DCMedical News: Wednesday, April 27, 2022
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY Wednesday, April 27, 2022
60% of U.S. Population, 75% of Children and Teens, Show COVID Antibodies
The CDC reported in Morbidity and Mortality Weekly Report (here) that "During [the period from] December 2021–February 2022, overall U.S. seroprevalence increased from 33.5% to 57.7%. Over the same period, seroprevalence increased from 44.2% to 75.2% among children aged 0–11 years and from 45.6% to 74.2% among persons aged 12–17 years." Phrased in summary, "As of February 2022, approximately 75% of children and adolescents had serologic evidence of previous infection with SARS-CoV-2, with approximately one third becoming newly seropositive since December 2021."
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Private Practice Ownership Dives in Pandemic
Becker's reports on an Avalere survey (here) which found that "In January of 2019, 62.2 percent of physicians were employed by hospitals or corporate entities, a number that increased slightly to 64.5 percent a year later. After the pandemic began, employed physicians rocketed to 69.3 percent by January 2021. By the beginning of this year, nearly 74 percent of physicians reported being employees, leaving 26 percent still in private practice. There are now around 135,300 hospital or corporate-owned physician practices in the U.S., with 36,200 being acquired in the last two years. Hospitals acquired 4,800 practices from 2019-21, while corporate entities bought 31,300 of practices."
"Physicians now own slightly less than half of all practices, at around 46 percent. Hospitals own about 26 percent of practices, and corporate entities own 27 percent."
One Million Doctors. . .
The Federation of State Medical Boards reports its sixth biennial census of licensed physicians in the U.S.. Reporting in the Journal of Medical Regulation (here), the FSMB says the nation has one million doctors, 20% more than a decade ago, older, with more women, DOs, IMGs and specialists.
"There are 1,018,776 licensed physicians in the United States and the District of Columbia, representing a physician workforce that is 20% larger than it was a decade ago . . . The licensed physician population has grown in number relative to the total population, but concerns about a doctor shortage remain as both the general and physician populations age. Late career physicians generally work fewer hours and retire at higher rates, as younger physicians place more emphasis on work-life balance that may also limit work hours, even as many older physicians have delayed retirement in recent years."
The report continues, "The mean age of licensed physicians is now 51.7 years, a year higher than it was in 2010. The physician workforce is increasingly mixed in gender and type of physician, with more women and more individuals with Doctor of Osteopathic Medicine (DO) degrees, specialty board certification and international medical degrees than a decade ago."
HOSPITALS AND OTHER HEALTH CARE FACILITIES
MRI Breast Imaging Poses Downstream Risk for Unnecessary Costs and Procedures for Low Risk Women
A study in JAMA Network Open (here), reported also in Radiology Business (here), found that "Physicians have increasingly deployed magnetic resonance imaging to monitor for the disease, particularly among those at high risk or with dense tissue. However, MR imaging of individuals at low or average risk for breast cancer poses potential problems, including excess costs, false positives and unnecessary biopsies. Researchers recently sought to measure the scope of such low-value care using commercial claims data from 9,200 women who underwent screening MRI. They matched their info up against 9,200 more women imaged with mammography alone and unearthed stark differences. Magnetic resonance recipients received about 39 more subsequent care services per 100 patients than those scanned via mammo alone. That included five additional imaging tests per 100 women, 17 more procedures, 13 extra visits, and about 0.34 hospitalizations." The researchers wrote, "Screening breast MRI recipients experienced more mammary and extramammary cascade events and spending relative to mammogram recipients, with potential for harms to these patients and the health system."
ASC Utilization Exceeds 1,000 Cases Per Room Nationally, Highest in Atlantic States, Lowest in the South
A commercial survey of ambulatory surgery center operating room utilization (here) found that nationally 1,152 cases per year and 4.6 per day took place in each room, with a high of 1,371 surgical cases per year, 5.5 per day in Atlantic states, 1,095 per year and 4.4 per day in the South.
Hospital Price Variation Studied by CBO
A presentation by the Health Analysis Division of the Congressional Budget Office to the American Academy of Actuaries (here) shows the high variation in hospital prices, notwithstanding (or perhaps because of) administrative rate setting in the public sector. "In 2018, commercial insurers’ prices for hospitals’ inpatient services varied substantially among states, as did the gap between their prices and Medicare’s prices. The difference between commercial prices and Medicare’s prices was highest in Massachusetts, New York, and Tennessee." Even within the same metropolitan area, "commercial insurers’ prices for the same hospital service, such as a vaginal birth, varied substantially," for example by 2.8 fold in Los Angeles, 2.3 fold in Kansas City, although there is also a strong correlation of commercial price variation with hospital wages.
In measuring market concentration, "The percentage of metropolitan areas with highly or very highly concentrated hospital markets (as measured by a Herfindahl-Hirschman Index of more than 2,500) increased from 2010 to 2017," from 63% of metropolitan statistical areas, to 70%, while the percentage of MSAs which are "competitive markets" (HHI<1,500) decreased from 10% to 6%.
Enthusiasm for Telehealth Plummets From Pandemic Peak, Has Support in the Harvard Business Review
Kaiser Health's CEO and Intermountain's digital chief write in HBR (here) that "Contrary to what many people think, virtual health care, also known as telemedicine or telehealth, is much more than a cheap digital knockoff of in person care. When used appropriately, it improves patient health, reduces costs, and makes care more equitable."
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Non-Medical Benefits in Your Medicare Advantage Medical Plan: Companions, Food, Cleaning
InsideHealthPolicy reports (here) that "More than 30% of Medicare Advantage plans are now offering non-medical benefits, according to a new whitepaper from ATI Advisory and the Long Term Quality Alliance, and the paper says that 20% growth over last two years has helped beneficiaries access food, medication and in-home support services, among other non-medical needs that impact beneficiaries’ overall wellbeing."
MACPAC Looking at Directed Payments
Additional Medicaid payments available to the states—often used to compensate for skimpy hospital payment rates—are attracting attention from the Medicaid and CHIP Payment and Access Commission (here). The "directed payments" - - an estimated $25 billion in known arrangements per year - - now exceed the total of disproportionate hospital share (DSH) payments. The directed payments began without fanfare in 2016, with 65 such arrangements, and now number over 200, most in the form of opaque arrangements between the states and companies managing their Medicaid programs.
READING & REFERENCES
Select Coronavirus Public Health Resources and References may be found here. The JAMA Patient Page explains the current status of oral anti-viral medications for COVID-19, here.
2022 CQ Congressional Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
April 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