DCMedical News: Wednesday, April 6, 2022
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY Wednesday, April 6, 2022
Hospitals Struggle to Return to Normal Business Following the Pandemic
Hospitals as businesses are having a difficult time. So says Moody's Investors Services, (here), projecting that "A shift in care delivery to lower-cost outpatient or in-home settings, underway for years but accelerated by the pandemic, will continue to constrain hospitals' revenue growth and margins. Changes in reimbursement models, new drugs, devices and growing investment in outpatient services, including ambulatory surgery centers (ASCs), will drive down inpatient care, the traditional measure of market share and presence. An aging population, higher acuity cases and strong population growth in some markets will lessen this shift."
Also, "Advances in drugs and medical devices will help keep patients out of the hospital. In cardiology, new drugs and at-home heart monitors will reduce the risk of hospitalizations for heart failure, a key reason that patients over 65 are admitted. In orthopedics, new technologies that help reduce surgical time or create patient-specific implants will aid the shift to outpatient procedures."
Offsetting these trends: Higher acuity and demographics will help . . . An aging population will also help offset the shift to less hospital-based care.
Also offsetting the trend may be safety problems in ASCs. A report delivered at the annual meeting of the American Society of Anesthesiologists (here) examined "A population of adult patients (age >17 years) who had a verifiable death, were not actively considered to be do not resuscitate” (DNR) status, and underwent a primary procedure (considered a major therapeutic procedure by HCUP) in one of 14 categories. The lead author noted that he "was actually surprised at the wide variability in mortality rates that our analysis revealed . . . We knew that lens replacement was going to be associated with very low risk. However, I was surprised that colorectal resection [mortality] was so high, even when compared with something like pacemaker procedures.”
One post following the report in Anesthesia News said, "The time-tested tradition of early admission and late discharge that was proven . . . to reduce surgical morbidity and mortality was summarily discarded without professional protest after insurance companies arbitrarily slashed reimbursements . . . Before this happened, postoperative patients were routinely observed by trained hospital nurses who knew to watch for postoperative problems . . . Is it any wonder that unexpected deaths from unexplained respiratory arrest have become a major problem in the aftermath of this disastrous change in policy? Substituting toxic 'multimodal analgesia' for opioids for postoperative pain control may eliminate some of this mayhem, but it cannot prevent unexpected respiratory arrest . . . In addition, the demand for rapid emergence and discharge has caused many practitioners to embrace 'open airway' techniques that invite fire, laryngospasm, aspiration, and unexpected respiratory depression during surgery."
HOSPITALS AND OTHER HEALTH CARE FACILITIES
Kaiser Foundation Surveys Where the COVID-19 Relief Funds Have Gone
The comprehensive survey (here) describes "The infusion of funds [was] intended to help alleviate the fiscal impact of revenue loss due to delays in non-urgent care, coupled with new costs associated with COVID-19. With the recent increase in Omicron-related cases, hospitalizations and deaths, this brief describes the main sources of federal funds for health care providers and how those funds have been allocated. It also describes federal spending for COVID-19 testing, including at-home testing, using the most recent data available."
Intensive Resources Upfront For Discharge Success
In Northumbria an experiment will help this "80-year-old, who has spent three weeks on a geriatric ward after a fall," in that, on discharge, she will be accompanied by a community nurse and an occupational therapist. The experiment (here, in The Financial Times) is an attempt to overcome post discharge failure, by concentrating resources and expenditures at the beginning of the discharge, rather than over a prolonged period. The program director said, "Previously assessments were spread over a longer period, sometimes leaving a patient in hospital while they waited for the checks to be completed and equipment delivered." The additional resources are coming from an increase in employer and employee contributions to the NHS, where early efforts will also be made to reduce the treatment waiting lists, now at a record 6.1 million.
VA Spokane Roll Out for IT System Veers Off Road
The Veterans Health Administration's decade long, $16 billion IT upgrade's premiere pilot program, in the Spokane VA facility, is going badly, say clinicians, here. "Physicians on the ground there said it is only a matter of time before serious safety problems — those causing injury or death — emerge, pointing to the program’s ongoing weaknesses amid VA leadership’s full-bore push toward implementation nationwide . . . The one-two punch of a dangerous outage and staff grievances is the latest setback . . . The issues have at times forced clinicians to see fewer patients and file tens of thousands of requests for help to Cerner with patient-safety problems, congressional and agency watchdog reviews show."
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Sixteen Million People Could Lose Medicaid as Public Health Emergency Ends; CMS Plans a Gentle Glide Path
"Millions Of People In US Could Lose Medicaid Coverage If Public Health Emergency Not Extended," USA Today (here) reported. “What Congress and public health experts initially viewed as a temporary measure to maintain health coverage during a once-a-century pandemic has dragged on for more than two years."
InsideHealthPolicy (here) reports that "Medicaid and CHIP enrollment has grown to nearly 85 million [combined] beneficiaries during the pandemic. This is due in part to Congress’ so-called maintenance of effort requirement where states receive a 6.2% bump in federal Medicaid matching funds as long as they don’t remove anyone from the rolls during the public health emergency declaration." As many as 16 million enrollees will be at risk once the PHE ends . . . CMS announced states will have 14 months to complete Medicaid renewals post-PHE, more than doubling the amount of time the Trump administration gave states to complete the redetermination process.
The Medicaid and CHIP Payment and Access Commission and the Medicare Payment Advisory Commission will each meet Thursday and Friday of this week.
MedPAC (agenda here):
On Thursday morning MedPAC will be addressing high prices of drugs covered under Medicare Part B. Here, "Staff will present approaches for Medicare to address (1) high prices for new 'first-in-class' drugs with limited clinical evidence, and (2) high and growing prices for drugs or new products with therapeutic alternatives. We will also discuss options to modify Medicare’s current six percent add-on payment to the Part B drug payment rate."
Thursday afternoon MedPAC will examine "Segmentation in the stand-alone Part D prescription drug plan [PDP] market." CMS allows insurers to offer up to three PDPs in each Part D region—one that provides the basic Part D benefit and two “enhanced” plans that provide the basic benefit plus supplemental benefits. Says the staff, "This strategy probably makes PDPs more profitable for insurers." Also Thursday afternoon, the Commissioners will discuss "Leveraging Medicare policies to address social determinants of health."
Friday morning the group will examine "An approach to streamline and harmonize Medicare’s portfolio of alternative payment models," and also "Aligning fee-for-service payment rates across ambulatory settings" where variations "encourage arrangements among providers that result in care being provided in the settings with the highest payment rates, thereby increasing total Medicare spending and beneficiary cost sharing."
MACPAC tomorrow in 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 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