DCMedical News: Wednesday, March 9, 2022
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY Wednesday, March 9, 2022
War Surrounds Hospitals in Ukraine
The New York Times writes (here) that "The Ukrainian Ministry of Health reported that 34 medical facilities had been damaged and that at least 10 doctors had been killed. Ambulance workers have also been killed. The ministry said seven ambulances had been fired on, killing four emergency medical technicians in separate incidents, and that another two emergency medical technicians were killed while traveling in civilian cars to treat the wounded."
The report continued, "The most dire conditions are not in Kyiv, the capital, but in cities partially or wholly surrounded, such as Kharkiv in eastern Ukraine, where three medical facilities have been damaged by artillery: the Kharkiv City Hospital, the Regional Children’s Hospital and a blood bank."
The Times further noted, "The W.H.O. said it had dispatched 76 tons of emergency medical supplies to Ukraine but that some life-saving items, such as oxygen, insulin and surgical supplies, were in short supply because of the war’s disruptions. The dwindling supply of oxygen is particularly worrisome, said Dr. Hans Kluge, the W.H.O.’s Europe director. He noted that deaths from Covid-19 in Ukraine, where only about 30 percent of people over 60 are vaccinated, are likely to rise because of oxygen shortages."
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Specialist Physicians Unevenly Distributed Among the States
The Kaiser Family Foundation (here) reports on the range, from 6.69 specialists per 1,000 residents in the District of Columbia, 3.15 in Massachusetts and 2.72 in New York, to .78 in Idaho, .98 in Wyoming and 1.25 in Texas.
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Non-Profit and Public Hospitals Offer Less Profitable Services
A study in Health Affairs (here) found that "Nonprofit, for-profit, and government hospitals are all more likely to offer services when they are relatively profitable than when they are relatively unprofitable. However, for-profit hospitals are considerably more likely than others to provide services based on profitability . . . nonprofit hospitals offer relatively unprofitable services more than for-profit hospitals and less than government hospitals. Profitable services typically exhibit the opposite pattern. For-profit hospitals are also more likely to adopt or discontinue services consistent with changes in service profitability than are nonprofits, which in turn are more likely to do so than government hospitals."
"These results are similar to those we found before passage of the Affordable Care Act, when many more patients were uninsured. Policy makers and researchers tend to focus on whether nonprofit hospitals provide sufficient free care to justify tax benefits, thereby overlooking the significance of ownership for service provision, which likely has critical health and spending consequences." (italics added).
Sample profitable services assayed: bariatric surgery; cardiac surgery and cardiology; and imaging. Sample unprofitable services: obstetrics, transplants, burn units, and mental health.
Other findings: Size mattered: Because nonprofit hospitals are larger, on average, than the other types, they were more likely to offer a service, without regard to profitability, than were for-profit hospitals during our study period.
Neither "system" membership nor certificate of need law presence or absence mattered.
For-profits change the neighborhood: "The results we present here may underestimate the significance of ownership. In addition to the direct effects of ownership on hospital behavior, there are large spillover effects of ownership within hospital markets: As for-profit penetration in a market increases, nonprofit and government hospitals in that market are more likely to behave like for-profits in service mix."
Summary: "Our outcome measures are not subtle. They represent whether hospitals offer major service lines . . . Medical service provision should play an important role in any evaluation of the social value of nonprofit hospital ownership. Yet federal regulation of nonprofit hospitals . . . focuses largely on poverty relief . . . their ease of measurement does not make uncompensated care costs more valuable, financially or otherwise, than providing a mix of services that is less driven by relative profitability."
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Big Spenders
AHRQ reports (here) on high expenditure patients, based on analysis of information from the 2019 Medical Expenditure Panel Survey (MEPS). "In 2019, the top 1 percent of persons ranked by their healthcare expenditures accounted for about 21 percent of total healthcare expenditures, while the bottom 50 percent accounted for only 3 percent." Characterized alternatively, "About 14 percent of the U.S. population had no personal healthcare expenditures in 2019, while 5 percent accounted for nearly half of healthcare spending." The top 1% spent $78,175 or more, the top 5% $27,560 or more.
"Hypertension and osteoarthritis/other non-traumatic joint disorders were the most commonly treated conditions among the top 5 percent of spenders. Inpatient hospital care accounted for about 37 percent of spending for persons in the top 5 percent of spenders. Over three-quarters of aggregate expenses for persons in the top 5 percent of spenders were paid for by private insurance or Medicare."
MedPAC Survey of Medicare Beneficiaries
A report at the MedPAC March 3 meeting (here) contended that Medicare beneficiaries who chose Medicare Advantage (MA) programs cited "provider acceptance of the insurance," notwithstanding that a major difference between MA plans and "traditional Medicare" is the absence of free choice of physician in the former.
Other findings: Wait times to see a specialist varied for new patients, from a few days to a few months. "No beneficiaries" surveyed were familiar with the term "Accountable Care Organizations," although many could have involuntarily been enrolled in an ACO. The few clinicians who reported understanding of the Merit-based Incentive Payment System (MIPS) reported "broken promises" regarding the financial upside, and difficulty reporting on electronic health record systems. "Most beneficiaries" reported that their drugs were affordable, and that they knew what those drugs would cost before going to the pharmacy.
MACPAC Prepares for April Votes, Recommendations to Congress
At its meetings March 3 and 4 (summary here), the Medicaid and CHIP Payment and Access Commission discussed directed payments in managed care (see DCMN 3-10); proposed that greater adoption of health information technology could facilitate clinical integration for behavioral health, if only there were standards for behavioral health adoption of such technology; and ways and means of combating institutional racism and addressing racial disparities in health care and health outcomes.
The group also discussed integrating care for the 12.3 million Americans who are dually eligible for Medicaid and Medicare; noted with regard to managed Medicaid, "Federal oversight . . . does not explicitly examine whether rates represent the most efficient use of Medicaid funds or provide for adequate quality of care or access to care; and debated whether existing risk mitigation and rate-setting tools are sufficient to deal with external shocks, such as COVID-19.
The Congressional advisory group also examined a key challenge for home and community-based services (HCBS), namely that under the Medicaid statute states must cover institutional care, but coverage of HCBS is optional, dependent on a complex web of waivers.
READING & REFERENCES
Select Coronavirus Public Health Resources and References may be found here.
2022 CQ Congressional Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
March 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