DCMedical News: Tuesday, July 12, 2022
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY Tuesday, July 12, 2022
Congress returns, attempting to salvage drug price control (here), facing the PPACA premium cliff (here) and physician unhappiness (here).
InsideHealthPolicy reports (here) that “Two health care pieces of the expected reconciliation package -- chiefly, drug pricing reforms and extension of the Medicare trust fund’s lifeline -- are set to the be the first aspects sent to the Senate parliamentarian. The policy to extend the life of the Medicare trust fund until 2031 (here) was unveiled last week, and echoes President Joe Biden’s 2022 budget proposal to close the so-called Medicare tax loophole. The deal comes as CMS eyes administrative action that could expand Medicare hearing and dental coverage -- through a proposed national coverage decision to expand coverage for cochlear implantation and through expanding what counts as medically necessary dental care through the physician fee schedule -- as those coverage expansions are no longer expected to be part of a pared-down reconciliation package.”
UN Reports Slow Growth, Declines in World Population
The Financial Times (here) reports that “The global population grew in 2020 and 2021 by less than 1 per cent a year for the first time since 1950, as Europe’s population went into decline during the coronavirus pandemic, according to a UN report. The populations of 61 countries are forecast to decrease by at least 1 per cent between 2022 and 2050, with low fertility rates combining with better healthcare to accelerate the ageing of societies.”
“But the rising proportion of older people in many countries is predicted to hit economic growth and public finances, and is already posing political challenges. Despite slowing growth, the global population is still poised to reach the milestone of 8bn people this year. In 2023, India is projected to surpass China as the most populous country.”
“Europe’s population shrank by 744,000 in 2020 and by 1.4mn last year — the largest fall of any continent since records began in the 1950s, reflecting a surge in deaths, falling births and lower net migration linked to the pandemic.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Internists Anticipate Need for More Robust Long Term Services and Supports
The American College of Physicians has published (here) a position paper on LTSS in the Annals of Internal Medicine. “The number of Americans aged 65 years or older is expected to increase in the coming decades. Because the risk for disability increases with age, more persons will need long-term serv-ices and supports (LTSS) to help with bathing, eating, dressing, and other everyday tasks. Long-term services and supports are delivered in nursing homes, assisted living facilities, the per-son's home, and other settings. However, the LTSS sector faces several challenges, including keeping patients and staff safe during the COVID-19 pandemic, workforce shortages, quality problems, and fragmented coverage options. In this position paper, the American College of Physicians offers policy recommendations on LTSS coverage, financing, workforce, safety and quality, and emergency preparedness and calls on policy-makers and other stakeholders to reform and improve the LTSS sector so that care is high quality, accessible, equitable, and affordable.”
“Co-Created” Low Value/Choosing Wisely Study From ABIM and Participating Professional Societies
The American Board of Internal Medicine has published (here) a study of “low value” medical services co-created by clinicians and patient advocates. “Launched in 2012 to lessen low-value clinical care practices, the American Board of Internal Medicine Foundation's Choosing Wisely campaign . . . in collaboration with 80 specialty societies . . .has generated more than 500 recommendations. Although clinician awareness has increased, changing practice has been more difficult.”
Using a patient-friendly questionnaire sent to clinicians and patients, the SHM's High Value Care Committee joined with patient advocates to solicit examples of low-value care practices; each of the 1265 examples was categorized by theme and scored on strength of evidence, potential for patient harm, and relevance to hospital medicine. The strongest recommendations were for less use of opioids, improving sleep by avoiding overnight awakenings, generally avoiding supplemental oxygen when O2 saturation exceeds 96%, not ordering creatine kinase-myocardial band for patients with chest pain, providing venous thromboembolism prophylaxis according to risk stratification (and not routinely for everyone), and avoiding routine daily chest x-rays.”
Social Factors In Medical School Attrition
A study in JAMA Internal Medicine (here) finds that “of 33 389 allopathic doctor of medicine medical school matriculants, students who identified as underrepresented in medicine race and ethnicity, had low income, and were from under resourced backgrounds were more likely to leave medical school. The rate of attrition increased with each additional coexisting marginalized identity.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Hospital and Pharma Lobbying Spending Under the Microscope
OpenSecrets has published a “massive report” (here) on 2021 lobbying spending, with special attention to the “leaders” in spending in the hospital and pharmaceutical industries. “While drugmakers tripled hospitals’ lobbying spend at the federal level, hospitals were dominant in state spending, with a $53 million spend compared with pharma’s $32 million.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Actuaries Predict Geography and Inflation Will Drive 2023 Premium Costs—Up
“Each year, the American Academy of Actuaries Individual and Small Group Markets Committee publishes a public policy issue brief [here] outlining the factors driving premium changes for the next plan year. The issue brief focuses on changes in gross premiums, rather than changes in premiums net of premium subsidies. For the 2022 rating cycle, the COVID-19 pandemic continued to generate uncertainties into the development of premium rates. While much of those initial uncertainties are abating, the 2023 rating cycle will see some related, additional impacts of the pandemic and the resulting economic impacts, including the expiration of the American Rescue Plan Act’s (ARPA) enhanced premium subsidies and Consolidated Omnibus JUNE 2022 Drivers of 2023 Health Insurance Premium Changes.
“Key Points • Although COVID-19-related costs may be more predictable and the worst days of the pandemic appear to be over, there is still uncertainty regarding whether new variants will evade immunity and cause a resumption in more serious health problems. • The expiration of the ARPA enhanced premium subsidies will likely cause a decline in enrollment and a worsening of the risk pool, leading to higher premiums. • Medicaid redeterminations could cause an influx of people into the individual market, potentially improving the risk pool and lowering the premiums somewhat . . . Inflation may have some effect on provider costs, but because provider payments lag inflation, real effects might not occur until later plan years. Nevertheless, workforce shortages could put upward pressure on provider payment rates. [Other factors include:] Budget Reconciliation Act (COBRA) subsidies, the probable end to the public health emergency (PHE) and the resumption of Medicaid eligibility redeterminations; costs of new COVID-19 vaccines, testing, and treatments; the impact of long COVID; changes in telehealth and mental health utilization; and high inflation.”
“After the COVID-19 public health emergency ends, there will also be a redetermination of who continues to be eligible for Medicaid, which is currently more widely available because of the PHE . . . people who are no longer able to receive Medicaid will get insurance through their employer, go to the individual marketplace, or become uninsured. . . Overall . . . rates are likely to trend higher with a bigger increase than in the most recent years.”
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
July 13, 14, 15, 18, 19, 20, 21, 26, 27, 28, 29
August, Congress adjourned, no editions of DCMN
September 13, 14, 15, 16, 19, 20, 21, 22, 28, 29, 30
Notes to Fred Hyde, MD, JD, MBA, news@dcmedicalnews.org