DCMedical News: Tuesday, July 19, 2022
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY Tuesday, July 19, 2022
Heat, Health and Hospitals
The Washington Post reports (here) that “Climate change is pushing hospitals to [a] tipping point.”
“When an unprecedented heat wave baked the Pacific Northwest last July, emergency rooms sought any way possible to lower the core body temperatures of patients coming in droves with heat-related ailments. Many emergency departments in the region began putting people in body bags filled with ice to help safely adjust their temperatures. But despite their lifesaving efforts, around 1,000 excess deaths occurred from the brutal heat.”
“The scramble to save lives paints the challenging reality that many hospitals and medical workers are facing again this year as severe weather-related health emergencies escalate because of extreme climate events. ‘We unfortunately had a real live stress test here for the Pacific heat dome because the temperatures were so high and we had a 69-fold increase in hospital-related presentations,’ said Kristie L. Ebi, the founder of the center for health and global environment at the University of Washington . . . At the same time, the health care sector contributes significantly to the worsening climate crisis, representing nearly 8.5 percent of all U.S. emissions.”
Heat in Hospitals, England
A report in The BMJ (here) notes “NHS trusts across England reported 4131 incidents between April 2020 and March 2021 when ward or other clinical area temperatures rose above 26°C—the point at which, according to NHS England’s heatwave plan, a risk assessment needs to be conducted and vulnerable patients protected.”
“Almost half, 104, of the 216 NHS trusts in England reported at least one overheating occurrence in 2020-21. And as temperatures are soon expected to hit record highs across the country, incidents of dangerous temperatures could get worse . . . The three heatwaves the UK experienced in the summer of 2020 resulted in 2556 excess deaths—more than the 2003 heatwave that triggered the plan to be drawn up . . . In 2021, the eight days that a level 3 heatwave alert was active caused 915 excess deaths.”
“Hospitals’ heat problems stem in part from the age of the infrastructure. A third of the NHS estate was built before 1965, and 14% before the foundation of the NHS in 1948, according to a 2020 National Audit Office report. With age comes problems. ‘High risk backlog maintenance’—issues that require urgent fixes to prevent catastrophic failure and disruption to clinical services—rose 139% between 2014-15 and 2018-19.”
Medical and Public Health Reports on Health and Climate Change
The latest edition (October 20, 2021) of The Lancet “Countdown on Health and Climate Change” is here. An introduction to the New England Journal of Medicine series on fossil fuel pollution and climate change is here.
HHS is sponsoring (here) voluntary hospital and health system commitment to mitigation of climate damage. “U.S. hospitals, health systems, suppliers, pharmaceutical companies and other industry stakeholders are invited to submit pledges to reduce greenhouse gas emissions and increase their climate resilience . . . The voluntary pledge asks signees to, at a minimum, commit to: (1) reducing their organization’s emissions (by 50% by 2030 and to net zero by 2050) and publicly reporting on their progress; (2) completing an inventory of Scope 3 (supply chain) emissions; and (3) developing climate resilience plans for their facilities and communities. It also asks them to designate an executive lead for this work.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Price Variation in Top Cardiovascular Hospitals—Just as Wacky as Price Variation in Other Hospitals
A study in JAMA Internal Medicine (here) of variation in prices for common cardiovascular tests and procedures focused on the 20 top-rated hospitals by USNews&WorldReport. “We chose these hospitals because they likely have resources to comply with the [price transparency] law and because we wanted to compare prices across hospitals with similar characteristics . . . We extracted payer-specific and self-pay cash prices for noninvasive (transthoracic echocardiogram, nuclear stress test) and invasive (right heart catheterization [RHC], diagnostic coronary angiogram, percutaneous coronary intervention [PCI], and pacemaker implantation) cardiovascular tests/procedures using Current Procedural Terminology codes.”
“To examine between hospital price variation, we determined the median negotiated price for a specific cardiovascular test/procedure across all payers at each hospital, then compared median prices across institutions. To evaluate within-hospital price variation, we compared the IQR of prices for each test/procedure across payers at each hospital. We included both commercial and public (e.g., Medicare and Medicaid) payers.” [Interquartile range (IQR) is a measure of statistical dispersion, which is the spread of the data. It is defined as the difference between the 75th and 25th percentiles of the data.]
Results: “Of the top 20 US hospitals, 19 (95%) hospitals posted a machine-readable file to their websites, 16 (80%) reported prices for some cardiovascular tests/procedures, and only 7 (35%) reported prices for all cardiovascular tests/procedures . . . Across hospitals, the median price ranged from $204 to $2588 for an echocardiogram and from $463 to $3230 for a stress test. The median price ranged from $2821 to $9382 for an RHC, $2868 to $9203 for a coronary angiogram, $657 to $25,521 for a PCI, and $506 to $20,002 for pacemaker implantation.”
“Within hospitals, the largest IQR of payer-specific prices was $470 to $3022 for an echocardiogram and $776 to $347 for a stress test. The largest IQR was $3143 to $12,926 for an RHC, $4011 to $14,486 for a coronary angiogram, $11,325 to $23,392 for a PCI, and $8474 to $22,694 for pacemaker implantation.”
“We observed a 10-fold difference in the median price of an echocardiogram and a greater than 3-fold difference in the median price of a diagnostic coronary angiogram across top hospitals . . . Even within the same institution—where tests and procedures should require similar resources and be of similar quality—prices across payers varied substantially.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Fake Reimbursement News
STAT+ (here) is calling out UnitedHealth on misleading claims that their (or other) Medicare Advantage plans save money for the Medicare program. “UnitedHealth Group says Medicare Advantage saves money, but the data say otherwise — a seeming effort to prevent changes to the program . . . This past June, UnitedHealth Group’s top two executives, Andrew Witty and John Rex, told a crowd at an investor conference that Medicare Advantage — the booming government program that outsources Medicare coverage to health insurance companies — saves the federal government money. But Witty’s and Rex’s claims don’t hold water.”
“Total federal payments to Medicare Advantage plans have been about 104% of traditional Medicare payments since 2018 and even higher in years prior, according to the Medicare Payment Advisory Commission . . . ‘Our review of private plan payments suggests that over a 37-year history, the many iterations of full-risk contracting with private plans have never yielded aggregate savings for the Medicare program,’ MedPAC’s commissioners wrote in their March report to Congress.” Much of the controversy stems from a report by the actuarial firm Milliman, paid for by the “Better Medicare Alliance,” whose “end goals have been to win over investors and policymakers and prevent drastic changes to the $420 billion program. But those advocating for Medicare Advantage often leave out the program’s profitable business model, allegations of fraud, tradeoffs for patients, and murky fine print.”
READING & 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 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