DCMedical News: Tuesday, June 21, 2022
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY Tuesday, June 21, 2022
Conditions Facing Physicians and Nurses Top the Docket
What physicians and nurses do tops the headlines, on the first day of summer.
The American College of Physicians addresses moral hazard in the physician fee schedule, here. “The American College of Physicians proposes specific policy recommendations on reforming payment programs, including those designed to treat underserved patient populations, to better address value in health care and achieve greater equity.”
The American Medical Association tells Congress (here) to get out of the exam room. IHP reports “The American Medical Association introduced a new, physician-specific workforce recovery plan that will help physicians rebound after two years of being battered by COVID-19, the gun violence epidemic and what AMA calls increased government interference in the patient-physician relationship and the practice of medicine.”
“AMA President Gerald Harmon during a June 10 speech called on policymakers to work with physicians on AMA’s five goals: supporting telehealth expansion; reforming Medicare payment; reversing physicians’ expanded scope of practice; overhauling prior authorization; and reducing physician burnout.”
“Physician shortages, already projected to be severe before COVID, have almost become a public health emergency. If we aren’t successful with this Recovery Plan, it’ll be even more challenging to bring talented young people into medicine and fill that expected shortage . . . We’re all better off when doctors can focus on medicine.”
The American Academy of Family Physicians sends a 17-page letter to HHS Secretary Becerra (here) promoting a soft landing for the end of public health emergency supports, and increased attention to public health.
IHP also reports (here) that “Rep. Larry Bucshon (R-IN) [a thoracic surgeons] expects to release soon the GOP Healthy Futures Task Force’s plan for addressing the doctor-patient relationship, which he says will address the challenges to rural primary care, administrative burdens to providers, and issues associated with prior authorization and electronic health records. . . He said the goal is to enable rural doctors to “sustain their business and see patients without it becoming a volume game."
Texas Rep. Mike Burgess (R) [an obstetrician] recently introduced a separate bill, “the Gold Card Act, to exempt qualifying providers from prior authorization in Medicare Advantage. Providers and insurers backed that type of arrangement in a consensus 2018 statement, but AHIP later said there are challenges with implementing programs based on providers’ prior authorization performance. Doctors’ performance tends to slip once they are given privileges, unless those privileges are paired with financial risks for overusing services, the group said in 2019.”
Nurses Are Worn Out, Too
NSI Nursing Solutions reported a survey (here) focused on nurse retention. “The COVID-19 pandemic wore down registered nurses, causing many to leave and retire early, leaving vacant spots in hospitals. Due to this, hospitals have been paying astronomical prices in turnover costs.”
The survey of 226 facilities in 37 states covering more than a half million healthcare workers found that since 2016, the average hospital turned over about 90 percent of its workforce and 83 percent of its RN staff . . . The top three reasons for RNs resigning were relocation and career advancement tied for first and retirement as the third reason. This is the first time retirement has been in the top three.”
Researchers publishing in JAMA (here) found that the nursing station is a hazardous place in COVID times: “In this cohort study, the finding of genetically identical SARS CoV-2 RNA fragments in aerosols obtained from a nurses station and in human samples during a nosocomial outbreak suggests that aerosols may have contributed to hospital transmission. Surveillance, along with ventilation, masking, and distancing, may reduce the introduction of community-acquired SARS-CoV-2 into aerosols on hospital wards, thereby reducing the risk of hospital transmission.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Epic Continues Research in Health Services Utilization and Cost
The most recent effort (here) involves telehealth, with the Epic researchers finding that “Rates of outpatient telehealth use in urban and rural areas vary only slightly despite documented barriers like broadband access and a higher proportion of elderly residents in rural areas. Telehealth use is greatest in the Medicaid population compared to private insurance or Medicare. However, telehealth use remains higher than pre-pandemic for all insurers, suggesting continued insurance coverage for telehealth services is important for ongoing healthcare access.”
The Epic research approach: “These data come from Cosmos, a HIPAA-defined Limited Data Set of more than 138 million patients from 161 Epic organizations, including 960 hospitals and more than 20,000 clinics, serving patients in all 50 states.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Home Health Rates and Payment Plan Hit
The home health industry is upended as the result of a new theory of payment, with CMS deducting from current payment rates in anticipation of the new plan failing to control costs. Home health agencies would see a net $810 million Medicare pay cut next year under a Centers for Medicare and Medicaid Services draft policy announced Friday (“fact sheet” here, Federal Register proposal to be published 6-23 here). Modern Healthcare reports that “The proposed rule calls for a 4.2% overall reimbursement decrease, which is primarily due to negative pay adjustments to account for increased expenditures CMS contends resulted from a recently implemented payment system.”
MH explains, “CMS imposed a new reimbursement policy for home health agencies in 2020 that pays them based on patient characteristics instead of the number of therapy hours provided. CMS assumed the new model, known as the Patient-Driven Groupings Model or PDGM, would lead home health agencies to bill with the highest-paying codes to maximize reimbursements. The Patient-Driven Groupings Model isn't allowed to cause higher Medicare spending, so CMS reduced home health agency pay by 4.36% starting in 2020 to account for how it anticipated home health agencies would respond to the model. Starting next year, CMS proposes a 7.69% cut to maintain budget neutrality. The $1.33 billion cut would be partially mitigated by a 2.9% increase in home health rates, according to CMS,” hence the $810 million cut.
One Year Post-Partum Medicaid Coverage for Mothers Available in 14 States
CMS announced (here) that “Nearly 253,000 Americans in 14 States and D.C. have gained access to 12 months of postpartum coverage through Medicaid and CHIP. . . CMS approved actions in Maine, Minnesota, New Mexico, and Washington, D.C., to extend Medicaid and CHIP coverage for 12 months after pregnancy. As a result, up to an additional 15,000 people annually in these states—including 2,000 in Maine; 7,000 in Minnesota; 5,000 in New Mexico; and 1,000 in Washington, D.C.—will have access to Medicaid or CHIP coverage for a full year after pregnancy.”
“Maine, Minnesota, New Mexico, and Washington, D.C., join California, Florida, Kentucky, Oregon, South Carolina, Tennessee, Michigan, Louisiana, Virginia, New Jersey, and Illinois in extending Medicaid and CHIP coverage from 60 days to 12 months after pregnancy . . . CMS continues working to extend coverage for 12 months after pregnancy in other states that have submitted extension proposals, including Connecticut, Indiana, Kansas, Maryland, Massachusetts, North Carolina, Pennsylvania, Washington, and West Virginia.” CMS contends that “More than half of pregnancy-related deaths in the United States occur in the 12-month postpartum period.”
READINGS & REFERENCES
Select Coronavirus Public Health Resources and References may be found here.
Monkeypox resources, CDC (here), JAMA Patient Page (here).
2022 CQ Congressional Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
June 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