DCMedical News: Wednesday, September 28, 2022
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY Wednesday, September 28, 2022
Congress Winds Down. The Market Winds Down Also, Except for Healthcare Investment
CQ reports that “The path to averting a partial government shutdown by Friday night just became a little easier to see after a key procedural vote in the Senate showed broad bipartisan support for a temporary spending bill. [HR 6833 here, section-by-section analysis here.] The Senate voted 72-23 Tuesday to end debate on the motion to proceed to the continuing resolution, after top Democrats said they'd drop a contentious environmental policy rider that had drawn critiques from the right and left.” Without the continuing resolution, government funding stops midnight Saturday. With it, government funding continues to December 16. “The bill's new Dec. 16 deadline would create pressure for a lame-duck omnibus spending deal as well as agreements on numerous other pieces of unfinished business.”
Still unfolding: analysis of the health-related provisions of the Inflation Reduction Act. A 35-page summary from HFMA is here.
Seeking Alpha reports (here) that investors are favoring healthcare in the current market decline. “Investors have been pouring money into healthcare stocks at one of the fastest clips since 2008 as players move into defensive sectors amid a tumbling equities market . . . Customers made the biggest net buys in the healthcare sector, which saw its fifth-largest weekly inflow since 2008. All told, B of A clients have been adding money to healthcare for six consecutive weeks after pulling money out for much of 2022.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Inflation-Adjusted RN Wage Rates Show California at the Top, New York Near the Bottom (44 of 50)
Becker’s (here) and the Missouri Economic Research and Information Center (here) publish an exhibit which adjusts average hourly wages for RNs (from the Bureau of Labor Statistics) to demonstrate the impact of state-specific cost of living on those wages. California’s $59.62 per hour becomes $42.65 per hour after cost of living adjustment, but is still at the top position in the listing. New York’s $44.86 becomes $32.79 per hour after adjusting for that state’s cost of living, falling to 44th on an ordinal ranking of the 50 states. “Hawaii's sky-high living expenses means that even though it pays RNs the second-most of any state [$51.22 per hour], after adjusting for cost of living, RNs there make the least of any state [$26.97 per hour].”
HOSPITALS, NURSING HOMES AND OTHER HEALTH FACILITIES
Mass General Brigham and Hospital Cost Reduction in Massachusetts
Modern Healthcare (here) reports that “The Massachusetts Health Policy Commission on Tuesday unanimously approved Mass General Brigham’s 18-month plan to curb excessive spending. In January, the commission ordered Mass General to come up with a performance improvement plan after it exceeded the commission's spending growth benchmark by $293 million from 2014 to 2019 . . . This is the first time the commission went through the approval process for a performance improvement plan . . . The largest portion of savings, $90 million a year, would come from changes in commercial pricing strategies, such as shifting pricing at outpatient facility MG West to a community hospital rate schedule.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Comprehensive Primary Care +
A federal initiative, previously discounted for any impact it might have on Medicare payments, has now been found in one study (here) to have no impact on commercial health insurance rates, or quality of care. “Comprehensive Primary Care Plus (CPC+) was a multipayer payment reform model that provided incentives for primary care practices to lower spending and improve quality performance . . . Using claims and enrollment data from the period 2013–20 from two large insurers in Michigan, we performed difference-in-differences analyses and found that CPC+ was not associated with changes in total spending . . . or overall quality performance . . . We conclude that CPC+ did not improve spending or quality for private-plan enrollees in Michigan, even before accounting for payouts to providers. This analysis adds to existing evidence that CPC+ may cost payers money in the short term, without concomitant improvements to care quality.”
Low-Value Services and Higher Prices
A study of “low-value” medical services (here) finds that “Low-value care and associated spending remain prevalent among commercially insured and Medicare Advantage enrollees . . . State-level variation in spending was greater than variation in utilization, and much of the variation in spending was driven by differences in average procedure prices.”
HIX Prices Better Than MA, Not as High as Commercial Rates
A study in the American Journal of Managed Care (here) shows that commercial health insurers pay providers less for services offered through Health Information Exchanges (HIX) plans, but more than they pay providers in their Medicare Advantage plans.
“The prices insurers pay hospitals for their HIX enrollees are lower than or equal to what they pay those same hospitals for their commercial group enrollees but higher than what they pay for their MA enrollees, with wide variation in relative generosity across insurers, hospitals, and settings of care. The lower prices we observe among HIX plans may be reflective of narrow network plan design, as prior studies have attributed cost savings in this market to narrow networks. Hospitals may also be willing to accept lower rates for insurers’ HIX plans, considering that many HIX enrollees would otherwise be uninsured and unable to pay hospital bills—73% of HIX enrollees in 2021 had a household income at 100% to 250% of the federal poverty level. Although hospitals receive lower reimbursement for HIX enrollees than other commercial plan enrollees, the HIX plan payment level is still preferable to the uncompensated care burden hospitals faced before the Affordable Care Act established the HIXs.”
MedPAC Meets Virtually This Thursday and Friday
MedPAC’s “October” 2022 public meeting will be held virtually on Thursday, September 29th and Friday, September 30th.” Agenda here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
September 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