DCMedical News: Wednesday, July 27, 2022
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY Wednesday, July 27, 2022
Reconciliation and Drug Price Controls
InsideCMS reports that [President] “Biden on Friday said he’s ready to sign a scaled-back reconciliation package prior to August that includes the drug-pricing deal agreed to by Democrats and extends the enhanced ACA subsidies” [see DCMN 7-26-22]. STAT+ reports (here) that “Democrats are closer than ever before to finally achieving a goal they’ve been pursuing for nearly two decades — allowing Medicare to negotiate prescription drug prices. Skeptical lawmakers seem to be on board; the bill text is already under review by the Senate’s rules referee. Congressional leadership and the White House have come up with a plan to barrel toward a vote.”
DOCTORS, NURSES & OTHER HEALTH PROFESSIONALS
Behavioral Health Intervention for Prevention of Cardiovascular Disease
JAMA Cardiology publishes (here) a series of articles on the use of behavioral health to mitigate or prevent cardiovascular disease. “The US Preventive Services Task Force (USPSTF) has published an updated recommendation statement on behavioral counseling interventions to promote a healthy diet and physical activity for cardiovascular disease (CVD) prevention in adults without CVD risk factors . . .The USPSTF recommends that clinicians individualize the decision to offer or refer adults without CVD risk factors to behavioral counseling interventions,” but only as a “C” recommendation. Randomized clinical trials for persons with known CVD risk, reported in JAMA (here), found that “Healthy diet and physical activity behavioral counseling interventions for persons without a known risk of CVD were associated with small but statistically significant benefits across a variety of important intermediate health outcomes and small to moderate effects on dietary and physical activity behaviors. There was limited evidence regarding the long-term health outcomes or harmful effects of these interventions.”
The Surgical Care Coalition and the Calculation of Reduced Physician Reimbursement for CY 2023 in Medicare
This coalition of physician associations notes that “If Congress does not take action to avert the additional 4% Medicare payment reduction due to statutory pay-as-you-go (PAYGO) requirements, surgeons and anesthesiologists will be cut by almost 8.5% in 2023. This would be on top of the 2% sequestration cut, which resumed earlier this month, and the ongoing devaluation of the global surgery codes.” The outline, the method for fee calculations and the impact of PAYGO, sequestration and budget neutrality are examined in three publications by the group, here, here and here.
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
“Cancer Centers” Pushing Screening, or Preventing Disease
A report (here) in The New York Times explores the financial motives and patient consequences of aggressive screening for cancer.
When the Shooting Starts
At Saint Francis in Tulsa, Oklahoma, “As building occupants immediately fled or hid, staff in a downstairs surgical suite quickly moved 2 recovering patients into an operating room and barricaded the doors. Turning out the lights and silencing their phones, they waited for the all clear. Neither patient in their care was injured.” The chronicle of this event, and links to useful resources, here, in JAMA.
Hospitals in NY Garnish Wages of Low Income Patients
The Community Service Society of New York reports (here, also news as reported in Gothamist, here) “In New York, private nonprofit hospitals are going to extraordinary lengths to recover unpaid debts from their patients – including taking a chunk out of their wages. Wage garnishment often affects low-wage workers . . . And the hospitals that engage in the practice don’t necessarily assess whether a patient qualifies for financial aid first, the report found.” Of the state’s 212 nonprofits, “112 New York hospitals sued 53,182 patients in civil courts between 2015 and 2020, with lawsuits taking place in every county. The Bronx, Brooklyn, Manhattan and Queens were among the 15 counties most affected.”
340B Hospitals Deliver on Uncompensated Care
A report in RevCycleIntelligence (here) says “Despite experiencing negative operating margins, 340B disproportionate share (DSH) hospitals provided 67 percent of all uncompensated care in 2020.” In a report from Dobson commissioned by 340BHealth (here), “Researchers used FY 2019 and FY 2020 Medicare hospital cost reports to compare financial metrics of 340B DSH hospitals to those of acute care hospitals that did not participate in the 340B drug pricing program . . . 340B DSH hospitals saw a 74 percent decrease in operating margins between FY 2019 and FY 2020, going from -3.5 percent to -6.1 percent. . . During the same period, operating margins for non-340B hospitals increased from 2.9 percent to 3.5 percent.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Medicaid and CHIP Growth During the Pandemic
From February 2020 to March 2022 Medicaid enrollment grew by 17 million (27%), CHIP by 261,552 (4%), according to the National Association of Medicaid Directors (here).
“Birthing-Friendly” Hospitals and Maternal Health: Will CMS Initiatives Work?
CMS has announced its program (here) to address maternal morbidity and mortality. Adding to measures encouraging the states to extend post-partum coverage for a year, CMS has also begun to expand quality reports. “In 2021, CMS finalized a rule requiring hospitals to report to CMS whether they have participated in a maternity care quality collaborative, and if so, whether they have implemented best practices to improve maternity care quality, such as initiatives to reduce maternal hemorrhage or sepsis . . . In April 2022, CMS proposed to add two additional maternal health quality measures to the Hospital Inpatient Quality Reporting Program, both of which are electronic clinical quality measures. A measure of severe obstetric complications, which describes the number of inpatient hospitalizations for patients with severe complications occurring during the delivery hospitalization, such as hemorrhage. A measure of low-risk Cesarean section rates, which describes the share of patients with low-risk pregnancies who give birth via a Cesarean section.”
Also in April, CMS proposed to create a “Birthing-Friendly” hospital designation. “The purpose of this designation is to create a consumer-friendly display indicating hospital commitment to improving maternal health outcomes through participation in maternity care quality activities. The designation would be displayed on a CMS website. Under this proposal, CMS would give this designation to hospitals that report ‘yes’ to both questions in the Maternal Morbidity Structural measure. In the future, CMS may consider a more robust set of criteria that may include other maternal health-related measures for awarding the designation.”
Multi-year attempts to measure, control and reward value, however, have yielded little, as assessed by Kip Sullivan and colleagues in STAT (here). “The value-based payment crusade is now two decades old. But despite the tens of billions of dollars — perhaps hundreds of billions — spent on these programs, they have done little to improve Americans’ health or lower health care costs. It is time for proponents of value-based care to call a halt to these programs until they have an answer to this question: ‘Why have the vast majority of value-based payment experiments failed to improve value?’”
READING & REFERENCES
Select Coronavirus Public Health Resources and References may be found here.
Monkeypox resources, CDC (here), JAMA Patient Page (here).
Side-by-Side Overview of Therapeutics Authorized or Approved for the Prevention of COVID-19 Infection or Treatment of Mild-Moderate COVID-19 (here).
2022 CQ Congressional Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
July 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