DCMedical News: Tuesday, January 24, 2023
DCMedical News is published every day both the House and the Senate are scheduled to be in session. The second formal session day of the 118th Congress is today.
THE BIG STORY Tuesday, January 24, 2023
The Omnibus Had Health Care Passengers
Margot Sanger-Katz for The New York Times (here) has focused attention on the large number of health measures carried along in the $1.7 trillion bill passed by the 117th Congress among its last acts.
She reports, “The giant spending bill passed by Congress last month kept the government open. But it also quietly rewrote huge areas of health policy: Hundreds of pages of legislation were devoted to new health care programs. The legislation included major policy areas that committees had been hammering away at all year behind the scenes — like a big package designed to improve the nation’s readiness for the next big pandemic.”
“It also included items that Republicans had been championing during the election season — like an extension of telemedicine coverage in Medicare. And it included small policy measures that some legislators have wanted to pass for years, like requiring Medicare to cover compression garments for patients with lymphedema. Though the bill was primarily designed to fund existing government programs, a lot of health policy hitched a ride.”
In the January 3 edition of DCMN we reported, in addition, that “For hospitals, the legislation (4,155-page bill here, Labor-HHS appropriations list here, Republican leadership summary of the bill here, Democratic leadership summary of the bill here) will postpone a 4% across-the-board Medicare payment cut that was to take effect in 2023. The 2% payment sequester will remain in place. Also, the Medicare-Dependent Hospital and low-volume hospital programs will continue to be funded through 2025.”
Said Becker’s, “The legislation curbs a scheduled cut of nearly 4.5 percent to the Medicare physician fee schedule that was set to take effect in 2023, narrowing the cut to 2 percentage points in the year ahead with a scheduled cut of 3.25 percentage points in 2024.”
In addition, the “Inflation Reduction Act” will also have an impact on health services, for example on drug pricing and drug policy. The Act is profiled in another NYT report (here) with the headline “Medicare Begins to Rein In Drug Costs for Older Americans. Reforms embedded in the Inflation Reduction Act will bring savings to seniors this year. Already some lawmakers are aiming to repeal the changes.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Corporate Investors in Primary Care
Erin C. Fuse Brown and colleagues discuss (in The New England Journal of Medicine, here) Amazon’s latest foray into health care, the acquisition of One Medical, the CVS acquisition of Signify Health, and, in general the investment of private equity and corporations in primary care, believing it to be the key to “savings” in “value-based” payment schemes. “Though potentially beneficial for certain well-insured patients, the trend of corporate investment in primary care could threaten equitable access to care, raise health care costs, and reduce physicians’ clinical autonomy.”
Brown, Soleil Shah and Hayden Rooke‑Ley note “Primary care practices can generate substantial profits by growing their population of patients covered by Medicare Advantage (and other lucrative payers), maximizing the ‘budget’ for each patient’s care using risk adjustment and quality bonuses, minimizing their health expenditures with utilization management, and referring patients to other [in house] product and service offerings, such as pharmacy. Primary care providers are health care’s front door not just for patients, but also for investors who see those patients as a revenue stream.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Fatal Financial Illness and Institutional Suicide: New Rural Emergency Hospital Program Already a Bust
Modern Healthcare (here) reports on the CMS “Rural Emergency Hospital” [REH] program, under which failing institutions would stop being hospitals, that is, would give up inpatient services, and would, instead, be supported more generously by CMS as free standing outpatient centers. “As of Jan. 1 [CMS] gives a reimbursement boost and an operating bonus to hospitals that eliminate inpatient services and provide 24-hour emergency care.” The story notes that the REH program is the first new effort at sustaining rural hospitals since the Critical Access program of 1997, which was built, in turn, on earlier experiments initiated by the Montana Hospital Association, in active cooperation with then-Senate Finance Committee chairman, Max Baucus, Democrat of Montana.
Nursing Home Rights: What If There Is No Remedy?
Nicole Huberfeld discusses the “Talevski” case (here), and the threatened loss of nursing home patient rights. “Recently, the U.S. Supreme Court heard a case (Health and Hospital Corporation of Marion County, Indiana v Talevski) that is primed to strike at the heart of Medicaid’s nursing home coverage and conditional spending programs generally. If the Health and Hospital Corporation (HHC) and state supporters have their way, people denied the legally promised benefits provided through Medicaid would have no recourse in federal court.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
MedPAC 2023
The Congressionally chartered advisory body met January 12-13 and received reports on payment updates for physicians (here), hospitals (here), telehealth (here), Part B (here), Medicare Advantage (here), Part D (here), behavioral health (here) and longer term (ESRD, hospice, SNF, HHA, IRF) care (here).
For physicians and other health professionals, the staff noted that Medicare pays for 8,000 different types of services by 1.3 million clinicians, spending $93 billion in 2021. Access to care appears stable, but the staff note that while Medicare beneficiaries have access comparable to or better than persons privately insured, the number of primary care providers is declining. The quality of care shows wide variation in rates of elective hospitalizations and ED visits. Physician median compensation grew 3% per year on average from 2017 to 2021, with commercial PPO payment rates measured at 134% of fee for service Medicare rates in 2021. The presentation drew attention to what the staff feels is “The need for Medicare to support clinicians who treat beneficiaries with low incomes,” especially patients dually eligible, for both Medicare and Medicaid.
The hospital payment report deals only with the fee for service Medicare program, since comparable information from Medicare Advantage plans is not routinely or easily available. FFS Medicare paid for 7 million hospital stays for $108 billion (an average of $15,428 per discharge) and 136 million outpatient services for $50 billion (average $368) in 2021. Volume showed a continued shift from inpatient to outpatient settings, with increased risk adjusted hospital mortality compared to 2019, and a projected Medicare hospital margin for 2023 of minus 10%. Here also the staff proposes additional measures to support hospitals serving significant volumes of low income Medicare beneficiaries.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
January 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