DCMedical News: Thursday, March 10, 2022
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY Thursday, March 10, 2022
Big Appropriations
The $1.5 trillion FY22 appropriations bill (here, 2,741 pages) stumbles over claw back of unspent funds previously sent to states. Final action is deferred to the 15th (or beyond). The bill has no major new health policy funding, but significant new investment in federal health program infrastructure. It continues eligibility for some 340B hospitals that would become disqualified for the program (which compels pharma to sell low and enables hospitals to sell high). The bill extends Medicare coverage for telehealth (including audio, f/k/a "telephone consultation") for 151 days after the end of the public health emergency. There are no provider relief funds, Medicare loan payment deferrals or new COVID-19 money. House Appropriations Committee Explanatory Statement here, Senate Appropriations Committee Explanatory Statement, here.
Unmasking at Your Peril
The Financial Times reports (here) "Covid less deadly than flu for most people. Immunity and weaker variant ease fatality rate in England but deaths from major respiratory diseases remain high."
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Nurse Power, May 12 March
STAT reports (here) that nurses, always the most trusted profession in surveys of the public, are poised to exert greater influence on health policy, demonstrating that influence with a planned National Nurses' March of 200,000 nurses in Washington, D.C. and state capitals on May 12. "It is an opening, advocates say, that nurses have awaited for years, or even decades. And while they lament that it took a pandemic to win Washington’s attention, national nursing groups as well as grassroots advocates say the national conversation about the health worker shortage and work conditions in hospitals represents a unique opportunity."
"The biggest issue, by far, is the increasing scrutiny of travel nurses whose pay has increased dramatically during the pandemic." A trauma nurse says, "No one caps doctors’ pay. No one caps CEOs’ pay. So why are we doing this to the backbone of health care?”
"More broadly," STAT reports, "the concept of a national staffing shortage is a myth. It’s not that there aren’t enough nurses — it’s that there aren’t enough nurses willing to work under the conditions that hospitals and the government writ large have forced upon health workers."
The Value of Volume
A study published 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." Researchers studied "31 physician organizations [POs] affiliated with 22 US health systems" and "found that volume was a component of primary care and specialist compensation for most POs (83.9% and 93.3%, respectively), representing a substantial portion of compensation when included (mean, 68.2% and 73.7%, respectively). While most primary care and specialist compensation . . included performance-based incentives, they averaged less than 10% of compensation."
A Paradox
Sara Rosenbaum blogs for the Commonwealth Fund (here), noting what she refers to as a paradox: "The 14 states with the most restrictive abortion laws also have the worst maternal and child health outcomes."
Designated Diagnostic Provider
UnitedHealthcare will begin July 1 to grade imaging centers on "established quality and efficiency metrics," offering patients tiered (lower out of pocket) cost benefits for going to such facilities, similar to a program begun for diagnostic lab services last year. United says its "program is designed to protect patients from expensive radiology services." A study in the Journal of the American College of Radiology (here) examines medically induced fear of financial burden: "One in three Americans experience medical cost distress, and more fear the cost of a serious illness more than getting seriously ill. Individuals vulnerable to financial burden may decline care or take on debt, intensifying cost distress. Advanced imaging remains one of the most frequently ordered diagnostic tests, yet the financial burden associated with advanced imaging is rarely evaluated."
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
TJC Reports on Sentinel Events for 2021--Falls the Leading Patient Safety Event--2% of Events Reported
The Joint Commission (TJC) reported on "Sentinel Events" for 2021, with the "Top 10 most frequently reported sentinel events: Fall — 485; Delay in treatment — 97; Unintended retention of a foreign object — 97; Wrong-site surgery — 85; Suicide — 79; Self-harm — 45; Fire — 38; Medication management — 35; Assault — 34; Clinical alarm response — 22."
From the program's beginning in 1995, a total of 18,018 incidents have been reported. Says TJC, "An estimated fewer than 2% of all sentinel events are reported to The Joint Commission. Therefore, these data are not an epidemiologic data set, and no conclusions should be drawn about the actual relative frequency of events or trends in events over time."
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Medical Necessity
Brennan, Newhouse and colleagues examine "medical necessity" in the January Health Affairs (here). The phrase, commonly used (at the time of Medicare's passage) to characterize what a physician prescribed, has become, together with "prior authorization," a bureaucratic nightmare, two spanners in the works, representing enormous cost to providers. The actual denials (and "savings"), however, once the friction is overcome, appear trivial: "We observed $416 million in denied spending, with 0.81 denials and $60 of denied spending per beneficiary annually. We found that 1.40 percent of services were denied, and 0.68 percent of total spending was denied, with rates rising over time . . . Denial rates varied greatly across . . . provider type, with the most . . . being for laboratory services and hospital outpatient providers."
Telehealth Extension
The omnibus FY22 appropriation bill (see lead story) will extend (and expand) Medicare payment for telehealth services. Coverage would continue until mid-September. Medicare will pay the cost of telehealth visits, including some audio-only visits, in patients' homes as well as in medical facilities, and will expand the practitioners eligible to provide telehealth services to include occupational therapists, physical therapists, speech-language pathologists and audiologists.
Acronym Madness
National Government Services (NGS), a Medicare Administrative Contractor (MAC), challenges you: "It's time for your Medicare BLAST challenge! Check it out by playing this week's topic, Medicare Acronyms. Will you be victorious? Medicare BLAST begins now and can be played on-demand until this Medicare challenge ends today at 3:00 p.m. eastern time. Select 'Leaderboard' after you've finished playing to see how well you have performed against your Medicare peers."
READINGS & REFERENCES
Echo of Richard Harris' A Sacred Trust
The New Yorker profiles discussion, discord and change within the American Medical Association on the subject of single payer health insurance, here.
Select Coronavirus Public Health Resources and References may be found here.
2022 CQ Congressional Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
March 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