DCMedical News: Wednesday, July 13, 2022
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY Wednesday, July 13, 2022
Abortion, HHS, the Senate and the House Are Involved
HHS Secretary Becerra has invoked the Emergency Medical Treatment and Active Labor Act (EMTALA) in a letter to providers (here) indicating that, in a medical emergency, “The federal EMTALA statute protects your clinical judgment and the action that you take to provide stabilizing medical treatment to your pregnant patients, regardless of the restrictions in the state where you practice.”
Further, “Emergency medical conditions involving pregnant patients may include, but are not limited to, ectopic pregnancy, complications of pregnancy loss, or emergent hypertensive disorders, such as preeclampsia with severe features. Any state laws or mandates that employ a more restrictive definition of an emergency medical condition are preempted by the EMTALA statute.”
“The course of treatment necessary to stabilize such emergency medical conditions is also under the purview of the physician or other qualified medical personnel. Stabilizing treatment could include medical and/or surgical interventions (e.g., abortion, removal of one or both fallopian tubes, anti-hypertensive therapy, methotrexate therapy etc.), irrespective of any state laws or mandates that apply to specific procedures.”
“Thus, if a physician believes that a pregnant patient presenting at an emergency department, including certain labor and delivery departments, is experiencing an emergency medical condition as defined by EMTALA, and that abortion is the stabilizing treatment necessary to resolve that condition, the physician must provide that treatment.”
The Congress is also busy. CQ reports “The [Senate] Judiciary hearing is the first of five congressional hearings on the aftermath of the Dobbs v. Jackson Women's Health Organization decision to be held over an eight-day period. The Senate Health, Education, Labor and Pensions, House Oversight and Reform, House Judiciary and House Energy and Commerce committees will also have hearings in the coming days. Each committee’s examination of the ruling is expected to be slightly different, with Judiciary looking at the legal ramifications of letting all states limit abortions pre-viability for the first time since the 1973 Roe decision. The administration has hesitated to immediately implement some of the actions called for by advocates, including instituting a public health emergency or using federal property to operate abortion clinics.”
House Members Reps. Ocasio-Cortez and Lieu have petitioned Senate Majority Leader Schumer (letter here) to have Supreme Court Justices Gorsuch and Kavanaugh declared liars, on grounds that their confirmation testimony on the issue of abortion is at complete odds with their subsequent actions. From their letter, “Our Constitutional Republic requires that the Justices of the third branch of government tell the truth during their confirmation hearings. Their power comes from a public willing to believe in their integrity. Justices who lie to the American people in order to get confirmed shred the legitimacy of the Supreme Court. According to a June 20, 2022, Gallup poll, public confidence in the Supreme Court has now sunk to 25 percent, the lowest in recorded history.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Calendar Year 2023 Medicare Physician Fee Schedule Proposal
CMS has published its proposal (Federal Register pre-publication of 2066 pgs. here, 16 pg. “fact” sheet here, 2 pg. news release here) for Medicare payment of physician fees in 2023, together with miscellaneous other payment proposals. The calendar year (CY) 2023 Physician Conversion Factor [which is multiplied by the appropriate Relative Value Unit to reach the sum to be allowed as payment for each RVU-related coded service] is $33.08, a $1.53 reduction from the CY 2022 Physician Conversion Factor of $34.61, according to a fact sheet. In the fact sheet CMS notes that the reduction reflects the combination of (a) the statutory update to the conversion factor for CY 2023 of 0%, (b) the expiration of the 3% increase in PFS [Physician Fee Schedule] payments for CY 2022 as required by the “Protecting Medicare and American Farmers From Sequester Cuts Act,” and (c) budget neutrality (“Pay-Go”) adjustments.
The proposed rule also includes other policy proposals, including expansion of behavioral health services. Specifically, CMS is proposing to allow licensed professional counselors, marriage and family therapists, and other types of behavioral health practitioners to practice under general (rather than direct) supervision and to pay for clinical psychologists and licensed clinical social workers to provide “integrated behavioral health services.” The proposed rule will be formally published July 29 in the Federal Register with comments due 60 days after that.
Racism and Health Care
Health care polling expert Robert Blendon and Harvard colleagues ask, “Does racism impact healthcare quality? Perspectives of Black and Hispanic/ Latino Patients” in Healthcare (here), and find that “Analysis of a 2020 nationally representative sample of 1003 U.S. Black and Hispanic/Latino households shows that experiencing racism in healthcare is associated with significantly worse quality of healthcare and lower trust in doctors reported by patients.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Is Hospital Safety Improving?
A study by Eldridge and colleagues in JAMA (here) of more than 190,000 hospital discharges, comparing results in 2010 to those in 2019, found that “There was a significant decrease in the rates of adverse events abstracted from medical records for patients admitted for acute myocardial infarction, heart failure, pneumonia, and major surgical procedures and there was a significant decrease in the adjusted rates of adverse events between 2012 and 2019 for all other conditions.”
A commentary in the same issue, however, by William Padula and Peter Provonost (here), says the study is “an unfortunate reminder that adverse events remain unacceptably frequent . . . Even though the authors reported statistically significant decreases across adverse events from 2010 through 2019, patients may be less convinced that risk-adjusted annual declines of 6% in the rates of acute myocardial infarction or pneumonia, for instance, imply that hospitals are adequately safer today.”
Padula and Provonost cite, in the other direction, AHRQ studies showing “specific adverse events have increased nationally between 2014 and 2017 (e.g., surgical site infections have increased 8%, pressure injuries have increased 6%)” and the defunding in 2018 of the National Guideline Clearinghouse.
As to the cost of such progress as has been made, “The US spent an estimated $282 billion in 2019 on initiatives to improve quality. Translated to the steepest marginal declines observed in the report by Eldridge et al, this could represent a staggering approximately $47 billion per 1% reduction in adverse events.”
Change in C-Section Rates
The National Vital Statistics System of the CDC has published (here) “Changes in Primary and Repeat Cesarean Delivery: United States, 2016–2021.” In summary, not much.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Payers for Maternal Emergency Department Care
A study by the Hospital Cost and Utilization Project (H-CUP, here) finds that “Medicaid was the primary expected payer for more than half of treat-and-release emergency department (ED) visits and costs for pregnant women versus just over one-third of ED visits and costs for nonpregnant women aged 12–55 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 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