DCMedical News: Friday, June 10, 2022
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY Friday, June 10, 2022
$1 Million Fine Levied On Atlanta Hospital Found Non-Compliant With Price Transparency Requirements
Becker’s reports (here) that “Atlanta-based Northside Hospital is the first health system in the nation to be fined by CMS for violating federal price transparency laws . . . Northside was fined more than $1 million, according to CMS. Northside Hospital Atlanta, the health system's flagship facility, was fined $883,180, according to CMS. Northside Hospital Cherokee in Canton, Ga., was fined $214,320.” CMS citation letters are here and here.
“CMS said Northside Hospital Atlanta didn't have a searchable list for consumers posted in a prominent manner that clearly identified the location of the hospital concerned. Becker’s noted “Northside told the Atlanta Journal-Constitution last year that the information required by the federal government would not actually be useful to consumers because it lacked context, according to the report. Prices paid by patients can vary depending on factors like insurance contract negotiations.
“CMS also said Northside didn't include all required services in a machine-readable file, and services weren't included in a single file, according to the report. As of early June, CMS has issued about 352 warning notices to hospitals that were found out of compliance with price transparency rules, which went into effect Jan. 1, 2021. CMS has also sent 157 requests for a corrective action plan to hospitals that received a warning and had not made any corrections.”
A study in JAMA (here) reported on compliance or “adherence” to the price transparency requirements. “Across 5239 total hospitals, 729 (13.9%) had an adherent machine-readable file but no shoppable display, 1542 (29.4%) had an adherent shoppable display but no machine-readable file, and 300 (5.7%) had both. There were 2668 hospitals (50.9%) without an adherent machine-readable file or a shoppable display.”
Further, “Being in the first quartile (lowest) of revenue per patient-day was associated with greater rates of adherence than was being in other quartiles. Compared with being in unconcentrated markets, being in a moderately concentrated one and highly or very highly concentrated one was associated with worse adherence. Urban vs rural location was associated with better adherence to the final rule. Hospital size, emergency service capabilities, and hospital ownership were not associated with adherence.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
AAMC on Unionizing of Resident Physicians
The newsletter of the Association of American Medical Colleges reports (here) that “Thousands of medical residents are unionizing.” They report, “Newly minted physicians often bemoan long hours and relatively low wages. Now, a growing number are unionizing, which those involved say brings benefits — but also drawbacks.”
The history: “In the United States, residents’ unions stretch back at least to 1934 when the Interne Council of Greater New York organized around compensation (there was none), limited learning opportunities, and concerns about work conditions. Over the ensuing decades, other residency programs unionized even as some faced legal battles over whether residents, as hybrid trainee-workers, had the right to unionize. In 1999, the National Labor Relations Board (NLRB) ruled in the affirmative, determining that medical residents should be deemed employees when it comes to federal labor rules. The 1999 NLRB decision, Boston Medical Center Corporation and House Officers’ Association/Committee of Interns and Residents, Petitioner, is here. A Milbank Memorial Fund history of early resident organizing published in 1978 is here.
“Although maximum allowable work hours are covered by the Accreditation Council for Graduate Medical Education, salaries are not. First-year residents earned just under $60,000 on average in 2021, according to AAMC data.” One residency program director noted “Residents work up to an 80-hour week, and they see other staff who work less and get paid more . . . At 80 hours, one could calculate that they could be earning less than minimum wage.”
Long COVID Cardiovascular Damage
MedPage Today reports (here) that “Risks for cardiovascular complications, including pulmonary embolism, arterial and venous thromboses, myocardial infarction, and stroke, are higher in patients with post-acute sequelae of SARS-CoV-2 (PASC), or long COVID, highlighting the need for greater awareness of these conditions among clinicians, according to a consensus statement released by the American Academy of Physical Medicine & Rehabilitation (AAPM&R).” The 67-page consensus statement is here.
"Unfortunately, many people could have chronic cardiovascular conditions due to COVID-19 infection -- even patients without previous cardiovascular disease, comorbidities, and otherwise low risk of cardiovascular disease," said lead author Jonathan Whiteson, MD, of NYU Langone Health in New York City, in a press release. "Because of the chronic nature of cardiovascular conditions, there will likely be long-lasting consequences for patients and health systems worldwide."
Ten Year Survival Improves for MI Patients
A report in JAMA (here) studied ten year survival for almost 4 million patients with acute myocardial infarction (AMI). The results showed “Ten-year mortality and recurrent AMI rates were 72.7% and 27.1%, respectively. Adjusted annual reductions were 1.5% for mortality and 2.7% for recurrence . . . For patients hospitalized in 2007 to 2009, the last 3 years for which full 10-year follow-up data were available, 10-year mortality risk was 13.9% lower than for those hospitalized in 1995 to 1997 and 10-year recurrence risk was 22.5% lower.”
HOSPITALS AND OTHER HEALTH CARE FACILITIES
OSHA COVID Inspections Up
Bloomberg Health Law & Business News reports that “Health-Care OSHA Inspections for Covid Surge Past 2021 Levels.” They note, “OSHA has inspected more hospitals and nursing homes this year than it did for all of 2021, signaling the agency won’t ease up on Covid-related enforcement . . . OSHA largely stopped citing health-care employers for violating a Covid-19 emergency temporary standard after the agency failed to meet a December 2021 deadline to issue a permanent rule. The recent inspection push indicates the agency needs to show violations are still occurring to support its position that a permanent standard is necessary, said Littler Mendelson attorney Alka Ramchandani-Raj.”
Cancer Care Cost Unchanged in “Global Budget” Controlled Maryland Hospitals
A study in JAMA Surgery (here) examined the impact of global budget caps in Maryland hospitals on the cost of cancer care, compared to controls in other, non-capped states. The hospitals involved in cancer care in Maryland “had a statistically significant reduction of 2.2 percentage points in the 30-day readmission rate. We found no statistically significant changes in 30-day spending, mortality, or ED visits. We report no significant results in the subgroup analysis of patients undergoing major surgical procedures . . . Global budget revenue was not associated with changes in expenditures, ED utilization, or clinical outcomes after cancer-directed surgery through 4 years. There was a modest decline in 30-day readmissions.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
InsideHealthPolicy reports that “Medicare trustees . . . projected the Part A trust fund would be insolvent in 2028 — two years later than they predicted in the previous report but two years earlier than the Congressional Budget Office’s recent 2030 projection — and attributed a better-than-expected economic recovery, COVID-related deaths among seniors and deferral of other health care visits during the pandemic as partially responsible for their new projection.”
READINGS & REFERENCES
Select Coronavirus Public Health Resources and References may be found here.
Oral anti-viral medications for COVID-19, JAMA Patient Page, here.
Monkeypox resources, CDC (here), JAMA Patient Page (here).
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
June 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 editions of DCMN
Notes to Fred Hyde, MD, JD, MBA, news@dcmedicalnews.org