DCMedical News: Monday, March 7, 2022
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY Monday, March 7, 2022
Consumer Debt in Collection is Largely Medical Debt
Rohit Chopra, director of the Consumer Financial Protection Bureau, reported this week (here, in The New York Times) that 20 percent of American households say they have medical debt, and that more than half (58 percent) of the debt that appears on credit reports as being in collection stems from medical bills.
Mr. Chopra deemed that “extraordinary,” but the CFPB has limited its proposals to exclusion of medical debt amounts from credit reports. An industry group for collection companies said the CFPB's report doesn’t focus on “significant problems” with insurance companies’ claim payment processes.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
What Is a "Clinical Labor" Cutback?
"Clinical Labor" is shorthand for this issue: If CMS (in the 2022 Medicare physician fee schedule, PFS) increases primary care physician office fees, the "budget neutral" nature of the PFS will cut back on the amount of reimbursement for specialists who perform procedures in their offices using medical devices.
Hence the major push of medical device manufacturers to forestall CMS' actions. InsideCMS reports that among the voices opposing revision in the "clinical labor" rules were the Advanced Medical Technology Association (AdvaMed), Medical Device Manufacturers Association (MDMA) and Medical Imaging & Technology Alliance (MITA).
These groups "Argue that the budget-neutral nature of the physician fee schedule has the practical effect of massive cuts to procedures with high supply costs, relative to labor costs. The cuts also only affect office-based providers, which the device makers say will almost certainly lead to a shifting of procedures from the non-facility setting, which is more accessible and clinically appropriate for many beneficiaries . . . It is difficult to believe that office-based physicians will continue offering a service for which the Medicare payment fails to cover even the cost of supplies—let alone physician work."
Too Much Imaging
Asymptomatic head and neck cancer patients receive too much imaging as follow up surveillance after radiation (here), at least according to guidelines of the National Comprehensive Cancer Network. "During the median surveillance period of 3.2 years (range, 0.3-6.8 years), a mean (SD) of 14 (10) imaging studies were performed for all patients, with a mean (SD) total cost of $36 800 ($24 500). In patients who remained disease free, a mean (SD) of 13 (10) imaging studies were performed during the surveillance period, with a mean (SD) total cost of $35 000 ($21 700)."
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Higher Priced Hospitals: Do They Deliver Higher Quality Care?
Zack Cooper and colleagues tackle that question in an NBER working paper, here. They found: "Being admitted to a hospital with two standard deviations higher prices raises spending by 52% and lowers mortality by 1 percentage point. However, the relationship between higher prices and lower mortality is only present at hospitals in less concentrated markets. Receiving care from an expensive hospital in a concentrated market increases spending but has no detectable effect on mortality."
"Likewise, being admitted to high-priced hospitals raises spending during emergency admissions by 52.39% and total spending at 365 days post admission by 21.94%."
COVID-19 "Relief" Funds—Some Still Remain, Replenishment Uncertain
InsideCMS reports that $5.5 billion still remains in the Provider Relief Fund, following distribution of $560 million for staff recruitment and retention to 4,100 providers. "Phase 4 distributions were designed to reimburse a higher percentage of smaller providers’ losses and include bonus payments for those serving Medicaid, Children’s Health Insurance Program and Medicare beneficiaries. The American Health Care Association/National Center for Assisted Living’s analysis of HRSA data found the latest distribution favored providers with $10 million or less in annual patient care revenue, covering 45% of those providers’ losses, compared to 20% of larger (revenue of $100 million or more) health care providers’ losses."
Another Financing Trick to Sustain Rural Hospitals: Donations as a Credit Against State Income Taxes
Add this to the district hospital subsidies and other stratagems for sustaining lower volume hospitals: in Georgia, taxpayers can earn a credit against their state income taxes by donating to local participating hospitals.
"Through the Georgia Heart Rural Hospital Tax Credit Program (here) . . . participating taxpayers are now able to subtract the full amount of what they donated from the taxes they owe the state of Georgia . . . single individuals or a head of household can contribute as much as $5,000 and a married couple filing joint can get a 100 percent state tax credit for as much as $10,000 . . . After June 30 individual taxpayers can get a 100 percent credit for an unlimited amount of contribution to this program."
The Hospital-at-Home
CMS reports approval through mid-February for Medicare H-a-H payment to 92 systems, 202 hospitals, in 34 states, here.
No Hospital Is an Island
The Wall Street Journal reports (here) that "As the Omicron variant surged through communities across the U.S., it also spread inside hospitals and infected non-Covid-19 patients, reaching a record number. . . analysis of U.S. government data found."
"'The proportion of patients with hospital-acquired Covid-19 as a share of non-coronavirus patients has risen and fallen closely in line with Covid-19 cases in their surrounding communities,' said Thomas Tsai, a Harvard T.H. Chan School of Public Health researcher who reviewed the Health department data and performed a statistical analysis that confirmed the Journal’s findings. Overall, the percentage of non-Covid-19 patients with infections they got inside hospitals doubles on days when Covid-19 surges hit their highs compared with days when cases drop to low points."
“The hospital itself is not an island,” Dr. Tsai said. "How many people have developed Covid-19 while in the hospital has been difficult to pin down since the federal Department of Health and Human Services stopped collecting and disclosing the numbers from hospitals in mid-2020."
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Medicaid and CHIP as Major Tools in the Public Health Emergency
CMS publishes (here) an analysis of Medicaid and CHIP benefits paid during the pandemic, through August of 2021. "From March 2020–August 2021, over 117 million Americans . . . were enrolled across each state’s Medicaid or the Children’s Health Insurance Program (CHIP) for at least one day during the PHE period . . . About 40% of beneficiaries were children, which translates to about 48 million beneficiaries, and 9% of beneficiaries were over the age of 65. Approximately 54% of beneficiaries were female. 13% of the population were dually eligible for Medicare and Medicaid. 33% of the population were white, 25% of the population were of unknown race, 20% were Hispanic, 16% were black, 4% were Asian, and 2% were American Indian and Alaska Native, Hawaiian/Pacific Islander, or multiracial."
READING & REFERENCES
Select Coronavirus Public Health Resources and References may be found here.
2022 CQ Congressional Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
March 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