DCMedical News: Tuesday, November 29, 2022
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY Tuesday, November 29, 2022
Excess COVID-19 and All-Cause Mortality
A research letter in JAMA (here) reports that “The US continued to experience significantly higher COVID-19 and excess all-cause mortality compared with peer countries during 2021 and early 2022, a difference accounting for 150,000 to 470,000 deaths. This difference was muted in the 10 states with highest vaccination coverage.”
“The US reported 370,298 COVID-19 deaths during the Delta and Omicron waves . . . COVID-19 deaths per capita in the US overall and in both state subgroups significantly exceeded those of all peer countries during the study period. However, there were significantly fewer COVID-19 deaths in the top 10 states by vaccination uptake (73% coverage) at 75 deaths/100,000 compared with the bottom 10 (52% coverage) at 146 per 100,000.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Government for Sale?
A study in JAMA Health Forum (here) chronicles increased “lobbying” by various commercial sectors of the health field, 2000 to 2020. “In 2020, US health care lobbying expenditures totaled $713.6 million vs $358.2 million in 2000. In 2020, pharmaceutical and health product manufacturers spent the most on lobbying activities ($308.4 million), followed by providers ($286.9 million), payers ($80.6 million), and other firms ($37.7 million) . . . Lobbying activities also were not distributed uniformly, with a small number of firms responsible for the majority of expenditures.”
Physician Agency
Does nephrologist ownership of dialysis facilities conflict with the physician’s role as agent for the patient? A study in JAMA Internal Medicine (here) found that “Nephrologist ownership was associated with increased home dialysis use, decreased ESA [erythropoietin-stimulating agent] use, and no change in anemia or blood transfusions.”
A separate opinion in the same edition (here) discussed this issue: “Central to this debate is the physician’s role as an agent acting on behalf of patients. Ownership of a health care facility could enable physicians to better navigate corporate constraints for their patients, or it could lead physicians to put their own financial interests ahead of their patients’ well-being.”
“Although dialysis chains assert that JVs [Joint Ventures] benefit patients by improving the coordination of care and its quality, other stakeholders have questioned whether they might distort treatment decisions and harm patients. A 2022 report from the Medicare Payment Advisory Commission, for example, suggests that clinicians with financial interests in dialysis facilities may be inappropriately influenced when it comes to decisions about patient care. This might include initiating patients on dialysis when it is of questionable value, pushing patients to in-center dialysis instead of home dialysis or transplantation, steering patients to facilities in which they have an ownership stake even if a different facility might be better for that patient, and overproviding profitable separately billed services or underproviding bundled services.”
Robot Arm, Complete With Shoulder, Elbow and Wrist
“Momentis Surgical, a medical device company, announced [here] that Medical City Plano will be the first medical facility to adopt a surgical robot arm for transvaginal gynecological procedures . . . The Anovo System, a surgical robot that mimics a human arm, complete with shoulder, elbow and wrist joints is specialized in transvaginal robotic surgery and it’s the first of its kind to be approved by the FDA. The robot’s humanoid-shaped arms are designed to emulate a surgeon’s precise movements and high agility and dexterity. According to the company’s official statement, the prototype at Medical City Plano is designed to enable minimally invasive transvaginal interventions for benign gynecological procedures including hysterectomy and ovarian cyst removal.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
English Nurses to Strike, But Not Scottish
“Nurses across the NHS will strike in the run-up to Christmas, threatening further disruption to healthcare in much of Britain at the busiest time of the year for hospitals that are already struggling to bring down record waiting lists,” according to a report in The Financial Times (here).
“The Royal College of Nursing announced on Friday that some of its members would walk out on December 15 and 20 in England, Wales and Northern Ireland . . . The union’s members will be in the vanguard of a wave of industrial action [here] that looks set to spread across the health service and many other parts of the public sector over the winter.”
“Its members could soon be joined by those of other unions representing NHS workers. Unison, which represents more than 400,000 health service staff across England, Wales and Northern Ireland, will close its own ballot on Friday and announce results next week. A GMB ballot of ambulance workers at 11 NHS Trusts will close at the end of the month; Unite is also balloting thousands of health workers; and unions representing junior doctors, midwives and physiotherapists are holding or planning votes.”
“Scotland’s government in contrast raised its pay offer to NHS staff on Thursday, with proposals that would deliver an average uplift of 7.5 per cent, and as much as 11.3 percent for the lowest paid. Unison said it was putting the offer to its members in Scotland with a recommendation to accept.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Final Rules, Continued
CMS published the final rules for the calendar year 2023 physician fee schedule and other amendments to Medicare Part B (here, 1297 pages) in the Federal Register November 18. The final rule for the hospital outpatient prospective payment system (OPPS), for ambulatory surgery centers and for other Part B institutional provider changes (rural emergency hospitals, prior authorization, etc.) was published (here, 563 pages) November 23. A summary of the OPPS rule by HFMA (here, 182 pages) shows the calculations behind this estimate, “CMS estimates that 2023 OPPS expenditures, including beneficiary cost-sharing, will be approximately $86.5 billion, an increase of $6.5 billion relative to 2022.”
Competition in Health Insurance
There isn’t much. That according to the 21st edition of the AMA’s unique study of competition in American health insurance markets (here). The bottom line: “The majority of health insurance markets in the United States are highly concentrated. Coupled with external evidence on their anticompetitive behavior, this strongly suggests that health insurers are exercising market power in many parts of the country and, in turn, causing competitive harm to consumers and providers of care.”
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
November 30
December 1, 2, 5, 6, 7, 8, 12, 13, 14, 15
Notes to Fred Hyde, MD, JD, MBA, news@dcmedicalnews.org