DCMedical News: Tuesday, March 29, 2022
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY Tuesday, March 29, 2022
Budget Day
The President sent his proposed $5.8 trillion FY 2023 budget to Congress Monday, with a 14 percent boost to domestic spending, compared to this year. The budget requests, for the year beginning October 1, 2022, come two weeks after the President signed a government spending bill for FY 2022. Documents: FY 2023 Budget summary here, Office of Management and Budget "fact sheet" here, Budget Appendix (1400 pages) here, HHS budget items here.
HHS Secretary Becerra will appear before the House Labor, Health and Human Services, and Education Appropriations Subcommittee on Thursday morning, a formal beginning for Congressional review. The HHS budget will direct $81.7 billion to pandemic related activities over five years, and $5 billion for the proposed new Advanced Research Projects Agency for Health, or ARPA-H. The budget proposes about $140 billion in discretionary funding for the Department of Health and Human Services in 2023, an 18 percent increase from the $118 billion provided in fiscal 2022.
CQ reports that "The $81.7 billion five-year request for pandemic funding includes $40 billion for the Office of the Assistant Secretary for Planning and Response to improve development of vaccines, therapeutics and diagnostics for high priority threats. The National Institutes of Health would receive another $12.1 billion to increase research in the same areas. The Centers for Disease Control and Prevention would receive $28 billion to strengthen public health infrastructure and lab capacity, increase workforce development and boost disease surveillance."
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Advanced Practice Providers Double Share of Activity in Image Guided Thora- and Paracentesis
Radiology Business reports (here) that "There has been a dramatic rise in nurse practitioners and physician assistants performing certain image-guided procedures . . . NPs and PAs have grabbed a growing share of Medicare reimbursement for the removal of fluid or gas from the lungs (thoracentesis) and abdomen (paracentesis)."
The study, from the Journal of the American College of Radiology (here) found that radiologists performed 74% of ultrasound-guided thoracentesis in 2013, a share which fell to 66% by 2018. During this period, advanced practice providers saw their share rise from 8% up to nearly 13%. Overall APP volume for these procedures doubled over the study period. "Researchers gathered their data from 2012-2018 Medicare claims for procedures performed with and without imaging guidance . . . 'blind' thoracentesis decreased nearly 44% during the study period, down to 15,000 procedures in 2018 . . . the volume of imaging-guided needle insertion into the pleural space around the lungs climbed 19%, up to almost 223,000 during the same time."
"Blind paracentesis volume also dropped during the study period, falling almost 30%, down to 12,000. On the other side, the volume of imaging guided, needle-based sampling of fluid from the peritoneal cavity leapt 48%, up to nearly 254,000 during the same time." Radiologists performed 84% of the image-guided procedures in 2012, which fell to 77% by the end of the study period.
Radiology Business reported that "Hospitals and radiology departments have recognized the value of APPs performing minimally invasive procedures . . . They can bill Medicare at about 85% of what physicians charge, with a salary at about one-third of radiologist pay."
Yale Starts Master's Degree Program Combining Surgery and Engineering, Aimed at 3-D, Robotics
"The new Master of Science in Personalized Medicine & Applied Engineering [here] will train the next generation of engineers, computer scientists, and medical professionals alike in using new technologies in 3-dimensional medicine and imaging with the goal of improving patient outcomes. The one-year advanced degree program, which is the first of its kind, will begin this summer." Says one of the program's founders, "There is no other integrated training program that teaches engineers and medical students how to take imaging and create custom treatments, either with robotics, XR, or 3D printing from a medical perspective.”
HOSPITALS AND OTHER HEALTH CARE FACILITIES
Hospital Finances Still Headed South
The Kaufman Hall "flash" report for February (here) shows hospital operating margins in the red for the second consecutive month, at negative 3.45%, with a few winners and mostly losers. Patient days were down 13.3 percent from January; fewer severely ill COVID-19 patients contributed to a 5.3% drop in the average length of stay; gross operating revenue decreased 7.4 percent compared to January 2022, with outpatient revenue falling 5 percent and inpatient revenue declining 19.3 percent. Expenses per adjusted discharge, however, also fell, 4.5% compared to January, labor by 6% and non-labor by 3.6%. However, expenses remain up compared to 2021, with total expense per adjusted discharge up more than 10% compared to February 2021.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
National Health Clinical Expenditures Projected to Increase 5.6% Per Year Through 2030
Spending on physician and clinical services is expected to increase by 6.2% this year, according to a report released Monday by CMS (report, here). Over the longer term, "for physician and clinical services, spending growth is expected to be 5.6% per year on average for 2021 through 2030," said Andrea Sisko, PhD, a senior economist in the National Health Statistics Group, CMS Office of the Actuary. "Slower projected overall growth in physician and clinical services spending reflects declines in federal supplemental payments to providers . . . However, the slowdown is projected to be offset somewhat by faster spending growth for Medicare, which is based on increases in projected use."
In addition, "faster growth in spending is projected as those with private health insurance are expected to resume more typical patterns of use, and effects of the pandemic on overall physician and clinical services spending are expected to diminish . . . for the remainder of the projection period."
"Overall, healthcare spending is expected to grow 5.1% per year on average from 2021 to 2030, the same as the expected growth rate in the gross domestic product (GDP), said John Poisal, deputy director of the National Health Statistics Group. But in the near term, he noted, growth has slowed due to the pandemic, with the national health expenditure growth rate down to 4.2% in 2021 compared with 9.7% in 2020."
Overall health spending is projected to have hit $4.3 trillion in 2021, which will rise to an estimated $6.8 trillion in 2030.
"On the health insurance side, the percentage of the population with health insurance is expected to peak this year at 91.1% -- due in part to more people enrolling in Medicaid during the pandemic thanks to loosened requirements in that program -- and then fall back to pre-pandemic levels once the public health emergency ends, dropping to 90.5% by 2030."
READINGS & REFERENCES
Hospitals-at-War: Another Famous Nurse in the Crimean War
Britannica reports, "The Crimean War was managed and commanded very poorly on both sides. Disease accounted for a disproportionate number of the approximately 250,000 casualties lost by each side, and, when news of the deplorable conditions at the front reached the British public, nurse Mary Seacole petitioned the War Office for passage to Crimea. When she was refused (she attributed her rejection to racial prejudice) Seacole financed the trip to Balaklava herself and established the British Hotel, an officer’s club and convalescent home that she used as a base to treat the sick and wounded on the battlefield . . . At the war’s end she returned to England destitute and was declared bankrupt."
"In 1857 her autobiography, Wonderful Adventures of Mrs. Seacole in Many Lands, was published and became a best seller. . . . and she received decorations from France, England, and Turkey. After her death she fell into obscurity but in 2004 took first place in the 100 Great Black Britons poll in the United Kingdom."
Select Coronavirus Public Health Resources and References may be found here.
2022 CQ Congressional Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
March 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