DCMedical News: Friday, April 1, 2022
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY Friday, April 1, 2022
Legislative Progress
The Hill reports (here) that "Senators are closing in on a deal to provide the Biden administration with $10 billion in COVID-19 relief funding, less than half of what the White House initially asked for."
The Hill also reports that "The House on Thursday was poised to vote on legislation to cap the cost of insulin at $35 a month, a move that would significantly lower the price of the life-saving drug for more than 7 million diabetes patients."
"Under the bill, Medicare beneficiaries would pay no more than $35 for each 30-day insulin prescription. Cost sharing for beneficiaries in private plans would be limited to the lesser of either $35, or 25 percent of the health plan’s negotiated price for a 30-day prescription."
"The U.S. pays 'dramatically' higher prices for insulin compared to other countries in the Organization for Economic Co-operation and Development (OECD)." A 2020 HHS report said that, in the U.S., a standard unit of insulin cost $98.70, compared to $15 per unit in Canada, Australia and the U.K.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Are One in Five Physicians Really Leaving Medical Practice?
A commentary in JAMA (here) described studies of physician burnout. "Over the past 2 years, more than 36,000 survey responses from clinicians across the country have painted an alarming picture of a workforce that’s increasingly burned out, traumatized, anxious, and depressed."
"Another national health care worker survey, the Coping With COVID study, found that burnout approached 50% in 2020 among 9,266 physicians across medical disciplines. Last year’s survey results, which haven’t been published yet, are more dire still"
A researcher at the University of Colorado noted that "Some physicians have had the opposite experience during the pandemic—too little work . . . Many medical specialties saw the workload decrease in the pandemic’s first year and even during subsequent surges, when demand for non–COVID-19–related visits and elective procedures evaporated. Some practices watched their business and finances dry up."
"Experts warn that the COVID-19 pandemic, now entering its third year, has pushed an already fragile workforce to the brink. For many clinicians, the workplace challenges—ranging from high stress and burnout to understaffing and reduced income, often in combination—have become insurmountable."
HOSPITALS AND OTHER HEALTH CARE FACILITIES
FAIR Health Reports on Utilization and Prices, 2021
The 5th annual edition of "Healthcare Indicators" and "Medical Price Index," here, was published by FAIR Health. The report is based on claims data which FAIR Health aggregates. The report shows a drop in 2021 utilization of 38% in ambulatory surgery centers, 30% in emergency rooms, 16% in urgent care centers and 4% in retail clinics, probably due to COVID-19.
Nursing Home Staffing and Pay Controversies
InsideHealthPolicy reports (here) that, at the recent MACPAC (Medicaid and CHIP Payment and Access Commission) meeting, "Congressional Medicaid payment advisers weighed into the boiling debate over how to fix the nursing home staffing crisis by floating a staff issue brief that echoes the administration’s call for mandatory minimum staffing standards as well as providers’ requests for higher Medicaid reimbursement as a way to retain staff."
MACPAC staff noted that "Nearly half of all nursing homes serving high percentages of Medicaid beneficiaries lack sufficient staff to meet the needs of their beneficiaries, a situation that was exacerbated by the COVID-19 pandemic."
Proposals included "Increase Medicaid payment rates, which would help facilities hire additional direct care staff and pay them enough to reduce turnover; revise Medicaid payment methods, which could require facilities to spend a specified portion of the Medicaid rate on staff wages; and issue mandatory minimum staffing standards that exceed [current] federal requirements."
“The relationship between higher staffing levels and better quality care has been well-documented,” MACPAC’s brief says. “For example, a recent systematic review found that higher RN staffing levels were associated with fewer pressure ulcers, decreased urinary tract infections, reduced emergency department use, fewer hospitalizations, and decreased mortality."
The President's FY 2023 budget calls on CMS to: establish a minimum nursing home staffing requirement; reduce resident room crowding; link payment to staffing adequacy; increase financial transparency for nursing homes, including the role of private equity investors; and allow workers to unionize.
One index of nursing home distress: more than 200,000 residents and staff in nursing homes have died from COVID-19 — nearly a quarter of all COVID-19 deaths in the United States.
An alternative favored by State leaders in Florida (here) involves cutting back minimum staffing requirements, so that they might be more easily met by nursing homes faced with manpower and recruitment challenges.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
CMS Publishes FY 2023 Proposed Rules
The Medicare payment proposed rule for hospices (here) will appear in the April 4 Federal Register; for inpatient rehabilitation facilities (here), on April 6; for inpatient psychiatric facilities, here, also on April 4.
For the rehabilitation facilities, CMS proposes an increase of $170 million, compared to the $410 million increase in FY 2022, but much different than the 5% reduction in rates recommended by MedPAC, the Medicare Payment Advisory Commission.
For inpatient psychiatric facilities, CMS proposes a 2.7% increase in the payment rate, applicable both to longer term care in psychiatric hospitals and to acute treatment units which are part of general hospitals.
READING & REFERENCES
Select Coronavirus Public Health Resources and References may be found here.
2022 CQ Congressional Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
April 4, 5, 6, 7, 26, 27, 28, 29
May 10, 11, 12, 13, 16, 17, 18, 19
June 7, 8, 9, 10, 13, 14, 15, 16, 21, 22, 23, 24
Notes to Fred Hyde, MD, JD, MBA, news@dcmedicalnews.org