DCMedical News: Monday, December 12, 2022
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY Monday, December 12, 2022
117th Congress Ending
CQ reports that “House and Senate appropriators made enough progress in bipartisan discussions over the weekend that Democrats are putting on hold plans to introduce their own versions of a fiscal 2023 omnibus and yearlong stopgap funding bill.”
“However, a full-year CR [Continuing Resolution] remains on the table as a fallback, but with a twist that could make it more palatable: it would contain lawmakers' earmarks secured in earlier versions of the fiscal 2023 appropriations bills. The decision to delay the partisan pressure tactics signaled new optimism that congressional leaders could finally reach a deal in the coming days on topline discretionary spending levels for the fiscal year that began Oct. 1.”
“Congress must pass an omnibus bill or another stopgap measure by midnight Friday to avoid a partial government shutdown when the current continuing resolution (PL 117-180) expires . . . If neither an omnibus agreement or full-year CR can be agreed to by both parties, a short-term continuing resolution into early next year becomes the fallback option.”
Data Watch
From today’s Financial Times, “One in four American parents say there have been times in the past year when they could not afford food for their families or to pay their rent or mortgage. Among lower-income parents, the share rises to 52 per cent.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
The Cost of Cancer Surgery, Down on a Unit Basis, Up on Volume
A Research Letter in JAMA Surgery (here) examined the component costs of 70,000 cancer surgeries, 2011-2019. “Surgery-related expenditures included all Part A (hospitals, skilled nursing facilities, home health agencies, and hospice organizations) and Part B (health care practitioners, imaging, laboratories, and durable medical equipment) claims for services delivered within 30 days of oncologic surgery. Payments were inflation adjusted to 2019 US dollars using the Consumer Price Index for Medical Care.”
Findings: “While outpatient surgery expenditures remained relatively stable, mean (SD) adjusted episode spending on inpatient surgeries decreased from $31,964 in 2011 to $27,418 in 2019, corresponding to a negative 2.27 annual percentage change. Over this period, the proportion of outpatient operations increased from 30.3% to 46.7%.
On overall cost, “the absolute number of patients with cancer aged 65 years or older is projected to nearly double from 52 million in 2018 to 95 million by 2060. The increasing use of minimally invasive approaches may have catalyzed the shift to outpatient surgery, while broad-based improvements in perioperative care (i.e., care standardization, implementation of enhanced recovery protocols, and multidisciplinary teams) may have led to reductions in surgical morbidity and mortality, contributing to the declines in 30-day episode spending for cancer directed surgery.”
Not The Root From Issyk-Kul: Melanoma Improvement With New Drugs
A study in JAMA Network Open (here) reports that the Melanoma Morality Rate is down, especially after the introduction of new drugs in 2011. “Significant reduction in MMR was seen from 2013 to 2017 in the US for the first time in the past 40 years. Rates increased from 1975 to 1988. No statistically significant change in MMR was seen from 1988 to 2013. The MMR decreased significantly from 2013 to 2017,” more than 6% per year.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Out-of-Pocket Health Expenses a Canadian Problem, as Well
A study in Health Policy (here) notes that, notwithstanding its public health insurance program, Canada has an “out-of-pocket” health care expense problem, especially, as in the U.S., among economically disadvantaged groups.
The study notes “The Canadian publicly financed system for physician and hospital services – Medicare – aims to improve the accessibility of healthcare for Canadians by reducing financial barriers to essential medical and hospital services. Although per capita healthcare expenditure in Canada is higher than the average of the Organization for Economic Cooperation and Development (OECD) countries (e.g., $6,448 versus $5,175 in 2018), the public-sector share of total health expenditure, 70%, is below the OECD average of 73%.”
“The private-sector spending in Canada accounts for the remaining 30% of the spending. Comparatively, private-sector spending on healthcare ranges between 16-23% in other OECD countries like France, Germany, Sweden, Netherlands, New Zealand, UK. Moreover, a higher proportion of private-sector spending in Canada is financed by out-of-pocket health expenditure (OHE). Canadian households on average spent $2,887 in 2015 on OHE and primarily use OHE for services not included in the Medicare basket, such as pharmaceutical, dental, and eye care. A significant share of OHE in Canada results in catastrophic out-of-pocket health expenditure (COHE), implying that households experience significant financial hardship due to healthcare costs.”
Why the US spends more treating high-need high-cost patients: a comparative study of pricing and utilization of care in six high-income countries
A study in Health Policy (here) places the focus on these granular examples: “A frail older person with a hip fracture and an older person with congestive heart failure and diabetes. Data on utilization and expenditure is collected across five health care settings (hospital, post-acute rehabilitation, primary care, outpatient specialty and drugs), in six countries (Canada (Ontario), France, Germany, Spain (Aragon), Sweden and the United States (fee for service Medicare).”
The study uses the information to “construct treatment episode Purchasing Power Parities (PPPs) that compare prices using baskets of goods from the different care settings. The treatment episode PPPs suggest . . . that US prices account for more of the differential in US health care expenditures. The US also differs with regards to the share of expenditures across care settings, with post-acute rehab and outpatient speciality expenditures accounting for a larger share of the total relative to comparators.”
Homage: “International research concludes that price differences across countries play a definitive role. This was most succinctly described by Uwe Reinhardt in 2003 as, ‘It's the Prices, Stupid.’”
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
December 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