DCMedical News: Thursday, January 26, 2023
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY Thursday, January 26, 2023
Life Expectancy in the U.S. Drops Again, at Lowest Age Since 1996
An article in JAMA (here) and the final summary of the National Center for Health Statistics on 2021 (here) report that “Life expectancy in the US decreased by about a half year between 2020 and 2021, from 77 years to 76.4 years . . . Life expectancy in 2021 was at its lowest level since 1996.”
“The report attributed the drop mainly to increased deaths from COVID-19 and drug overdoses. The 0.6-year drop between 2020 and 2021 followed a 1.8-year decrease in life expectancy between 2019 and 2020. The overall death rate from 2020 to 2021 in the US increased by 5.3%, from 835.4 to 879.7 deaths per 100 000 people.”
“The leading causes of death in 2021 were heart disease, cancer, and COVID-19. Deaths attributed to COVID-19 increased from 2020 to 2021 by 18.8%, from 350,831 to 416,893 deaths. Influenza and pneumonia dropped out of the top 10 causes of death in 2021, likely because of pandemic related infection prevention precautions. Chronic liver disease moved up to the 9th leading cause of death. However, the other leading causes of death in the top 10, including unintentional injuries, stroke, chronic lower respiratory diseases, Alzheimer disease, and diabetes, remained the 4th to 8th leading causes of death, respectively, and kidney disease remained the 10th leading cause of death.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Hospital Resistance to Compliance With Federal Transparency Law: Will Crime Pay?
Modern Healthcare reports (here) that many hospitals are opting to chance CMS fines for non-compliance with the January 2021 price transparency requirements, rather than expose their prices to public scrutiny.
“As of the end of September, 65% of U.S. hospitals had posted the rates they negotiated with commercial insurers, according to data from data aggregator Turquoise Health. That marks a significant improvement from June 2021, when researchers from Michigan State University and Johns Hopkins University found fewer than half had posted machine-readable files with negotiated prices.”
“Still, many hospitals fall short of full compliance, as defined by the Centers for Medicare and Medicaid Services' 21-point checklist. Hospital and health system administrators claim the administrative burden is not worth it and will not achieve CMS’ goals . . . a peer-reviewed study published earlier this month in the Journal of General Internal Medicine concluded that only 19% of a nationally representative sample of 64 hospitals met CMS’ definition of fully compliant . . . Still, the authors noted that at least 72% of those hospitals complied with key pricing metrics, such as publishing negotiated rates, gross charges, descriptions of procedures and discounted cash prices.”
CMS has fined two related hospitals for non-compliance, a total of $1.1 million, and has issued 437 warning notices to hospitals and 263 corrective action plan requests.
Skilled Nursing Facilities Faulted for Sending Funds to Related Corporations, REITs
Controversy over staffing in skilled nursing facilities (SNFs) will escalate as plans draw near for publication of proposed staffing regulations (letter from Senators concerning rural area SNFs to CMS, here).
An investigation in New York State by the Empire Center (here) notes that “It’s increasingly common, in New York as in other states, for nursing homes operators to structure themselves as networks of interlocking companies. They typically establish a separate company to own each facility in their chain, and sometimes create additional companies to hold the real estate. Other side businesses supply shared services such as physical therapy, payroll processing or liability insurance. In many cases, these various companies are owned by the same set of people – or by their family members and business partners – and outwardly function as a single organization. These practices have become a focus of criticism from watchdog groups and some policymakers. They contend that nursing homes operators use ‘related company’ transactions to divert money away from patient care and disguise the true profitability of their businesses.”
New York State Attorney General Letitia James has filed suit (Memorandum of Law here; press release here) against the Villages at Orleans Health and related companies and individuals, alleging a “reprehensible history of insufficient staffing and low quality care [which] is directly traceable to the owners’ financial scheme.”
A comprehensive data base of all nursing homes in the State (breaking out those involved in this Complaint), with staffing hours, profit, quality measures, payments to related companies, is found here.
“The owners wove a complicated web of fraud, using their ownership stakes in multiple companies to turn The Villages into a profit machine. The named respondents in the complaint are The Villages of Orleans LLC; Telegraph Realty LLC (Telegraph), which owns the real property where The Villages is; CHMS Group LLC (CHMS), which provides administrative services to The Villages; and ML Kids Holdings LLC (ML Kids), which received over $1.5 million in cash transfers from Telegraph. Also named are individual owners, including the sole official owner of The Villages, his three sons-in law, his daughter-in-law; three undisclosed owners of The Villages; and the owners of Telegraph Realty LLC.”
“From 2015 through 2021, The Villages received $86.4 million in funding, including millions in taxpayer dollars from Medicare and Medicaid, intended to provide quality healthcare to vulnerable residents. Instead, the owners cut staffing to increase their personal profits. By making payments to Telegraph and CHMS, and by making other transfers to themselves directly and indirectly, the owners were able to divert $18.6 million — more than 20% of The Villages’ operating budget. When the Villages was owned by Orleans County, the facility’s nursing home rating from the Centers for Medicare & Medicaid Services(CMS) was three out of five stars. In April 2015, just four months after the owners purchased The Villages, CMS decreased the rating to one star, the lowest possible rating.”
Commentary from Bill Hammond of The Empire Center (here) following the filing of AG James’ suit said “If her legal argument holds up in court, hundreds of other New York homes would have to consider whether their business structures put them at risk of similar litigation . . . A recent Empire Center study found that 72 percent of New York’s for-profit nursing homes reported doing business with related companies in 2020. These side companies are typically far more profitable than the nursing homes themselves. Among operators of for-profit homes, related companies accounted for two-thirds of their collective profits, or $306 million.”
The New York State effort follows closely on the timing and theme of a House Select Subcommittee on the Coronavirus Crisis, chaired by Rep. James E. Clyburn, which “released new evidence of dire conditions inside for‑profit nursing home chains during the early months of the pandemic, as well as documents that shed light on how convoluted corporate structures have been used by for-profit nursing home chains and may have helped these companies to obscure profits and avoid accountability.” (Press release here, Bloomberg coverage here, McKnight Long Term News coverage here).
Casalino and colleagues in the forthcoming Health Affairs (here) find that investment by Real Estate Investment Trusts in nursing homes result in measurable change in staffing. “REIT investments were associated with an overall 6.25 percent relative decrease in RN staffing and no changes in LPN and CNA staffing. Larger deals resulted in increases in LPN and CNA staffing, with no changes in RN staffing; smaller deals appeared to replace more expensive and skilled RN staffing with less expensive and skilled staff.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
MACPAC Meets Today and Tomorrow
Agenda here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
January 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