DCMedical News: Monday, January 30, 2023
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY Monday, January 30, 2023
Congress Tackles Entitlement Programs, Or Not
The 118th Congress has begun with high stakes debates on entitlement programs, Medicare, Medicaid and Social Security, with significant political positions on all sides.
In December, the Congressional Budget Office published (here) an analysis (“Health Care Options for Reducing the Deficit,” presented to the “Committee for a Responsible Federal Budget”) of projected savings from options for reducing the federal deficit by controlling one or another aspect of health spending, showing these savings (in billions of dollars) over the course of the next decade.
The top five potential areas for reduced spending were: (1) establishing caps on federal spending for Medicaid, savings of $501 to $871 billion; (2) limiting state taxes on health care providers (a stratagem through which states increase their Medicaid matching amounts from the federal government), $41 billion to $526 billion; (3) reducing federal Medicaid matching rates, $68 billion to $667 billion; (4) increasing premiums for Medicare Part B, $57 billion to $448 billion; and (5) reducing Medicare Advantage benchmarks, $392 billion (spending on MA plans depends in part on bids that the plans submit and how those bids compare with predetermined benchmarks set by the federal government).
CBO lists a total of 12 additional “high savings” options. All 17 have the potential to reduce the deficit by more than $300 billion. Fifty-nine lesser options are listed by the CBO, each with a total reduction in the vicinity of $10 billion during the decade. Without action, according to the CBO, over the 2023–2032 period total federal deficits will be $15.8 trillion.
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Private Equity Descends on Rural Hospitals
In the latest of a multi-part series (here), the Private Equity Stakeholder Project (PESP) reports on private equity investment in rural hospitals and health services.
“Many rural hospitals, with their finances in the red, must contend with closing the hospital or declaring bankruptcy if unable to find a willing buyer or source of capital to keep it afloat. Rural hospitals on the verge of closure and/or bankruptcy may be more likely to accept offers from buyers they may otherwise have never taken if it means being able to keep the hospital open for the surrounding community. Regulators may also apply less scrutiny to such transactions if failing to approve a deal would result in the imminent closure of a hospital. Therefore, private equity firms looking to buy failing hospitals may have the leverage to get a price and terms for the deal that they would not be able to obtain otherwise—even private equity firms with little or no healthcare experience.”
A previous PESP study sought to “illustrate the ways private equity firms have generated returns from struggling hospitals. A common strategy they have used involves asset stripping hospital real estate by selling it to a real estate investment trust (REIT) which then leases it back to the hospital.”
Also, “Outsourcing clinical services, specifically those of radiology, emergency medicine, laboratory services, and environmental services, runs high risks of deteriorating quality of care for patients . . . outsourcing, in general, can produce cost savings in the short term, but . . . there are often ‘hidden (sometimes ballooning) costs’ that often make outsourcing an unreliable strategy to save money in the longer term.” The paper has 223 footnote citations.
CMS Publishes Rules for “Rural Emergency Hospitals”
Following through on the 2021 legislation, CMS has published (here, together with FAQs, State Operations Manual, Regulations and Interpretive Guidelines, compliance templates, total 118 pgs.,) new rules for organization and payment of Rural Emergency Hospitals (REHs). “In response to rural hospital closures and in an effort to address barriers in access to health care for rural communities, the Consolidated Appropriations Act was signed into law on December 27, 2020, and established Rural Emergency Hospitals (REHs) as a new Medicare provider.”
“The conversion of an eligible facility [existing hospital, with inpatient services] to an REH allows for the provision of emergency department services, observation care, and additional outpatient medical and health services, if elected by the REH, that do not exceed an annual per patient average length of stay of 24 hours. REHs are prohibited from providing inpatient services, except those furnished in a unit that is a distinct part licensed as a skilled nursing facility to furnish post-hospital extended care services. Effective January 1, 2023, this new provider type will promote equity in health care for those living in rural communities by facilitating access to needed services.”
“REHs must have a clinician, a doctor of medicine (MD), doctor of osteopathy (DO), physician assistant (PA), nurse practitioner (NP) or clinical nurse specialist (CNS), with training or experience in emergency care on-call at all times and immediately available by phone or radio contact and available on-site within 30 or 60 minutes depending on if the facility is located in a frontier area.”
Coroner Warns Health Secretary
The Guardian reports (here) that a “Coroner has urged the health secretary to take action to prevent needless deaths after a woman died of heart failure following a four-hour wait in the back of an ambulance . . . Approximately seven ambulances were waiting to offload patients outside A&E . . . a number that had risen to 17 commonly queueing outside the department at the time of the inquest earlier this month. There were also 140 beds occupied by patients who were “medically fit” but could not be discharged due to a lack of social care places . . . But the coroner said evidence indicated the problem was ‘much wider and more complex’ than a single NHS trust and that action was needed at government level.”
“The warning comes amid reports of record NHS backlogs and treatment delays. Figures released last week by the Association of Ambulance Chief Executives show an estimated 57,000 patients experienced potential harm due to delays in ambulance handovers in December, with 6,000 of those experiencing “severe harm”. The Royal College of Emergency Medicine has estimated that there are 300-500 excess deaths across the UK each week due to overcrowding and long waiting times in emergency departments. NHS England has said it does not recognise those figures.” More on the UK crisis and the December nurses’ strike here, here, here, and here.
Virtual Hospital Beds, More Ambulances, Treatment at Home: UK NHS Meltdown
The Financial Times reports (here) that the government’s response to the meltdown of the NHS is that “More urgent care will be provided in the community in an attempt to increase the number treated at home, avoiding hospital. These services will be available for at least 12 hours a day, and officials said they would mean people who had fallen or were injured could get treatment at home within two hours. Such calls would otherwise have required an ambulance.”
Also, “At the same time, all hospitals with a major A&E department will have same-day emergency care units, staffed by consultants and nurses. Officials said this would allow thousands of people each week to avoid an overnight hospital stay. One of the biggest problems for the NHS is the number of people who cannot be released from hospital due to a lack of care in the community. The NHS will now pilot a new approach to “step down” care, with some patients receiving rehabilitation and physiotherapy at home.”
The optimistic tone of government response notes that a long-awaited NHS workforce plan will be published soon “which is a once in a generation opportunity to put the NHS on a sustainable footing.”
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
January 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