DCMedical News: Monday, April 4, 2022
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY Monday, April 4, 2022
Congress, at Work
Near a Senate deal: pandemic money for treatment, but not for providers.
Budget for 2023: HHS Secretary Becerra testifies Tuesday before the two tax law writing committees; his proposed department budget increases 27%.
The Pandemic
The FDA's vaccine advisory committee meets Wednesday to discuss additional booster shots.
An essay in The New Yorker (here) explores the meaning of the pandemic in the U.S., to date: "The coronavirus has exacted its toll unevenly. Covid is relatively unthreatening to younger people, but has killed one in seventy-five older Americans; residents of long-term-care facilities make up less than three per cent of the population, but have accounted for about one in five covid deaths. The death rate for Blacks and Hispanics has been twice that for whites. And, owing to divergent immunization rates, people in the reddest counties have been dying at more than three times the rate of those in the bluest. For some of us, the pandemic may feel over, but more Americans died of covid in 2021 than in 2020. So far in 2022, the virus has taken another hundred and thirty thousand lives." Overall, "U.S. life expectancy has now fallen by nearly two years—the sharpest single-year decline since the Second World War."
As a new variant increases cases in half the states in the U.S., British offices empty out: The Financial Times reports (here) that "Employers are warning of accelerating rates of staff absences in offices across the country as the latest coronavirus wave takes Covid-19 infections to their highest ever level in the UK . . . white-collar positions in financial and professional services were being affected after people returned to the office when the government rolled out its living with Covid strategy. It has told business lobby groups there will be no legally binding rules on how companies treat staff with Covid. Coronavirus infection rates reached a record high across the UK in the week ending March 26, with 4.9mn Britons having Covid, according to the Office for National Statistics — an increase of 15 per cent on the previous week."
The Cleveland Clinic, meanwhile, is "Betting [£1 billion] Against the NHS," according to the Guardian (here), opening a pricey private hospital in London.
In the aftermath of two years of the pandemic, hospitals and policy makers are examining their position. In the U.S., hospitals are "grabbing" for the last of provider relief funds, with the largest and most profitable systems succeeding. STAT+ reports (here) that "Some hospitals are using their muscle to catch whatever dollars are left from the nearly depleted fund. And hospital lobbyists continue to push Congress to replenish the kitty to offset the Delta and Omicron waves — even though the subsidies have inflated the fortunes of the nation’s wealthiest and well-performing hospital systems."
To the north, the Globe and Mail (here) recount the story of the pandemic in Canada, and examine the adequacy of national stores of hospitals, doctors and nurses. Long before the pandemic, says the report, "Canadian hospitals were regularly operating at or above full capacity. Hallway medicine, lengthy surgery backlogs and emergency-room wait times, the shortage of nurses and primary-care physicians, the looming catastrophe in long-term care – these have been top-of-mind problems for more than 20 years."
Now, "Fueled by a potentially more contagious subvariant of Omicron, BA. 2, lighter public-health measures and people taking a more relaxed attitude to the pandemic, the sixth wave appears imminent if not already here. Waste-water surveillance in Ontario, Alberta, British Columbia and Saskatchewan shows infections are climbing once again. In Quebec, hospitalizations are also on the rise."
War Crimes Against Hospitals in Ukraine
A Viewpoint (here) and Editorial (here) in JAMA discuss the prosecution of war crimes against attackers of hospitals and health facilities, in Ukraine, Syria and other arenas, and the consequences of such attacks for health care. "The proof required must only demonstrate that civilians were willfully and intentionally targeted. Moreover, domestic courts invoking principles of universal jurisdiction could bring charges, including for indiscriminate attacks against civilian populations."
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Consult Codes Discarded by Third Parties
Modern Healthcare reports (here) that "Health insurers Anthem and Aetna began denying providers' claims that include consultation codes this year, joining the growing ranks of payers cutting reimbursement amid an industrywide coding change." United and CIGNA stopped paying for consult codes in 2019. CMS led the way: "Medicare stopped paying claims that include consult codes in 2010. Instead, providers bill for inpatient or outpatient visits using codes that pay less."
Medicare's change came four years after a seminal HHS-OIG report (here) which found that "Approximately 75 percent of services billed as consultations and allowed by Medicare in 2001 did not meet all applicable program requirements, resulting in $1.1 billion in improper payments. Services billed as consultations often did not meet Medicare’s definition of a consultation (19 percent—$191 million), were billed as the wrong type or level of consultation (47 percent—$613 million), or were not substantiated by documentation (9 percent—$260 million). Consultations billed at the highest billing level (the most complex services, which generate the highest reimbursements under the physician fee schedule) and follow-up inpatient consultations were particularly problematic; approximately 95 percent of each were miscoded."
MH reported at least one observer thought the change might endanger the availability of specialists to see patients in hospitals at night: "It is hard to get up in the middle of the night, go to the hospital and see the patient. This was a way of reimbursing more doctors more for doing the consultation." In recent years, however, hospitalists, nocturnists, laborists and other on-site medical help have substituted for many such specialist visits, with variable results.
HOSPITALS AND OTHER HEALTH CARE FACILITIES
Massachusetts Commission Forces Change in Mass General Expansion Plans
Concerned that new ambulatory outlets would direct patients away from lower cost providers, and toward higher cost Mass General (MGH), the Massachusetts Health Policy Commission has disapproved (news here, report from HPC here) ten percent of MGH's $2.3 billion expansion plan, leaving in place $1.88 billion in hospital expansion and renovation for three hospitals, Mass General, Brigham and Women's Faulkner. "The proposed [ambulatory care] sites in Westborough, Westwood and Woburn would have amounted to a $223.7 million expenditure and would each have included an ambulatory surgery center and an array of physician services, including primary care and behavioral health services."
Shrewsbury Infant Care Scandal Shakes Confidence in the National Health
A report in The Financial Times (here) describes an "horrific account of hundreds of babies who died and suffered brain injuries at an English maternity unit." The reporter, a member of the UK hospital regulator, writes "To our eternal shame, we rated its maternity services as 'good' . . . What happened in Shrewsbury between 2000 and 2019 was an extreme example of failure to provide a basic, humane, health service. But if it’s shocking to read about militant midwives, locum doctors and a series of CEOs who swanned off into other lucrative jobs without the regulator noticing, it’s also saddening how little this scandal surprises NHS insiders. Too much of the system is run for the benefit of staff, not patients. But to say so has been to face a wall of indignation."
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
The Medicaid and CHIP Payment and Access Commission and the Medicare Payment Advisory Commission will each meet Thursday and Friday of this week. Detail in tomorrow's DCMN.
READING & REFERENCES
Select Coronavirus Public Health Resources and References may be found here.
2022 CQ Congressional Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
April 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