DCMedical News: Wednesday, March 16, 2022
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY Wednesday, March 16, 2022
Severe Consequences Predicted in the Absence of Additional COVID-19 Pandemic Funding
CNN reports "White House Official Warns Of 'Severe Consequences' If Congress Fails To Approve COVID-19 Funding." The story cites White House Coronavirus Response Coordinator Jeff Zients calling on Congress to pass pandemic supplemental funding or face "severe consequences" in treatment, testing, vaccines, efforts to help deliver more vaccines globally and fight future variants. "The Administration had requested $22.5 billion in supplemental Covid-19 relief funding in the omnibus spending bill."
The Administration presentation here, notes that "With cases rising abroad, scientific and medical experts have been clear that in the next couple of months there could be increasing cases of COVID-19 here in the U.S as well. As the Administration has warned, failure to fund these efforts now will have severe consequences as we will not be equipped to deal with a future surge. Waiting to provide funding once we’re in a surge will be too late. Without funding, the United States will not have enough additional boosters or variant specific vaccines, if needed, for all Americans. The federal government is unable to purchase additional life-saving monoclonal antibody treatments and will run out of supply to send to states as soon as late May. The federal government cannot purchase sufficient quantities of treatments for immunocompromised individuals . . . [and] the federal government will be unable to sustain the testing capacity we built over the last 14 months, as we head into the second half of the year."
InsideHealthPolicy reports (here) that "The White House warned that certain COVID-19 response efforts will stop as early as next week if Congress doesn’t grant HHS’ request. '[W]e need this money now,' a senior administration official said in a press call. 'These are immediate, near-term consequences, some of which we're having to act on this week, next week, and the first week of April.' The Biden administration says it will have to cancel its next order for monoclonal antibodies and booster shots on March 25 and reduce shipments to states by 30% so it can stretch its current supply. Meanwhile, the uninsured program that reimburses providers caring for uninsured patients will be scaled back and run out of money in early April. HHS will stop accepting vaccination claims on April 5 due to a lack of funds. The White House also said it wouldn’t be able to support the country’s domestic testing capacity beyond June, making them ill-prepared if there’s a surge in late 2022."
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Primary Care and The Commonwealth Fund
The Fund reports (here, charts here) that "From access to care to coordination of patient services, the U.S. lags far behind other wealthy countries in primary care . . . The U.S. primary care system has been weakened by decades of chronic underinvestment. Policymakers should act now to strengthen it, including by narrowing the wage gap between generalists and specialists."
Comparing the U.S. to ten other high-income countries, the Fund finds that "U.S. adults are the least likely to have a regular physician or place of care, or a longstanding relationship with a primary care provider. Access to home visits or after-hours care is lowest in the U.S.," but also "U.S. primary care providers are the most likely to screen for social service needs."
UK to Increase Funds to Reduce 6 Million Patient Waiting List, But Does the Government Have a Plan?
The Financial Times reports (here) that critics of the government believe the new funding coming to the National Health Service in April will be ill spent, without a plan, and without measurements for success. "The House of Commons public accounts committee criticised the Department of Health and Social Care in a report published on Wednesday for having 'overseen years of decline' in cancer and non-urgent operation waiting times, which predate the pandemic . . . NHS England and the health department 'appeared unwilling to make measurable commitments', the report noted . . . The report by the committee follows a tussle between the Treasury and health bosses over setting clearer targets for the NHS pandemic recovery plan ahead of a manifesto-busting £12bn increase in national insurance contributions, which takes effect in April."
"As of December last year, nearly 6.1mn patients were waiting for non-urgent care, including hip or knee replacements, the most since comparable records began in 2007. The eight targets for cancer care have not been met since 2014, the committee noted. A National Audit Office estimate indicates the backlog will continue to grow to around 7mn by 2024 despite the extra funding."
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Partners Unifies Opposition
Mass General Brigham (formerly Partners) appears to have unified opposition by health plans to its $2.3 billion expansion plan. According to the Boston Globe (here), "The Massachusetts Association of Health Plans (the state's 15 largest payers except Blue Cross Blue Shield) condemned the project in a March 15 letter to regulators. . . MAHP says the state's largest provider should not be allowed to expand while also being the first to ever come under a state spending audit. 'We urge the Department of Public Health to reject the [expansion] applications, until such time as MGB addresses its system's high health care unit costs, cost structure and cost growth that continues to contribute to overall rising health care costs here in Massachusetts.'" MGB responded by stating that "the project will allow for more patients at downtown hospitals and lower outpatient care costs for suburban patients."
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
MedPAC Releases Report to Congress on Payment Policy
The Medicare Payment Advisory Commission (MedPAC) has released its March 2022 Report to the Congress: Medicare Payment Policy, including (a) MedPAC’s analyses of payment adequacy in traditional fee-for-service (FFS) Medicare; (b) reviews of the status of Medicare Advantage (MA) and the prescription drug benefit (Part D) programs; and (c) reports on four additional legislative mandates. The report (604 pages) is here, the Executive Summary (22 pages) here, the press release (4 pages) here.
With regard to MA programs, the report says "We estimate that Medicare spends 4 percent more for MA enrollees than it would have spent if those enrollees remained in FFS Medicare. In aggregate, for the entire duration of their Medicare participation, private plans have never produced savings for Medicare."
With regard to Part D drug programs, MedPAC said "Part D has improved beneficiaries’ access to prescription drugs, generic drugs now account for nearly 90 percent of the prescriptions filled, and enrollees’ average premiums for basic benefits have remained steady for many years (around $30 per month)."
Overall, says MedPAC, "Medicare’s Trustees estimate that total Medicare spending will nearly double between 2020 and 2030 . . . In 2021, Medicare premiums and cost sharing were estimated to consume 23 percent of the average Social Security benefit, up from 14 percent 20 years earlier. The Medicare Trustees estimate that in another 20 years, these costs will consume 34 percent of the average Social Security benefit."
How to control that spending? "One of the most powerful ways Medicare can control spending growth is by setting prices. . . Hospitals and physician groups have increasingly consolidated, in part to gain leverage over private insurers in negotiating higher payment rates. From 2010 to 2020, that consolidation contributed to a 2.8 percent average annual per enrollee growth in spending on private health insurance. By comparison, over that same period, Medicare spending per enrollee increased an average of 1.9 percent per year—nearly the same as the general inflation rate of 1.8 percent over this period. This difference suggests that private plans’ greater ability to constrain volume has less of an effect on spending than the Medicare program’s greater ability to constrain prices under its administered pricing system."
Tomorrow: MACPAC reports to Congress.
READINGS & REFERENCES
Select Coronavirus Public Health Resources and References may be found here.
2022 CQ Congressional Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
March 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