DCMedical News: Thursday, April 7, 2022
DCMedical News is published every day both the House and the Senate are scheduled to be in session. Publication will resume April 26.
THE BIG STORY Thursday, April 7, 2022
England Sees Rise in Latest COVID-19 Variant
The Financial Times reports (here) that "NHS [National Health Service] leaders in several parts of England have temporarily scaled back services except for patients whose life is in danger as the number of those in hospital with coronavirus nears that of the first Omicron peak . . . warnings from health workers on the frontline demonstrate how the latest surge, driven by the Omicron BA.2 sub-variant, has piled pressure on the health service, as the government pressed ahead with ending free mass testing and scrapping the remaining coronavirus restrictions."
The New York Times reports (here) that "New Covid-19 cases in the U.S. have not begun to rise. Over the past two weeks, they have held roughly steady, falling about 1 percent, even as the highly contagious BA.2 subvariant of Omicron has become the dominant form of Covid in the U.S. Across much of Europe, by contrast, cases surged last month after BA.2 began spreading there, and many experts expected a similar pattern here."
The Los Angeles Times, reports, on the other hand (here), that "Coronavirus cases have begun to rise in Los Angeles, San Diego and San Francisco counties, likely a result of the highly contagious Omicron subvariant BA.2, decreased use of masks and waning immunity. The increases are modest, and it’s unclear whether this is a brief hiccup, the beginning of a larger wave of cases or something in between."
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Hospitalist Billing Higher Than Billing By Other Physicians For Similar Hospitalized Patients
A study reported in JAMA Health Forum (here) found that "High-severity billing increased over time for hospital encounters at higher rates for hospitalists than for nonhospitalists. These differences do not appear to be explained by patient complexity. The increase in the number of hospitalists over time may be contributing to rising national costs related to hospital care." The study examined billing for the care of 4 million patients over ten years.
The study noted that "In the US, individual physicians are responsible for coding the initial admission evaluation, subsequent encounters during the hospital stay, and discharge encounters, which subsequently affect physician reimbursement. There is likely considerable individual-level discretion at what constitutes a high severity E/M billing. One potential source of variation may be driven by the type of inpatient medical professional who bills for patient encounters."
For example, in discharge encounters, and billing for same, the study found that "Across all time periods, hospitalists also billed higher for discharge encounters, and this gap increased over time. In 2009, 48.2% of discharge encounters were billed as high severity (>30 minutes) compared with 34.4% by nonhospitalists. By 2018, the proportion of discharge encounters billed as high severity increased for hospitalists to 70.6% compared with 45.3% for nonhospitalists."
When examining potential explanation for the higher billing for the same services, the study's authors noted "Hospitalists may be more likely to receive productivity incentives, which could translate to higher levels of compensation or bonuses based on the number of relative value units (RVUs) they bill. A 2018 survey from the American Medical Association showed that from 2012 to 2018, there was an increase in the percentage of internal medicine physicians that received compensations predominantly based on personal productivity. Therefore, it is possible that increases in personal productivity compensation models for hospitalists led to either more accurate vs more aggressive coding (and potentially inappropriate upcoding) of hospital encounters. Currently, there is no national, detailed data on physician compensation and incentive schemes available for public research."
In the alternative, the higher bills at discharge may represent institutional responses to government policy, especially penalties deducted from Medicare payments to hospitals. "In 2011, the Centers for Medicare & Medicaid Services introduced the Hospital Readmissions Reduction Program, which penalizes hospitals for higher-than-expected readmission rates across common medical conditions and a subset of surgical conditions. Prior work has shown that this policy had a substantial effect on the practices of hospitals, including investment in care coordination and post discharge strategies. Inpatient physicians are thus seeing increased pressure from leadership to improve transitions of care. This may then translate into spending more time communicating with PCPs, providing patient or caregiver education, and performing better medication reconciliation, all of which could account for the increase in higher-intensity billing for discharge encounters."
However, "Higher intensity being coded by hospitalists is concerning, especially given that prior data have suggested that nonhospitalist PCPs may have lower mortality rates while having similar readmission rates when caring for their patients in the hospital."
"Prior work has also found evidence of higher intensity billing across other specialties, including emergency department physicians. A notable difference, however, is that patient complexity partially explained these trends, which is not likely to be the reason behind differences in hospitalists' vs nonhospitalists’ billing patterns." No mention is made in the study of the potential role of private equity funds as owners of hospitalist groups (e.g., TeamHealth, Blackstone), one aspect of the hospitalist business which is found in common with emergency room physicians (e.g., KKR, Envision, EmCare).
Institute for Healthcare Improvement Statement on Criminalizing Negligent Provider Conduct
The Institute checked in (here) with a statement on the criminal conviction of a nurse at Vanderbilt University Hospital for overriding blocks against selection of the wrong drug in a medication cabinet, and the information system which allowed such workarounds.
"The decision to criminally charge the nurse who administered the wrong medication with reckless homicide and impaired adult abuse is not a remedy. We know from decades of work in hospitals and other care settings that most medical errors result from flawed systems, not reckless practitioners. We also know that systems can learn from errors and improve, but only when those systems encourage reporting, transparently acknowledge their mistakes, and are held accountable for those errors. Criminal prosecution over-focuses on the individual and their behavior and diverts needed attention from system-level problems and their solutions. This is not how safety is achieved in health care."
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
MACPAC Meets Today, Friday
The Medicaid and CHIP Payment and Access Commission (agenda here) meets today and Friday to discuss its forthcoming recommendations to Congress for changes in the programs. The subjects are access, equity, vaccines, managed Medicaid directed payments, IT in behavioral health and coverage transitions, and, Friday morning, managed Medicaid procurement practices in the states and reports due to Congress on managed Medicaid and the IMD exclusive and best practices for prescription drug monitoring.
Postpartum Coverage Extended Through Medicaid Demonstration Authority
The Kaiser Family Foundation publishes a graphic (here) showing the extent of Medicaid demonstration authority usage for the twelve month Medicaid postpartum coverage experiment, which began in 2021 with Illinois, New Jersey and Virginia. HHS publishes a news release (here) on the program, naming the President five times and the Vice President six times.
Commonwealth Discussion on Health Insurance Purchaser Coalitions
The think tank publishes (here) summary case studies addressed to this challenge: "Between 2011 and 2021, insurance premiums for families covered by employer-sponsored plans increased 47 percent — outpacing inflation (23%) and wage growth (31%)."
READING & REFERENCES
Select Coronavirus Public Health Resources and References may be found here.
2022 CQ Congressional Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
April 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