DCMedical News: Wednesday, November 30, 2022
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY Wednesday, November 30, 2022
Twenty days to fund the government
CQ reports that “Lawmakers returned to Washington yesterday to pass 2023 fiscal appropriations and tackle a long list of health policy priorities . . . President Joe Biden has requested $9 billion to address issues related to COVID-19. Republicans punted on another pandemic funding request earlier this year, and it's unlikely this one will gain more traction with the GOP. It's more likely that we'll see some health policy action along with the spending bill. The current stop gap funding law (PL 117-180) ends Dec. 16, and lawmakers are eyeing a slew of policy riders.”
Possible add-ons: continuous health care coverage for children in Medicaid and the Children's Health Insurance Program; continued payment for telehealth under Medicare, at the same rate as in-office payments; mental health bills; Momnibus; and the PASTEUR Act, to fight antimicrobial resistance. Also in play, physician fees, hospital sequesters and miscellaneous payment shortfalls.
Says CQ, “If a final fiscal 2023 omnibus is not ready for a vote by mid-December, lawmakers may look to clear another continuing resolution — either one lasting just a few days, giving them time to finish negotiations on the package or, alternatively, a longer-lasting spending measure that would fund the government into 2023, possibly for a few months.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Scope of Practice, and Practice Productivity
A bruising and uncomfortable confrontation: InsideHealthPolicy reports (here) that “A coalition of 80 provider groups is calling on Congress to abandon a bill that would broaden the types of providers who can offer physician-level services, arguing the bill could destroy quality of care and hike health care costs.”
The American Academy of Family Physicians, the American Medical Association and the American College of Emergency Physicians urged Congress not to pass the Improving Care and Access to Nurses Act which would expand the scope of practice under Medicare and Medicaid for nonphysician practitioners including nurse practitioners, certified nurse midwives, certified registered nurse anesthetists, clinical nurse specialists and physician assistants. IHP reports that “American Nurses Association President Ernest Grant said . . . ‘We cannot be hindered by antiquated barriers to practice or petty turf wars over perceived hierarchies. The health of our patients and communities must come first.’”
Physician groups say “Allowing nonphysician practitioners to offer services outside the scope of their education, effectively removing physicians from the equation in the process, could harm patients. They also say that expanding the scope of practice for nonphysician practitioners wouldn’t increase access to care for patients living in rural areas because nonphysician practitioners and physicians tend to practice in the same areas of rural states.”
Some support for the physician position comes from a new NBER study (here) of MD and NP productivity and costs. Limited to the VA, to the ED and some additional modeling, the study concludes “Compared to physicians, NPs significantly increase resource utilization but achieve worse patient outcomes . . . Counterfactual analysis suggests a net increase in medical costs with NPs, even when accounting for NPs’ wages that are half as much as physicians’. Despite large productivity differences between professions, we find even larger productivity differences within professions and substantial productivity overlap between professions. Yet there is little overlap in wages between NPs and physicians and, within professions, no significant correlation between productivity and wages.” (Italics added.)
Reports IHP, “A new update on the state of the physician workforce found that many physicians are facing capacity issues that impact their ability to deliver care to patients. According to a new survey from The Physicians Foundation [in three parts, here, here and here], around a third of physicians report their current practice is overextended and overworked, and nearly half of physicians report being at full capacity in their current practice.”
What Do We Need to Know About Telemedicine?
A “Perspective” in the New England Journal of Medicine (here) summarizes the state of three key questions, as Congress is pressed to extend, expand or curtail telemedicine.
Does it save money, or spend more? “To date, Congress has permanently expanded telemedicine reimbursement for only certain populations (e.g., patients in rural areas) and conditions (e.g., acute stroke), relying on an assumption that telemedicine is more cost-effective in these contexts than for other patients and conditions.”
Is it safe to treat patients remotely? “Many randomized trials comparing telemedicine with in-person care have found that telemedicine is a safe clinical option; however, these studies have had important limitations and have evaluated only a small fraction of telemedicine’s myriad applications. Moreover, trials have generally compared fully virtual care with in-person care, even though it’s uncommon for clinicians with brick-and-mortar practices to treat a patient only through telemedicine.”
Also, “Clinicians are using a wide range of methods to interact with patients — from audio-only and video visits to portal messages and remote patient monitoring. Ideally, policies would be informed by assessments of these mixed models as well as by data on the effects of telemedicine expansion on other components of care (e.g., cancer screenings and vaccinations).”
Does it advance health equity? “The third question is whether telemedicine advances health equity. Policymakers have expressed hope that telemedicine could make it easier for members of underserved populations to obtain care and could thereby narrow disparities in access and outcomes. Because of the digital divide, however, members of underserved populations may be less likely to use telemedicine than more advantaged patients . . . Studies of telemedicine uptake among various populations have come to conflicting conclusions, with some finding higher uptake among members of marginalized populations than among more advantaged patients and others finding the opposite.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
CMS Reminds Hospitals to Prevent Workplace Violence
InsideHealthPolicy reports (here), that “CMS emphasizes that hospitals have a responsibility to counteract violence by providing their staffers proper training, ensuring sufficient staffing levels and conducting ongoing assessments of patients and residents for aggressive behavior -- all of which the agency says will help providers adapt their care accordingly if an issue should arise.” The agency has cited hospitals in the past for failing to train its employees properly or promote a safe environment for patients and staff.
Toledo Uses Federal Funds to Extinguish Medical Debt
Following the example of Cook County, Illinois, the city of Toledo, Ohio has devoted $800,000 of federal American Rescue Plan Act funds to the extinction of medical debt, working with RIP Medical Debt, story here. The surrounding county doubled the funds, and the resulting $1.6 million will eliminate $240 million of medical debt.
A complicated application for financial assistance? Nope. “Those eligible for the debt cancellation -- people who make 400% of the poverty level or below, or whose debts make up at least 5% of their total income -- won't have to apply. Instead, after the debt is sold, RIP Medical Debt will send them a letter in the mail notifying them that they're debt-free.”
Toledo City Councilwoman Michele Grim said “It’s a uniquely American problem.”
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
December 1, 2, 5, 6, 7, 8, 12, 13, 14, 15
Notes to Fred Hyde, MD, JD, MBA, news@dcmedicalnews.org