DCMedical News: Wednesday, October 12, 2022
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY Wednesday, October 12, 2022
Policy Influencers Push Price Controls for Hospitals, Others in the Health Field
The Congressional Budget Office unveiled a study at the end of September (here) which indicated that, of the major policy choices available to control the cost of American health care, price controls, especially of hospitals, promised the greatest impact.
The Commonwealth Fund (here) subsequently unveiled a study/opinion piece which discusses the difficulty of avoiding regulatory capture by hospitals, one reason being the number of large hospital system executives, attorneys, consultants and supporters who make “contributions” to candidates for public office. A second theme in the Commonwealth report is how to mitigate the damage of regulation, and of capture. This publication followed another and related endeavor by the Fund in 2021 (here), on hospital consolidation and price control, or lack thereof.
“After several decades of deregulation, concern over high and rapidly rising hospital prices has renewed interest in government oversight of these prices and how they are determined. However, both past and more recent experience indicate the regulation of health care markets faces two potential weaknesses. The first is regulatory failure, which occurs when intrusive regulations increase an industry’s cost both directly and by reducing incentives to improve. The second is regulatory capture, where regulators serve the interests of the regulated industry rather than the public interest.” On that second issue, the study contends that “structural features that protect the independence of regulatory agencies, coupled with fully transparent and not overly complex pricing systems, can help prevent or reduce the incidence of regulatory capture and failure.”
The American Hospital Association has now followed with a study (summary here, report here) indicating that it is not hospitals which are responsible for the high cost of health insurance, and health care generally, at least not for most of it.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Primary Care Billing Codes of Less Use Than Anticipated in Support of Primary Care Physician Income
ACP Internist (from the American College of Physicians) reports (here) that “While Medicare has added new codes to increase the reimbursement available to primary care practices, they can be difficult to implement and may not align with the integrated flow of a visit.” The report notes that “recent research leaves little doubt that primary care physicians aren't fully reimbursed for the patient care they already provide.” However, code complexity, learning time, time consumed in a patient visit for problems identified by the patient, all work to prevent full payment to the physician practice for prevention, “wellness” and “coordination” services which are delivered more frequently than they are billed. The study’s lead author reported that, in his own practice, he does not use many of the Medicare codes: “I don't think the juice is worth the squeeze.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Extended ED Boarding Leads to Bad Patient Outcomes
Boarding of patients in the hospital emergency department is the focus of two studies from Yale. In one (here), boarding is described as the “Emergency department (ED) . . . holding admitted patients in the ED, often in hallways, while awaiting an inpatient bed. The Joint Commission identified boarding as a patient safety risk that should not exceed 4 hours. Downstream harms include increased medical errors, compromises to patient privacy, and increased mortality. Boarding is a key indicator of overwhelmed resources and may be more likely to occur when hospital occupancy exceeds 85% to 90%.”
The second study (here) assessed EDs from which patients leave without being seen (LWBS). “The failure of the emergency care system to maintain broad access in the context of pandemic demands suggests that existing regulatory and financial incentives may be inadequate to meet challenges of future pandemic waves and other disasters. Historically, LWBS was viewed as an ED management problem rather than a hospital- or systems- level issue. Thus, most solutions to date have relied on intradepartmental operational fixes to mitigate ED crowding; for example, doctor-in-triage or split-flow models offer more rapid medical screening evaluations, effectively bypassing traditional triage processes. These processes promote rapid but limited physician evaluations, often in the waiting room. Amid the current crisis, these ED-focused operational efforts may be inadequate to stem this growing problem.”
Publication of the studies took place simultaneously with general press reports (here) of crowding in Connecticut hospital EDs, including Yale.
DRUGS & DEVICES
Fast Track FDA Approval: Haste and Waste
Medscape reports (here) on accelerated drug application approval by the Food and Drug Administration. “In granting accelerated approvals, the FDA sets timelines for drugmakers to carry out confirmatory trials. But these target dates are often missed.” Now the Office of the Inspector General has issued a report (summary here, report here) stating that “The Medicare and Medicaid programs spent more than $18 billion over 3 years on medications for which there was no proof of a significant clinical benefit.”
“The FDA's expectation is that drug companies will continue research in order to definitively prove the efficacy of medications approved via this [fast track] process. However, for a variety of reasons, sponsors do not always complete trials promptly. This can result in drugs staying on the market ― and being administered to patients ― for years without the predicted clinical benefit being verified and insurers ― including Medicare and Medicaid ― paying billions for treatments that are not verified to have clinical benefit."
At the same time, Congress has passed a Continuing Resolution with a provision stripping the FDA of the authority to enforce such follow up studies. Reports Medscape, “The OIG released its report as members of Congress dropped plans to address the accelerated approval process in FDA legislation. In June, the House passed a bill to reauthorize the Prescription Drug User Fee Act (PDUFA), which included new authority for the FDA to better ensure swift completion of confirmatory trials. However, these provisions were dropped amid protest by Sen. Richard Burr (R-NC). Congress is expected to clear a PDUFA reauthorization that strips the FDA's authority to ensure completion of trials for drugs cleared via the accelerated approval process. This PDUFA reauthorization will be bundled with a stopgap budget bill, known as a continuing resolution. On Thursday, the Senate voted 72-25 on this package. The House is expected to clear it quickly,” and did.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
October 13, 14, 17, 18, 19, 20, 21
November 14, 15, 16, 17, 18, 29, 30
December 1, 2, 5, 6, 7, 8, 12, 13, 14, 15
Notes to Fred Hyde, MD, JD, MBA, news@dcmedicalnews.org