DCMedical News: Monday, September 19, 2022
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY Monday, September 19, 2022
The Lancet Commission on COVID-19 Reports
A multi-national effort to summarize lessons from the COVID-19 pandemic, undertaken by The Lancet, has now reported (here, 57 pages; Comment, here). “The Lancet COVID-19 Commission was established in July 2020, with four main themes: developing recommendations on how to best suppress the epidemic; addressing the humanitarian crises arising from the pandemic; addressing the financial and economic crises resulting from the pandemic; and rebuilding an inclusive, fair, and sustainable world.”
“The 28 Commissioners are global experts in public policy, international cooperation, epidemiology and vaccinology, economics and financial systems, sustainability sciences, and mental health. The Commissioners oversaw the work of 12 thematic Task Forces, which met on an ongoing basis (once every 2 weeks or once per month) to support the work of the Commission. These Task Forces included a total of 173 experts.”
The verdict? Not good. 7 million confirmed deaths, 17 million estimated deaths, no consensus on the origin of the pandemic, WHO too cautious, governments in general too slow and uncoordinated, epidemic control hindered by opposition to basic public health measures, dramatically unequal effects of the pandemic on different groups, and money helps. Vaccines were a triumph of science, mitigated by “lack of a multilateral and coordinated approach by governments to manage intellectual property rights, technology transfer, international financing, the allocation of vaccines from multinational pharmaceutical companies, and the support for vaccine production in LMICs [low and middle income countries] for use in those countries.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Financial Bleeding Continues
Poor financial performance in U.S. hospitals continued in the second quarter and into the summer, says the August Kaufman Hall Flash report based on data through July (here), and a special Kaufman Hall study commissioned by the American Hospital Association (here).
In the AHA-sponsored document, KH reports that “Margins remain depressed relative to pre-pandemic levels. After a difficult first half of 2022, optimistic projections for the rest of the year indicate margins will be down 37% relative to pre-pandemic levels. More than half of hospitals are projected to have negative margins through 2022. Projections for the remainder of the year demonstrate an increase in hospitals with negative margins relative to pre-pandemic levels, to 53%. Expenses are significantly elevated from pre-pandemic levels. Expenses are projected to increase throughout the rest of 2022, leading to an increase of nearly $135 billion over 2021 levels. Labor expenses are projected to increase by $86 billion, while non-labor expenses are projected to increase by $49 billion.”
The Bond Buyer (here) reports that “Deepening NFP [Not For Profit] hospital fiscal wounds cast shadow over 2021 recovery.” Note is taken of investment losses by larger hospitals and health systems, including “Recent reported losses from big systems like the Cleveland Clinic, Providence Health, Advocate Aurora Health, UPMC, and Mass General with investment losses driving much of their red ink.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE PLANS
P4P Falls Flat
Researchers publishing in BMC Health Services Research (Springer Nature, BioMedCentral, here) find that the “Pay For Performance” or P4P programs initiated in the Patient Protection and Affordable Care Act, and managed by CMS, have no or negative impact on actual quality of hospital services. [The P4P programs studied together included readmission reduction, hospital acquired conditions and value based purchasing.] “Medicare P4P programs were not associated with consistent improvements in targeted or non-targeted quality and safety measures. Moreover, mortality rates across targeted and untargeted conditions were generally getting worse after the introduction of Medicare’s P4P programs.” Further, “Trends in PSIs [Patient Safety Indicators] were extremely mixed, with five outcomes trending in an expected (improving) direction, five trending in an unexpected (deteriorating) direction, and three with insignificant changes over time. Sensitivity analyses did not substantially alter these results. Conclusions: Consistent with previous studies for individual programs, we detect minimal, if any, effect of Medicare’s hospital P4P programs on quality and safety. Given the growing evidence of limited impact, the administrative cost of monitoring and enforcing penalties, and potential increase in mortality, CMS should consider redesigning their P4P programs before continuing to expand them.”
Big Spenders, But Not Big Out of Pocket Spenders
An AHRQ study on the “Source of Payment Among High Spenders” (here, AHRQ, Medical Expenditure Panel Survey Statistical Brief #540) found that in 2019, Medicare and private insurance paid for more than three-quarters of expenses for people who ranked among the top 5 percent of healthcare spenders (Medicare: 31.3 percent; private insurance: 45.4 percent). Out-of-pocket payments comprised just 7.3 percent of expenses in this group.
DRUGS & DEVICES
Drug Companies Enforcing Their Own Rules in 340B Program
340BHealth, a lobby specifically aimed at hospital interests in the eponymous drug discount program, reports on a new survey (here), demonstrating the impact of drug company refusal to honor discounts hospitals expect. The story to date: “Since July 2020, a growing number of drug companies have imposed limits on 340B discounts on outpatient prescription drugs sold to safety-net hospitals and dispensed to eligible patients through community and specialty pharmacies under contract with the hospital. The federal government has determined that such actions violate the law, but the number of companies imposing such restrictions has more than doubled since the government issued the first enforcement letters.”
Says 340BHealth, 500 hospitals in the most recent survey report that the restrictions imposed to date will cost the median hospital $2.2 million per year.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
September 20, 21, 22, 28, 29, 30
October 11, 12, 13, 14, 17, 18, 19, 20, 21
November 14, 15, 16, 17, 18, 29, 30
Notes to Fred Hyde, MD, JD, MBA, news@dcmedicalnews.org