DCMedical News: Monday, March 28, 2022
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY Monday, March 28, 2022
Cleaning Up
Hospitals continue to seek a reprise of Provider Relief Funds. In a letter (here) to Congressional leaders March 23 the AHA wrote, "PRF funds have been exhausted through the disbursement of several tranches . . . In addition, $17 billion of the PRF resources were diverted to other uses. Shockingly, no distributions were made for expenses related to the Delta or Omicron variant surges, despite 49% of COVID-19 admissions occurring during these two surges resulting in steep increases in cases, hospitalizations and deaths. The lack of PRF dollars to address issues wrought by these surges has left many hospitals facing overwhelming financial and operational challenges."
Also of concern to the AHA: Relief from the 2% Medicare "sequester" – a $3 billion annual loss for hospitals – which will transition to a 1% reduction at the end of April, then disappear in three more months. Other items of import: having CMS continue to pay for telehealth and hospital-at-home experiments.
The GAO critiques government responses during the pandemic, (here).
The money out: "As of January 31, 2022 . . . the federal government had obligated $4.2 trillion and expended $3.6 trillion, 90 percent and 79 percent, respectively, of the $4.6 trillion in funds from six COVID-19 relief laws." In his testimony, the Comptroller General concluded that "GAO found that agencies had significant shortcomings in . . . internal controls and financial and fraud risk management practices. Such shortcomings . . . were exacerbated by existing financial management weaknesses . . . billions of dollars were at risk for improper payments, including those from fraud, providing limited assurance that programs effectively met their objectives."
Rural Areas Took the Brunt of COVID-19
A report in Politico (here) finds that "Some of the biggest disparities in the Covid-19 crisis aren’t just among red states and blue states, or Black, white and Latino populations; they’re between rural and urban communities . . . Of the 50 counties with the highest Covid deaths per capita, 24 are within 40 miles of a hospital that has closed . . . Nearly all 50 counties were in rural areas."
An example: "Tennessee lost over 1,200 staffed hospital beds between 2010 and 2020 despite a population that grew by over half a million . . . Mississippi, with the most Covid-19 deaths per capita, lost over 1,100 beds over that decade. Alabama, second only to Mississippi in per-capita deaths from the virus, lost over 800."
On the ground: "In rural hospitals in western Tennessee, people would wait days in emergency room hallways, hoping for a bed to open up — even if the bed were on the other side of the state. Nurses would have to hand-pump air into patients for hours with manual ventilators because of shortages. Other hospitals in West Tennessee would connect two patients to a single ventilator while their owner, Braden Health, tried to buy ventilators from a recently closed field hospital —but they had already been sold to another state." From a retired physician who contracted COVID: "Most everybody knows one of those stories, and it’s really sad.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Secretary Becerra Wants to Fix Physician Fees
The HHS Secretary, criticized for a low profile during the pandemic, has shown strong interest in becoming personally involved in physician fee schedule matters. He told MedPage Today (here) "'I'm definitely interested, because I remember those 'cliffs' when I was in Congress,' referring to his time as a House member when Congress had to vote each year to stave off a mandated cut in physician payments under the Medicare program." CMS physician fee proposals for a "Sustainable Growth Rate," beginning in 1997, and ending in 2015, promised reductions in individual fees when aggregate spending rose, in order to make Medicare "sustainable." Only one such proposal was ever implemented, in 2002, physicians having been successful in every other year in persuading Congress, often at the last minute, to void the CMS proposals.
Alcohol Related Deaths Up 25% in Pandemic
A Research Letter in JAMA Network (here) reports that "Alcohol consumption and related harms increased during the first year of the COVID-19 pandemic. Studies reported increases in drinking to cope with stress, transplants for alcohol-associated liver disease, and emergency department visits for alcohol withdrawal." Deaths increased, as well: "The number of deaths involving alcohol increased between 2019 and 2020 (from 78 927 to 99 017 [relative change, 25.5%])."
HOSPITALS AND OTHER HEALTH CARE FACILITIES
Safe, Happy and Cheap
So says the medical director of Mayo's Hybrid Care Hotel in Jacksonville, FL, (here), in Becker's, describing the experience of post operative patients. "The Hybrid Care Hotel allows patients' families to wait in the hotel while they get their procedure done and visit them afterwards without having to wait in a crowded waiting room. Patients also said that they really loved the use of the tablet, which allows patients to connect to a bedside nurse virtually. Response time using the tablet was 30 seconds, that's faster than our hospital."
Hospital Services Purchasing Coalition Proposed by NYC Union
The SEIU32BJ Health Fund, a joint labor-management health payment fund in New York City, has proposed to its fellow unions and health service purchasers that they create a purchasing coalition to negotiate hospital prices, downward. In a report (here) the Fund said that "Private hospital networks charged the Fund over 300% of what they charged Medicare for the same services," that "there is no correlation between increased hospital prices and enhanced quality of care or improved health outcomes for patients," that "the majority (56%) of the Fund’s total spending in 2019 went to cover hospital services," that "escalating healthcare prices may have cost 32BJ members as much as $5,000 a year in wage increases over the past decade," and that "New York City hospital costs have increased significantly faster than surrounding states and are much higher than costs in Boston, a comparably expensive market."
More on Hospital Prices
A class action suit (Complaint, here) is underway against North Carolina's Vidant system. Axios chronicles (here) other efforts at the state level to control hospital prices: "Legislators in half of the states have debated transparency bills that, among other things, would force hospitals to disclose prices or in some cases cap cost increases, per the National Academy for State Health Policy."
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
American Community Survey Finds Health Insurance Uncovered for Many in the Lone Star State
The annual "snapshot" Census survey found that Texas had twice the national average percentage of population with no health insurance, 17.3%, compared to the national average of 8.7%. CQ reports that "12 states had an uninsured rate of higher than 10 percent: Alaska, Arizona, Florida, Georgia, Idaho, Mississippi, Nevada, North Carolina, Oklahoma, South Carolina, Texas and Wyoming."
Michigan Can't Wait
The legislature has passed the "Health Can't Wait" bill (here) sponsored by the State's medical society, a full stop to prior authorization abuse, according to the bill's sponsors. The provisions: prior authorization requirements must be on the payer website, aggregated information on approvals and denials must be public, clinical review criteria must be based on peer-reviewed evidence, "financially incentivized" reviewers are prohibited, authorizations must be prompt.
READINGS & REFERENCES
Select Coronavirus Public Health Resources and References may be found here.
2022 CQ Congressional Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
March 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