DCMedical News: Thursday, December 1, 2022
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY Thursday, December 1, 2022
President’s Funding Request: COVID Preparations and the Military
The President sent his request to Congress (here), for “comprehensive, bipartisan agreement to fund the Government for the rest of the fiscal year (FY) and invest in critical national priorities before the December 16th funding deadline.” For COVID the President’s message is “we are requesting funding to help prepare for a possible winter surge, smooth the path to commercialization for vaccines and therapeutics, accelerate research and treatment for long COVID, and develop next-generation vaccines and treatments.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Kansas OB/Gyn Tries to Deliver Limits on Prior Authorization
Senator Roger Marshall, Republican of Kansas and an obstetrician/gynecologist, as well as former Chairman of the Board of Great Bend Kansas Regional Hospital (a for-profit hospital opened in 2009, and, since August of 2018, part of the University of Kansas Health System), is on the verge of delivering relief to the nation’s physicians, plagued by the “spanner-in-the-works” impact of “prior authorization,” (PA) used by commercial health insurers to delay and oppose physician decisions.
Marshall’s challenge is that a Congressional Budget Office study (here) indicates that, if the insurers were not allowed to use PA in their Medicare Advantage programs, more clinical services would be provided, at higher cost to Medicare. CBO “scores” the change at $16 billion, which may prevent passage of Marshall’s bill.
CQ reports that “Private Medicare Advantage plans administer benefits to nearly half of the Medicare population . . . practices they use to lower costs have faced criticism from doctors and patients, including prior authorization, which requires providers to seek approval for coverage of certain services before providing it.
“Marshall’s bill would require Medicare Advantage plans establish electronic prior authorization programs to speed up the process and issue ‘real-time’ decisions for procedures and services that are commonly approved. For services not eligible for real-time decisions, Medicare Advantage insurers would be required to respond to requests within 24 hours for urgent matters and no more than seven days for non-urgent matters.”
Americans Score Their Health System Low, Trust a Big Issue
HealthExec reports (here) that “Most Americans aren’t happy with their healthcare experiences, and the perception of quality has slid to a new low this year. That’s according to a recent survey from The Beryl Institute,” (here) “which found only 40% of Americans rate the quality of U.S. healthcare as good or very good.”
A big issue is trust, the question of whose interest is being served in the American health care system. “The most significant item to healthcare consumers was their selection of ‘Feeling as though the healthcare system acts out of self-interest rather than mine as a patient’ as the top reason people’s trust has eroded. Just shy of half of consumers (48%) identified this as the leading reason for their reduced trust in healthcare.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
“Every aspect of patient care — from being admitted, to treatment, to discharge — is affected by the labor shortage”
So says Erik Swanson, senior vice president of data and analytics with Kaufman Hall, whose November Hospital “Flash” report (here) shows hospitals continuing to lose money, staff and capacity.
“Hospitals are nearing the end of an exceptionally difficult year for finances with a slight downturn to their operating margins and smaller likelihood of ending the year in the black,” with negative operating margins year-to-date through October, 13% below October of 2021. Labor expenses are up 10 percent, but as some volume recovers “hospitals struggled to discharge patients in October due to shortages of labor both internally and in post-acute settings, which resulted in a 3 percent increase in length of stay that did not translate to additional revenue.”
How Far is Too Far to Transfer a Stroke Patient to a Hospital With Endovascular Thrombectomy?
It turns out 300 miles is not too far, according to a study (here) in Stroke. The study was a “retrospective analysis of patients transferred from 31 referring hospitals >300 miles (measured by the most direct road distance) to 9 comprehensive stroke centers in Australia and New Zealand for EVT consideration.” The result: “outcomes similar to those treated in the comprehensive stroke center in the EVT extended window trials.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Government Health Insurance Programs Cover 158 Million People
CMS has reported updated enrollment (here) totals for enrollees in Medicare, Medicaid, CHIP and PPACA-Marketplace Insurance. Medicaid and CHIP now have 90.5 million enrollees, 83.5 million in Medicaid, 7 million in the Children’s Health Insurance Program. Medicare now has 65 million enrollees, 35 million in fee-for-service or traditional Medicare, 30 million in Medicare Advantage (MA) programs. The state and federal marketplaces have 14.5 million applicants. Eliminating 12 million Medicare/Medicaid dual eligibles, the mathematical total for the programs is 158 million. Since the August report, more than 111,000 people have been added to the Medicare rolls, and almost 600,000 to Medicaid and CHIP.
Medicare Part D membership overlaps with MA, and also has some standalone drug coverage, with a total of 50,443,950 enrolled.
Will Clinical Volume Bounce Back and Raise Insurer Medical Loss Ratios?
The Wall Street Journal reports that “From a financial standpoint, the pandemic years have been good for managed care companies. Hospitals faced unprecedented labor shortages in recent years as nurses and doctors quit their jobs, forcing many patients to defer costly care, a boon to insurers. One data point says it all: the medical loss ratio at UnitedHealth Group, the largest managed care company, has beaten the Wall Street analyst consensus in 10 of the last 11 fiscal quarters.”
WSJ continued, “Since the start of the pandemic, hospitals have faced unprecedented margin pressures as nearly 20% of their workforce quit. The massive exodus of workers in the healthcare space drove up salaries for those who stayed while limiting hospitals’ capacity to provide services. The lower capacity, and perhaps lingering concerns about Covid-19 among the elderly, meant many patients continued to postpone lucrative procedures such as hip replacements. That trend is now finally starting to reverse.”
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
December 2, 5, 6, 7, 8, 12, 13, 14, 15
January 3, 4, 5, 9, 10, 11, 12, 24, 25, 26, 27, 30, 31
February 1, 2, 6, 7, 8, 9, 27, 28
March 1, 7, 8, 9, 10, 22, 23, 24, 27, 28, 29, 30
Notes to Fred Hyde, MD, JD, MBA, news@dcmedicalnews.org