to (Health Care) Work? Not So Many
Masks and mandates are disappearing (here), but health care workers evidence continued concern over safety in the workplace, and their treatment. A study from the Mayor Foundation for Medical Education and Research (here) found that "Approximately 1 in 3 physicians, APPs, and nurses surveyed intend to reduce work hours. One in 5 physicians and 2 in 5 nurses intend to leave their practice altogether."
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
From Volume to Value, Then Back to Volume
A study in JAMA Health Forum (here) found that "Despite growth in value-based payment arrangements from payers, health systems currently incentivize physicians to maximize volume, thereby maximizing health system revenues."
Arbitration Provisions in No Surprise Act to be Rewritten, Will Begin in March
A federal judge in Texas (opinion here) has tossed out a portion of regulations from the Department of Health and Human Services which would have governed the independent dispute resolution portion of the "No Surprises" Act. In ruling on a suit brought against the regulations by the Texas Medical Association, the judge wrote that the government failed to follow the text of the act, and also failed to provide proper notice and opportunity for comment. The court took issue with the provisions which would have required arbitrators to select the amount closest to the median in-network rate in settling payment disputes between insurers and out-of-network health-care providers.
Bloomberg reported that "The Texas Medical Association and doctor who challenged the requirement argued Congress never meant for the arbitrators to give the median in-network rate a presumptive weight." The Act established an independent arbitration process to settle disputes when an insurer and an out-of-network provider can’t agree on the appropriate reimbursement amount for a patient’s care. "In that process, the provider and insurer give the arbitrator the payment amounts requested or offered, and the arbitrator selects one as the appropriate rate by considering a number of factors, including the median in-network rate, information related to the training and experience of the provider, the market share of the parties, their previous contracting history, and the complexity of the services provided."
The Court agreed with the Association that “Congress did not assign primacy to any one factor, but rather left it to the IDR [independent dispute resolution] entity’s discretion to determine how best to weigh the statutory factors in light of all the facts and circumstances of a particular case." The Department contended that the challengers’ reading of the law would give arbiters “virtually unfettered discretion to rely on any information he or she may wish to consider in choosing one of the parties’ competing offers.” But the judge wrote that the rule "places its thumb on the scale for the QPA [Qualifying Payment Amount, the median in-network payment], requiring arbitrators to presume the correctness of the QPA and then imposing a heightened burden on the remaining statutory factors to overcome that presumption.”
Arbitrations are set to begin in March.
Medical Board Certification Report
The American Board of Medical Specialties publishes (here) a profile of board certified physicians in the U.S., as of 6-30-21. Colon and Rectal Surgeons (2,445) were the least and Internists (253,914) the most numerous. Massachusetts had 45 physicians per 10,000 population, 12 states had less than half that number per 10,000, only thirteen states (including Massachusetts) had more than 30.
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Charity Care Lacking in Tax-Exempt Hospitals, Especially Larger Health "Systems"
Ge Bai and research colleagues from Johns Hopkins report (here) that "Charity care equaled 2.3% of not-for-profit hospitals' total expenses in 2018, less than either public or for-profit hospitals' spend." Charity care equaled 2.3% of total expenses in 2018, compared with 3.8% and 4.1% of for-profit and government-run hospitals' expenses. The largest fifteen health systems had 1.4% of expenses spent on charity care.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
CMS Presses Forward With Privatization of Medicare: Direct Contracting Program Now "REACH"
Bloomberg reports that "The Biden administration is redesigning a Trump-era Medicare pilot program opposed by dozens of congressional Democrats who viewed it as an effort to privatize the beloved health program for the elderly and disabled. The Centers for Medicare & Medicaid Services on Thursday announced the global and professional direct contracting model will be replaced by the Accountable Care Organization [CMS 'fact sheet' here] realizing equity, access, and community health (REACH) model," beginning Jan. 1, 2023.
Physicians for a National Health Program, which favors a single-payer health system, said in a statement that the ACO REACH program has “virtually no limits on what type of company can participate; entities can be owned by commercial insurers, private equity investors, and other profit-seeking firms, including current Direct Contracting entities.” The group said beneficiaries would still be automatically enrolled into ACO REACH entities “without their full understanding or consent, and once enrolled cannot opt out” unless they change primary care providers.
CBO Studies Economic Impact of Single Payer Health Insurance
A report from the Congressional Budget Office (here) says that a single payer health insurance system would result in: (1) employers [who] would no longer provide health care benefits would pass along the savings to employees, increasing their taxable wages; (2) Households’ health insurance premiums would be eliminated, and their out-of-pocket (OOP) health care costs would decline; (3) Administrative expenses in the health care sector would decline, freeing up productive resources for other sectors and ultimately increasing economywide productivity; (4) Reduced payment rates to providers would increase productivity and efficiency in providing health care; however, some of the reduction in payment rates would be passed through to workers’ wages in the health care sector and throughout the supply chain; (5) Longevity and labor productivity would increase as people’s health outcomes improved; and (6) LTSS benefits would further reduce OOP spending, provide payments for care that is currently unpaid, increase wages among workers providing care, and allow some unpaid caregivers to increase their hours worked at their primary occupation.
Also, "Under a single-payer system, workers would choose to work fewer hours, on average, despite higher wages because the reduction in health insurance premiums and OOP expenses would generate a positive wealth effect that allowed households to spend their time on activities other than paid work and maintain the same standard of living. If the system was financed with an income or payroll tax, gross domestic product (GDP) would be between approximately 1.0 percent and 10 percent lower by 2030, depending on the specification of the single-payer system and the details of the financing policy."
MedPAC in Town Thursday and Friday, Virtually. Agenda, here, registration required.
Racial and Ethnic Profile of Medicaid and CHIP Beneficiaries
MACPAC publishes (here) a study finding that "In 2020, Medicaid and the State Children’s Health Insurance Program (CHIP) covered over 44 million children and over 51 million adults. The majority of Medicaid beneficiaries are racial and ethnic minorities, with over 57 percent of adults enrolled in Medicaid and over 67 percent of children enrolled in Medicaid and CHIP identifying as Black, Hispanic, Asian American, American Indian or Alaska Native (AIAN), or multi-racial."
READING & REFERENCES
Select Coronavirus Public Health Resources and References may be found here.
2022 CQ Congressional Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
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
May 10, 11, 12, 13, 16, 17, 18, 19
Notes to Fred Hyde, MD, JD, MBA, news@dcmedicalnews.org