DCMedical News: Thursday, July 28, 2022
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY Thursday, July 28, 2022
Reduce the Deficit, Control Inflation, Fix the Climate, Lower Medicare Drug Prices—and Extend Obamacare Premium Subsidies, In One Bill
CQ reports (here) that “The Senate plans to begin floor consideration of a roughly $300 billion deficit-reducing budget reconciliation package next week after Sen. Joe Manchin III and Majority Leader Charles E. Schumer announced a surprise agreement Wednesday to add climate and tax provisions Manchin previously shunned . . . The bill, which they’re dubbing the ‘Inflation Reduction Act of 2022,’ would devote $369.8 billion to clean energy and climate change programs and would extend the expanded health insurance subsidies for three years instead of two. The measure would preserve the prescription drug pricing deal Manchin and Schumer had previously agreed to, while the remainder would be paid for, and then some, ‘by closing tax loopholes on wealthy individuals and corporations,’ according to the joint statement.”
The Hill reports (here) that the bill “Would raise $739 billion in new revenue through a variety of proposals . . . $313 billion through a 15-percent corporate minimum tax, $288 billion from empowering Medicare to negotiate lower drug prices, $124 billion from strong IRS enforcement of tax law and $14 billion from closing the carried interest loophole for money managers.” The report added, “The newly crafted budget reconciliation deal is a fraction of the size of the $1.75 trillion framework that the White House unveiled in October with the belief that Manchin would support it. Its price tag also falls far below the $3.5 trillion spending blueprint Senate Democrats passed as part of their budget resolution a year ago.”
The text of the bill, 725 pgs., is here.
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Hospital Financial Assistance as Vendor Financing
Criticism of hospital charity care policies (here, from The Wall Street Journal), and responses to that criticism (here, from the American Hospital Association), may overlook the role of financial assistance to patients as “vendor financing.”
Researchers publishing in an NBER working paper (“The Impact of Financial Assistance Programs on Health Care Utilization” here), found that “Financial assistance significantly increases health care utilization. . . Financial assistance also increases the detection of and medication refills for treatment-sensitive conditions, suggesting financial assistance may increase receipt of high-value care.”
Specifically, “Patients who were eligible for the program received more diagnostic tests than similar patients who didn’t receive assistance, and these tests revealed instances of heart disease, diabetes and other serious conditions that, if caught early, can be controlled. The analysis also showed increased use of prescription drugs for the treatment of high cholesterol, diabetes and depression . . . financial assistance increases the use of high-value care for at least some patients.”
“An applicant approved for financial assistance is 3.6 percentage points more likely to have an inpatient stay than a patient who doesn’t receive assistance; 13.4 percentage points more like to have outpatient treatment; and 6.7 percentage points more likely to visit the ER. Recipients also were more likely to receive lab tests. Thanks to the increased amount of testing, there’s a greater likelihood of identifying an abnormal health condition. Participants are twice as likely to have a test that identifies high cholesterol and therefore increases the use of cholesterol-lowering drugs. Financial assistance increases utilization for drugs to treat depression by about one-third.”
FY 2023 IPPS Rate Increase Too Low
In a letter (here) to the Centers for Medicare & Medicaid Services (CMS) administrator, 112 bipartisan House members said payment updates to the hospital inpatient prospective payment system (IPPS) proposed rule for fiscal 2023 were not enough.
Overlapping Anesthesia: Probably Not a Good Idea
A study in JAMA Surgery (here) finds that “Increasing overlapping coverage by anesthesiologists is associated with increased surgical patient morbidity and mortality. Therefore, the potential effects of staffing ratios in perioperative team models should be considered in clinical coverage efforts.”
Cerner VA EMR Roll-Out Puts Spotlight on “Hidden Harms” of Electronic Medical Records Systems
STAT+ reports (here) that “The rollout of Cerner’s electronic health record in Veterans Affairs hospitals has been a high-profile struggle: outages, training troubles, and now, an alarming report showing it directly harmed scores of patients. And while the system’s stumbles are noteworthy, they’re far from rare. Health informatics and patient safety experts acknowledge that electronic health records regularly break, in ways big and small — and largely, those problems and the harms they cause go unrecorded.”
STAT+ continued, “When the Boeing 737 MAX crashed, it made the news because 300 people died all at once,” said Dean Sittig, a biomedical informatician at the UTHealth Houston School of Biomedical Informatics, who has been involved in EHR deployments for multiple health systems. ‘With the EHR, it’s spread out all over the country. It’s very difficult to separate the people that were going to die from the people that died because of an error.’”
“The VA EHR rollout is an uncommonly transparent look at those failures, and the ways even small problems in a technical rollout can have dramatic impacts on patients.” A report from VA’s Office of Inspector General (here) found that more than 11,000 requests for clinical orders in the new Oracle-Cerner EHR at one medical center ended up in a digital no-man’s land called the “unknown queue.” Those overlooked orders resulted in 149 cases of patient harm.
STAT+ noted that “There are likely far more EHR errors than the public ever hears about . . . There are no dedicated national systems to report issues, and hospitals aren’t necessarily incentivized to investigate or make problems.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
InsideHealthPolicy reports (here) that “CMS finalized three fiscal 2023 pay rules on Wednesday, projecting higher pay rates than previously proposed for hospices at 3.8%, inpatient psychiatric facilities at 2.5% and inpatient rehabilitation facilities at 3.2% compared to this year.” In addition, “CMS also finalized in each rule policies meant to mitigate the impact of year-to-year payment changes, putting in place a permanent 5% cap on annual wage index decreases for inpatient psychiatric facilities and inpatient rehabilitation facilities as well as a 5% hospice payment cap on any decrease to a geographic area’s wage index.”
DRUGS & DEVICES
The Financial Times (here) reports that the return of common viruses after the coronavirus pandemic—and COVID-19 becoming “part of everyday life”—have “sparked a boom in sales of over-the counter cold and flu medicines.
The manufacturers of Mucinex and Nurofen, as well as Haleon, the over-the-counter spinoff of GSK (Panadol, Theraflu, Contac), both reported sharp increases in sales. The story notes that “COVID-19 is in the process of moving” from pandemic to endemic status, with researchers at the Yale School of Medicine “saying it could be reached [in] as soon as two years’ time.”
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 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