DCMedical News: Wednesday, July 20, 2022
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY Wednesday, July 20, 2022
Congress continues to grapple with differing views on how to deliver premium subsidies for PPACA plans, how to control the price of prescription drugs, and much more. The August Congressional recess begins July 29.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Another Low Value Treatment? 5 Year Follow Up of Partial Meniscectomy v. Physical Therapy Shows No Difference
A summary of past work: “In a previously published randomized trial, arthroscopic partial meniscectomy was compared with 16 exercise-based physical therapy (PT) sessions in 321 Dutch patients (mean age, 58) who had degenerative meniscal tears of the knee (JAMA 2018; 320:1328). Patient-reported functional outcomes in the two groups were similar after 2 years of follow-up.”
Now, the five year follow up, in JAMA Network Open (here). “In this noninferiority randomized clinical trial, no significant or clinically relevant between-group difference in patient-reported knee function was noted on the International Knee Documentation Committee Subjective Knee Form at the 5-year follow-up. Physical therapy was not inferior to arthroscopic partial meniscectomy . . . The findings of this trial support the recommendation that exercise-based physical therapy should be the preferred treatment over surgery for degenerative meniscal tears.”
Interoperability: the FTC and the NLRB
The National Labor Relations Board (NLRB) and the Federal Trade Commission (FTC) executed a Memorandum of Understanding (MOU) (here) forming a “partnership between the agencies that will promote fair competition and advance workers’ rights . . . The MOU identifies areas of mutual interest for the two agencies, including: labor market developments relating to the ‘gig economy’ such as misclassification of workers and algorithmic decision-making; the imposition of one-sided and restrictive contract provisions, such as noncompete and non-disclosure provisions; the extent and impact of labor market concentration; and the ability of workers to act collectively.”
“Workers in this country have the right under federal law to act collectively to improve their working conditions. When businesses interfere with those rights, either through unfair labor practices, or anti-competitive conduct, it hurts our entire nation,” said NLRB General Counsel Jennifer A. Abruzzo. “This MOU is critical to advancing a whole of government approach to combating unlawful conduct that harms workers.”
In the spring, the FTC unveiled an initiative (New York Times report here) to use antitrust authority to protect worker’s pay. From the Times, “In a first, the Justice Department has brought a series of criminal cases against employers for colluding to suppress wages. The push started in December 2020, under the Trump administration, with an indictment accusing a staffing agency in the Dallas-Fort Worth area of agreeing with rivals to suppress the pay of physical therapists. The department has now filed six criminal cases under the pillar of antitrust law, the Sherman Act, including prosecutions of employers of home health aides, nurses and aerospace engineers.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
FTC Blocks Hospital Combinations, More to Come
Kaiser Health News and USA Today publish (here) an analysis of recent and anticipated future actions by the Federal Trade Commission to block hospital and health system business combinations. “Fresh off the Federal Trade Commission’s successful challenges to four hospital mergers, the Biden administration’s new majority on the commission is primed to more aggressively combat consolidation in the health care industry than it has in past years.”
Also, “Although hospital mergers were supposed to improve cost efficiency, experts [now!] agree that the creation of huge conglomerates and hospital networks has driven up U.S. medical costs, which are by far the highest in the world. Many enjoy near-monopoly pricing power.”
“The trade commissioners say this is a key way to slow health care price increases; protect patient access to and the quality of care; and prevent employee layoffs, pay cuts, and unfair labor practices.”
“Under the FTC’s traditional economic theory, high prices in a region should attract new competitors and that competition will bring down prices. But regulatory hurdles and massive costs involved in setting up a health care network — which includes hospitals and doctors, as well other aspects like testing facilities — make such movement unlikely, if not impossible. So Biden appointees at the FTC and Department of Justice have announced that they want to adopt some legal theories of antitrust enforcement that have been less frequently deployed.”
In January, the two agencies launched a joint effort (here) seeking public comment on ways to strengthen enforcement against mergers that could result in societal harm.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Got Cancer? On Medicaid? Don’t Come Here
A “secret shopper” study published in JAMA Network Open (here, separate commentary on structural racism in cancer care here) found that only two-thirds of nationally recognized cancer centers would accept new patients with Medicaid coverage in all four common cancer diagnoses. “Medicaid acceptance differed by cancer site, with 319 facilities (95.5%) accepting Medicaid insurance for breast cancer care; 302 (90.4%), colorectal; 290 (86.8%), kidney; and 266 (79.6%), skin.”
“Comprehensive community cancer programs were significantly less likely to provide high access to care for patients with Medicaid. Facilities with nongovernment, nonprofit (vs for-profit) and government ownership, integrated salary models, and average (vs above-average) or below-average (vs above-average) effectiveness of care were associated with high access to Medicaid.”
The authors note, “We found that organizational and financial characteristics of facilities were drivers of Medicaid access. Comprehensive community cancer programs, or programs that assess 500 or more newly diagnosed cancer cases annually, were less likely to accept Medicaid. This finding is concordant with trends in literature, which show that patients with Medicaid may face significant financial and logistic barriers to care and are less likely to receive surgical care at high-volume centers.”
“Given that patients with Medicaid typically have complex health needs, worse outcomes, and lower reimbursement rates, performance and revenue-conscious facilities with access to more favorably insured patients may continue to exercise greater selectivity and exclude patients with Medicaid. Reduced access to high-volume centers may, in turn, generate self-fulfilling cycles of adverse outcomes for patients with Medicaid. Greater complexity may also contribute to the below-average effectiveness of care of high-access facilities. Academic, NCI-designated, and integrated network cancer programs also had lower access for patients with Medicaid. Reduced access in these settings may serve to limit clinical trial participation and magnify racial and ethnic disparities in cancer care.”
Medicare July 2022 Data Book
MedPAC has published its annual data book on health care spending and the Medicare program (here). In 208 pages the detailed study summarizes the work of Medicare as the largest single payer (22%) of the nation’s $3.4 trillion health bill in 2020 (all commercial health insurers account for 30%), with commensurate impact on the organization, structure and working of the American health care system.
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 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