DCMedical News: Monday, October 17, 2022
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY Monday, October 17, 2022
England’s National Health: A Drain on the UK Economy or an Engine for UK Economic Recovery?
A report in The Financial Times (here) notes that “A record 7mn people were waiting for hospital treatment in England at the end of August . . . [the report] included 2.75mn patients waiting more than 18 weeks for treatment and 387,000 waiting more than a year. More recent data for accident and emergency departments showed that only 57 per cent of patients were seen within four hours in September, a sharp drop on the 76 per cent for the same month in 2019 before the coronavirus pandemic hit.” Lack of investment in health personnel is frequently cited as the cause.
As in the U.S., however, expensive health services are also important drivers of economic growth. A new study of health investment and the workforce (here) finds “The NHS is a major contributor to the UK economy, with every £1 spent on health generating £4 of economic growth. . . The research, carried out by the consultancy Carnall Farrar, comes as the health service battles rising inflation, high energy costs and the prospect of further spending reductions with the government enforcing fiscal discipline in the wake of its mini Budget. Against a backdrop of high sickness absence levels, the study, which was commissioned by the NHS Confederation, showed that reducing the number of Britons not in employment due to ill-health by 1 per cent could increase the number able to work by 180,000”.
Matthew Taylor, chief executive of the NHS Confederation, suggested economic growth would not be achieved without an increase in the UK working population. “More than 200,000 people have left the labour market since the onset of the Covid pandemic because of ill health, with a record 2.5mn people now inactive due to long-term sickness, almost 500,000 more than just five years ago. Taylor said the analysis ‘debunks the myth that the NHS is a drain on public resources — in fact, it’s a key driver of labour productivity and wider economic activity.’”
In a companion piece, Taylor (here) holds that “The economic activity of a local area, and how productive it is, is heavily influenced by its inhabitants’ health. Unmet health and care needs are among the key reasons for people of working age being out of the labour market. Relatively small reductions in the number of those off for long-term sickness could have a huge impact on labor productivity and economic activity.”
The wage and price gap may be closed, and should be, according to the unions of the NHS. In an announcement today (here) “The head of Britain’s biggest union has warned that the largest nationwide strike by NHS workers since the early 1980s could hit health services this winter if ministers ignore calls to match pay with inflation.”
Total spending on health services in the UK in 2021 was £277bn for a population of approximately 67 million people ($318.5bn at $1.15 to the £, $4,754 per person per year), compared to $4tn total annual health expenditures for the U.S. population of 330 million people ($12,121 per person per year).
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Private Equity-Backed OB Services Have “Emergencies”
“Routine births are turning into moneymaking ‘emergency’ events at hospitals that work with private equity-backed staffing companies,” according to a report (here) from Kaiser Health News published in Fortune. “Obstetrics emergency departments—often just triage rooms in labor-and-delivery areas—are billing patients like the ER.”
A patient interviewed for the study “was surprised to discover she was an ‘unknown accident’—at least from a billing standpoint—when she went to the hospital during labor. Her bill included a charge for something she said she didn’t know she’d ever entered: an obstetrics emergency department . . . The area is separated from the rest of the labor-and-delivery department by a curtain. The hospital got about $1,300 for that visit—$530 of it from Huffner’s pocket.”
“In recent years, hospitals of every stripe have opened obstetrics emergency departments, or OBEDs. They come with a requirement that patients with pregnancy or postpartum medical concerns be seen quickly by a qualified provider, which can be important in a real emergency. But it also means healthy patients . . . get bills for emergency care they didn’t know they got.”
“Three of the main companies that set up and staff OBEDs—the OB Hospitalist Group, or OBHG; TeamHealth; and Envision Healthcare—are affiliated with private equity firms. The fourth, Pediatrix Medical Group, formerly known as Mednax, is publicly traded. All are for-profit companies . . . In a document aimed at hospital administrators, TeamHealth says OBEDs are good for ‘boosting hospital revenues’ with ‘little to no structural investment for the hospital.’. . OBHG, which staffs close to 200 OBEDs in 33 states, markets a scoring tool designed to help hospitals maximize charges from OBEDs and has marketed its services to about 3,000 hospitals.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
MedPAC Grapples With Staffing, Money and Quality in Skilled Nursing Facilities
At its meeting September 30, the Medicare Payment Advisory Commission concluded that “A minimum staffing ratio for the nursing home sector is a good policy in a vacuum, but likely would require more dollars in the system,” according to a report in the October 6 edition of InsideCMS.
MedPAC was deliberating its members’ view on “a highly controversial effort to develop a federal minimum staffing standard, which the agency expects to unveil the first half of 2023.”
“Commissioner Dave Grabowski said the nursing home sector would likely need additional funding to handle a new federal staffing minimum, as well as a thorough assessment of how best to use funds that are already in the system. But commissioners did offer some preliminary ideas, including factoring staffing more into star ratings, increasing the salary of certified nursing assistants, upping the number of Graduate Nursing Education slots and looking into the role of immigration.” Grabowski said the commission should consider recommending an increase in the weight of the staffing metric used to calculate nursing homes’ star ratings and Commissioner Betty Rambur suggested that “increasing the salary of certified nursing assistants and increasing the number of Graduate Nursing Education slots covered by Medicare could also improve the number of well-trained staffers who enter and stay in the nursing home sector.”
DRUGS & DEVICES
Remote Laboratory Work to Continue After the Public Health Emergency Period Ends
InsideCMS reports that “Pathologists and other laboratory staff will be able to continue reviewing laboratory data, slides and digital images while working remotely after the COVID-19 public health emergency ends, CMS announced, as the agency will keep exercising its enforcement discretion under Clinical Laboratory Improvement Amendments to allow for remote review.”
The American Clinical Laboratory Association, which had requested the extended approval, said through a spokesperson “By allowing laboratory professionals to review digital images and data from a remote site like their home offices, they will in turn be able to more nimbly serve patients across the country — particularly in rural areas and under more urgent public health challenges.”
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
October 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