DCMedical News: Monday, December 5, 2022
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY Monday, December 5, 2022
Full Court Press
Physician organizations in a letter to Congressional leaders (here) urge fixes for what they believe to be problems with physician pay in the Medicare program, prior authorization, the continuity of Medicaid and CHIPs coverage, mental health resources, telehealth payment, and the “teaching health center” (non-hospital) residency program.
The medical groups include the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the American College of Physicians, the American Osteopathic Association and the American Psychiatric Association, but not the AMA.
On fees, the group wrote “The current payment rates are not sustainable for physicians to cover the basic expenses of their practice including payroll for their staff, maintenance and rent for their office buildings, and the purchase of new health information technology and equipment to advance the quality of health care they provide to their patients. According to an American Medical Association (AMA) analysis of Medicare Trustees data, Medicare physician payment has decreased by 20 percent from 2001–2021 when adjusted for inflation.” The groups noted a looming 4.42 percent cut on Medicare physician payment January 1, a freeze on annual physician payment increases, and the fact that “Physicians are the only health care professionals in Medicare who have not received updates that are adjusted with the cost of inflation.”
On prior authorization, the group wrote that “Today, nearly half of Medicare eligible beneficiaries are enrolled in MA plans. These plans have prior authorization approval procedures that needlessly delay care for patients and are overly burdensome for physicians. Prior authorization requirements often delay patient care, which can be a life-or-death situation for people with serious diseases.”
The physicians urged adoption by Medicaid and CHIP of “policies [to] prevent children from losing coverage due to paperwork errors like lost mail or small changes in family income,” and to “ensure that new mothers can rely on coverage that can address pregnancy-related complications like postpartum depression, heart conditions, and high blood pressure, many of which may not surface for weeks or months after giving birth. Given that most maternal deaths are preventable and occur in the postpartum period, this coverage is critical to saving lives.” They noted that Medicaid and CHIP are the insurance coverage for more than half the children in the nation, and for nearly half of the births each year.
November 10 the administration announced that it would extend the COVID-19 Public Health Emergency (PHE) which, according to InsideCMS, will “grant states more time to prepare for the Medicaid redetermination process slated to re-start once the emergency ends. The move also gives telehealth lobbyists additional time to get Congress to further extend, or make permanent, regulatory flexibilities that vastly expanded virtual care during the COVID-19 pandemic.”
InsideCMS reports that “Lobbyists expect Congress will likely waive the effects of upcoming PAYGO cuts on Medicare as part of the year-end package, but much of the rest of what could be a large legislative deal is still in flux — including the extent to which the physician fee cuts will be mitigated and how much money lawmakers will dedicate to the health care industry overall.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Pandemic Physician Burnout, Aggravation and Mitigation
A study in JAMA Health Forum (here) asked the question, “How have clinician burnout rates changed during the COVID-19 pandemic nationally, and what are the key aggravators and mitigators of burnout?” The study queried more than 20,000 clinicians. “Chaotic workplaces and lack of control of workload were associated with higher burnout, while efficient teamwork and feeling valued were associated with lower burnout.”
Going Up: Maternal Mortality
From the 2022 AHRQ National Healthcare Quality and Disparities Report (here) “The United States has worse maternal health and healthcare than other industrialized nations, pointing to suboptimal maternal health outcomes for multiple measures, as well as considerable racial disparities for those measures. The overall maternal mortality rate in 2020 was 23.8 deaths per 100,000 live births, an increase from 2019 (20.1 deaths per 100,000 live births) and 2018 (17.4 deaths per 100,00 live births).”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
MedPAC to Meet, Focus on Payment Adequacy in the Medicare Program
MedPAC, the Congressionally chartered advisory body on the Medicare program, will meet this Thursday and Friday, December 8-9, virtually, (meeting notice and registration here).
The Thursday program will cover “Assessing payment adequacy and updating payments: Hospital inpatient and outpatient services and supporting Medicare safety-net hospitals; Status report: Ambulatory surgical center services . . . Assessing payment adequacy and updating payments: Physician and other health professional services and supporting Medicare safety-net clinicians; Assessing payment adequacy and updating payments: Outpatient dialysis services; Assessing payment adequacy and updating payments: Hospice services.”
The Friday program will cover “Assessing payment adequacy and updating payments: Skilled nursing facility services; Assessing payment adequacy and updating payments: Home health care services; Assessing payment adequacy and updating payments: Inpatient rehabilitation facility services.”
MedPAC explains: “By law, each year the Commission reviews Medicare’s fee-for-service payment policies and makes payment update recommendations. For our March 2023 Report to the Congress, we consider whether Medicare inpatient and outpatient payments to general acute care hospitals are adequate and how they should be updated in 2024. This year, we also consider whether disproportionate share hospital and uncompensated care payments could be better targeted to hospitals that treat a high share of Medicare beneficiaries with low incomes . . . We also consider how best to support Medicare safety-net hospitals through a Commission-developed measure called the Safety-Net Index.”
On ASCs, “The Commission’s assessment of payment adequacy for ASC services has been hampered by a lack of cost data and concerns about available quality data. The Commission has recommended since 2010 that the Congress require ASCs to submit cost data.”
On physician fees, “We consider whether payments to physicians and other health professionals are adequate and how they should be updated in 2024. This year, we also consider a new safety-net add-on payment to physician fee schedule payment rates to support clinicians who treat beneficiaries with low incomes.”
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
December 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