DCMedical News: Thursday, May 12, 2022
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY Thursday, May 12, 2022
Overdose Deaths Climb to 107,000 in Twelve Months
STAT and AP reported (here) that "More than 107,000 Americans died of drug overdoses last year, setting another tragic record in the nation’s escalating overdose epidemic, the Centers for Disease Control and Prevention estimated Wednesday," (CDC report here). "It marked a 15% increase from the previous record, set the year before." Bottom of Form STAT noted, "Last year, overdoses involving fentanyl and other synthetic opioids surpassed 71,000, up 23% from the year before. There also was a 23% increase in deaths involving cocaine and a 34% increase in deaths involving meth and other stimulants. Overdose deaths are often attributed to more than one drug. Some people take multiple drugs and inexpensive fentanyl has been increasingly cut into other drugs, often without the buyers’ knowledge, officials say."
"Overdose death trends are geographically uneven. Alaska saw a 75% increase in 2021 — the largest jump of any state. In Hawaii, overdose deaths fell by 2%."
What Do We Talk About When We Talk About Quality?
Dr. Lisa Rosenbaum attempts to reimagine the health quality industry, ensnared in reimbursement-related and frequently clinically irrelevant metrics. In a three-part series in The New England Journal of Medicine (here, here and here). Second of three parts.
In "Metric Myopia-Trading Away Our Clinical Judgment," Dr. Rosenbaum describes a "casualty of our attempts to systematize care: 'Doctors are increasingly hamstrung in their freedom to just use clinical judgment.' If physicians perceive quality-improvement (QI) efforts as undermining autonomy, it’s partly because, in some ways, that was the point. Though the QI movement’s origins are multifaceted, one important force was the recognition of widespread variation, in process and outcomes, for patients who were being treated for the same conditions."
Dr. Rosenbaum notes that the variability of medical treatments "signals quality deficiencies," notwithstanding the difficulty of measuring the inputs and outputs of quality and "value" in medical care. "Writing in 1997, David Blumenthal, now president of the Commonwealth Fund, observed that such variation 'has created the impression that much medical practice lacks scientific foundation, and it has emboldened purchasers and policy makers to challenge physicians’ claims that they know authoritatively what constitutes optimal health care.'"
She asks, "So why do we continue to embrace these flawed constructs, particularly when it’s not clear that the current regulatory approach serves patients or clinicians?" She notes international comparisons made by Blumenthal: "The French, the Brits, the Swedes — they don’t torture their clinicians the way we do with these administrative encumbrances. But U.S. health care costs, including physicians’ salaries, are much higher than those in other countries. 'If costs weren’t so unrestrained,' says Blumenthal, 'we wouldn’t be as intrusive into the lives and autonomy of professionals.' With the public increasingly concerned about runaway costs, quality or value becomes a way to prove our worth — so essentially, 'U.S. physicians have traded income for autonomy.'"
Referring to surveys which, consistently over time, show that the public believes more medical care is better, and more expensive care the hallmark of the best, she notes that "Insofar as high value care is defined as evidence-based care, its appeal may reflect the allure of value as a concept more than what people actually value in their care."
Dr. Rosenbaum asks, "Most of us enter this profession sincerely desiring to help people. Why hasn’t sustaining this impulse been at the center of QI efforts?"
HOSPITALS AND OTHER HEALTH CARE FACILITIES
National Academy of Medicine Calls for Fundamental Change in American Nursing Homes
A report (here) in JAMA discusses the new report of the National Academies of Medicine (here) on fundamental changes the Academy's Committee feel necessary in nursing homes.
"The [NAM report] authors recommend fundamental changes to how the US delivers, finances, regulates, and measures the quality of care in the nation’s nearly 15 600 nursing homes, which serve more than 1.3 million individuals. The panel emphasized that immediate action is needed to begin overhauling the troubled system, requiring a shared commitment from a number of federal agencies, state governments, nursing homes, providers, payers, researchers, and others. The recommendations include improving low-paid nursing home workers’ wages and benefits while shoring up minimum staffing standards and education requirements. Nursing homes should be constructed or renovated to provide smaller and more home-like environments with single- rather than multiple-occupancy bedrooms and bathrooms, with ready access to personal protective equipment. Residents’ and their families’ experiences should be incorporated into enhanced quality measures in the Centers for Medicare & Medicaid Services (CMS) Care Compare website, where consumers can research facilities, for the first time."
The report notes that "By the beginning of the next decade, about 1 in 5 people in the US will be aged 65 years or older and the number of people aged 85 years or older will grow from 6.7 million in 2020 to 9.1 million."
The report is a follow up to the "landmark 1986 Institute of Medicine (IOM) report Improving the Quality of Care in Nursing Homes, which exposed a now-familiar array of problems including resident neglect and abuse, poor quality of life, high costs, and insufficient regulatory oversight. The Nursing Home Reform Act followed a year after the IOM report, leading to
federal regulations and survey processes."
The new study "Found that many of the concerns identified more than 35 years ago persist today."
Proposed IPPS Rule for FY 2023 Published in Federal Register, Clock Begins
Arguably the most important single document in health policy each year, the "proposed rule" for the hospital Inpatient Prospective Payment System (and a variety of largely related programs) for FY 2023 was published in Tuesday's Federal Register, here. Comments are due by June 17. The final rule, published usually in late summer, would be effective October 1, 2022. (Second of a continuing series.)
In the IPPS FY23 proposed rule Medicare makes changes to the methodology for determining graduate medical education payments to teaching hospitals. An HFM report (here) notes that "The primary change, which arose from a 2021 federal court ruling, affects the weighting of FTE slots . . . A federal district court said the formula long used by CMS to determine direct GME payments contradicted the Medicare statute in calculating a hospital’s weighted number of FTE residents and fellows. The issue stemmed from the methodology used to assign FTE weights for hospitals that exceeded their GME caps."
Also in the proposed rule, "Some rural hospitals can participate in ‘slot sharing’ . . . to provide flexibility to rural teaching hospitals that participate in a rural training track. According to the rule, participating hospitals would have the same opportunity as other teaching hospitals to share and redistribute FTE-resident cap slots . . . Starting with the academic year beginning July 1, 2023, an urban hospital and a rural hospital participating together in a rural training program (RTP) could enter into an 'RTP Medicare GME affiliation agreement,' CMS stated."
DCMN will discuss at least one feature of the proposed rule in each edition published prior to June 17.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
The Past Is Not Even Past
John McDonough opines on CMMI (here) in JAMA. Lewin reports on BPCI (here).
READINGS & 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
May 13, 16, 17, 18, 19
June 7, 8, 9, 10, 13, 14, 15, 16, 21, 22, 23, 24
July 12, 13, 14, 15, 18, 19, 20, 21, 26, 27, 28, 29
August, Congress adjourned, no issues
Notes to Fred Hyde, MD, JD, MBA, news@dcmedicalnews.org