DCMedical News: Thursday, September 22, 2022
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY Thursday, September 22, 2022
Continuing Resolution
“Government shutdown” like “nuclear war” is in the headlines. The federal fiscal year ends next Friday, the 30th, and a “Continuing Resolution” (CR) is proposed to keep the government running. Continuing resolutions (CRs) are joint resolutions that provide continuing appropriations for part or all of a fiscal year. A CR that covers only a part of a fiscal year is referred to as a "short-term" CR, and a CR that covers a full fiscal year is referred to as a "full-year" CR (congress.gov). The last time Congress was able to maintain government operations without a CR was 1996. Government shutdowns have come in 1995-1996 (21 days), 2013 (6 days) and January 2018 (3 days).
The challenge for Congress is to pass a CR, which some Members say they will not support unless the CR includes their cause, and others say they will not support if the CR includes any unrelated proposals, that is, unrelated to the business of funding current government expenditures until political conditions are such that a more measured approach could be debated, and perhaps taken.
The Congressional Budget Office offers (here) a summary of the outlays and revenues of the federal government in 2021. In that year, government outlays were $6.8 trillion, about 30% of the Gross Domestic Product (GDP), of which 10% ($689 billion) was for Medicare, and 7.6% ($521 billion) for Medicaid. Government revenues, unfortunately, were less, at $4 trillion. The deficit of $2.8 trillion was 12.4% of GDP, compared to an average deficit of 3.5% of GDP per year over the past half century.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Cardiologist Compensation Boosted by Hospital Ownership, More Work With APPs, More Patients, More Hospitalists
MedAxiom, an affiliate company of the American College of Cardiology, has reported (here) on compensation and utilization in cardiology practices for 2021. Becker’s reports (here) that “Interventional cardiologists are the top earners among all cardiologist subspecialties,” based on “data from nearly 200 cardiovascular programs representing 5,700 total cardiovascular providers.”
The ten-year period ending in 2021 saw a dramatic upswing in the number of cardiologists “integrated” with a hospital or health system. At the same time, however, the productivity of cardiologists diverged by ownership status, with private practice cardiologists increasing wRVUs (work Relative Value Unit, a standard unit of production in medical services) 16%, while those “integrated” with hospitals saw only a 4% increase over the same ten-year period.
Part of the increase in utilization, in turn, was made possible by an increase in the number of cardiology patients, up 25% in the 10 year period, and by a 67% increase in the use of Advance Practice Providers. Advanced imaging volume per cardiologist was up 311%, and hospital admissions were down.
From the report, “Cardiologists are much less likely to be the admitting physicians for hospital patients in 2021 than they were in 2011. Median hospital discharges per FTE cardiologist have plummeted 75% in that timeframe, from 73 discharges per physician in 2011 to 18 in 2021. This highlights the expanded role of hospitalists in the hospital setting and a conscious move by many cardiology groups to shift to a more consultative role.”
Here is the median compensation per full-time employee among cardiology subspecialties:
Interventional cardiologists: $694,967
Electrophysiologists: $686,209
Invasive cardiologists: $644,146
Advanced heart failure physicians: $572,488
General noninvasive cardiologists: $559,467
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE PLANS
MedPAC Reviews Fight to Obtain Encounter Data from Medicare Advantage Plans
At its September 1-2 meeting, MedPAC, the Congressional advisory body, reviewed the long history of attempts by CMS to obtain “encounter data” (as opposed to projections or estimates) of utilization from Medicare Advantage plans. The efforts began in 1997, “but efforts were abandoned” until 2008, and actual data collection began in 2012. The group was told that, this year, 2022, is the first in which all MA enrollee diagnoses used for risk scores come from encounter data.
As a result of the data collection challenges, MedPAC staff in their presentation (here) noted that $350 billion per year is being spent on MA plan enrollees, that there is “little understanding of service use,” that CMS makes (each year) $10 billion + in “quality payments,” but that the “quality data is not meaningful,” and that there is “little visibility” on the spending of $50 billion per year by the MA plans on “extra benefits.”
DRUGS & DEVICES
After All That “Pharmaceutical Innovation” . . .
A “thought experiment” survey (here) sponsored and analyzed by Sensible Medicine, a new (and free, so far) substack newsletter, asks “Which 20 drugs would practitioners take to a desert isle?”
The top 20 MVPs (Most Valuable Pills) are discussed, with rationale for each as given by participating practitioners. “What drugs, currently available today, do you think are really the most useful? Imagine a world where you could only have 20 drugs to provide the care for your patients. Assume cost is NOT an issue and one can use all available dosage forms. Which ones would be in your list?”
At the end of the list, and following explanations for the use of each drug, the authors conclude “Amazingly, the mean date of release/patenting of these 20 medications was the mid-1950s (before any of us were born).”
Not included on the list: statins. “While statins represent one of the most frequently used medications in the world, we felt despite the fact they very likely do reduce the risk of cardiovascular disease they really provide no additional benefit on any symptomatic conditions. We do realize statin’s exclusion will likely expose us to the wrath of those people who believe statins should be in the water supply.”
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
September 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