DCMedical News: Tuesday, January 31, 2023
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY Tuesday, January 31, 2023
Public Health Emergency Ends, Pandemic Deaths Continue
The administration has announced (here) that the “Public Health Emergency” (PHE) will end May 11. OMB says in the announcement, “The COVID-19 national emergency and public health emergency (PHE) were declared by the Trump Administration in 2020. They are currently set to expire on March 1 and April 11, respectively. At present, the Administration’s plan is to extend the emergency declarations to May 11, and then end both emergencies on that date. This wind-down would align with the Administration’s previous commitments to give at least 60 days’ notice prior to termination of the PHE.”
Opposing pending legislation in the House which would end the PHE at an earlier date, OMB says “First, an abrupt end to the emergency declarations would create wide-ranging chaos and uncertainty throughout the health care system — for states, for hospitals and doctors’ offices, and, most importantly, for tens of millions of Americans. During the PHE, the Medicaid program has operated under special rules to provide extra funding to states to ensure that tens of millions of vulnerable Americans kept their Medicaid coverage during a global pandemic. In December, Congress enacted an orderly wind-down of these rules to ensure that patients did not lose access to care unpredictably and that state budgets don’t face a radical cliff.”
With an early and unplanned end, “tens of millions of Americans could be at risk of abruptly losing their health insurance, and states could be at risk of losing billions of dollars in funding. Additionally, hospitals and nursing homes that have relied on flexibilities enabled by the emergency declarations will be plunged into chaos without adequate time to retrain staff and establish new billing processes, likely leading to disruptions in care and payment delays, and many facilities around the country will experience revenue losses.”
“Finally, millions of patients, including many of our nation’s veterans, who rely on telehealth would suddenly be unable to access critical clinical services and medications. The most acutely impacted would be individuals with behavioral health needs and rural patients. Second, the end of the public health emergency will end the Title 42 policy at the border. While the Administration has attempted to terminate the Title 42 policy and continues to support an orderly lifting of those restrictions, Title 42 remains in place because of orders issued by the Supreme Court and a district court in Louisiana.”
Meanwhile, COVID-19 deaths, which led to the creation of PHE provisions, continue, and in fact are rising. The New York Times (here) reports “Deaths have not seen the same improvement. Many states now report death data in weekly batches, which can make daily trends fickle. But the average number of deaths announced each day has remained at or above 500 for most of January — a troublingly high figure that is about double the number of daily deaths typically seen in a bad flu season.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Staff Numbers are Down, Expenses Up, in Medical Practices
The American Medical Group Association reports (here) that “Workforce challenges persisted for medical groups in 2022 as the number of clinical staffing FTEs fell by 11.3 percent and staffing expenses rose by 15 percent . . . The 2022 Medical Group Operations and Finance Survey reflects data from more than 24,000 healthcare providers across 5,600 clinics . . . Positions with a high turnover risk, such as medical assistants, saw a more significant decrease.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Pre-Hospital Troponin Testing and Point of Care Testing Generally
An opinion piece in JAMA Internal Medicine (here) says “Nearly 10% of emergency medical service (EMS) encounters in the US are for chest pain. Personnel for EMS perform initial triage and stabilization; some are empowered to interpret electrocardiograms and activate hospital catheterization laboratories.” A study in the same edition “modeled potential cost savings of troponin testing for prehospital triaging of patients with chest pain. The study concluded that implementing such a strategy could realize cost savings by appropriately triaging patients to lower levels of care.”
The opinion continues, “For patients with neurologic symptoms, studies have shown effective EMS triage of patients with acute stroke to hospitals with endovascular intervention capability while safely steering patients with stroke mimics, such as hypoglycemia, to less critical resource use settings,” but that “The use of point-of-care testing to triage patients, except for glucose testing, is not currently routine EMS practice” and that “the default will remain emergency department triage. In the US, where first responders are more likely to be emergency medical technicians than paramedics, the feasibility of use and potential cost savings may be substantially diminished.”
Optum Addresses Rural Health Needs
The giant insurer-provider began offering mobile RV-based primary care and screening services in Utah (here). “Optum Care in Utah is proud to present Optum mobile clinic . . . It offers an easy, convenient way to get care and general health screenings, including mammograms. How it works: Optum mobile clinic is a recreational vehicle (RV) that goes to different areas. After it parks, simply board the RV for your visit. Unlike a regular doctor visit, it offers many important screenings that most primary care clinics don’t do on site.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
CMS Proposes to “Claw Back” Overpayments to Medicare Advantage Plans, With Shorter Claws
CQ reports “The Centers for Medicare and Medicaid Services on Monday finalized a long-awaited rule to claw back ‘overpayments’ to Medicare Advantage insurers.” The final rule (here) is meant to address “risk adjustment” by MA plans. “Medicare Advantage plans are paid fixed amounts to pay for beneficiaries' care. Those amounts are ‘risk adjusted’ to account for populations that are sicker or have greater health needs.” The plans say they have sicker patients, but critics say the MA plans have scoured medical records of their enrollees to artificially produce higher bills.
Shorter Claws: “CMS did appear to compromise with the industry, stating that while it plans to recoup overpayments from between 2011 and 2017, it won’t use extrapolation during those years. But from 2018 onward, it will use that tactic.”
Kaiser Asks, “Did Your Health Plan Rip Off Medicare?”
A report in the Kaiser Health Network (here) notes “KHN has released details of 90 previously secret government audits that reveal millions of dollars in overpayments to Medicare Advantage health plans for seniors . . . The audits, which cover billings from 2011 through 2013, are the most recent financial reviews available, even though enrollment in the health plans has exploded over the past decade . . . KHN obtained the long-hidden audit summaries through a three-year Freedom of Information Act lawsuit against CMS, which was settled in late September.”
Prior Authorization Targeted in State Legislatures
BeckersPayer reports (here) that “As many as 42 states could introduce bills this year to limit or change prior authorization . . .So far, 26 bills have been introduced in 16 states . . . Prior authorization reforms have been targeted by states in recent years. Texas passed a "gold card" law in 2021. Under the law, physicians who have a 90 percent prior authorization approval rate over a six-month period on certain services are exempt from prior authorization requirements for those services. Rules for the law went into effect in October.”
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
February 1, 2, 6, 7, 8, 9, 27, 28
March 1, 7, 8, 9, 10, 22, 23, 24, 27, 28, 29, 30
April 17, 18, 19, 20, 25, 26, 27, 28
Notes to Fred Hyde, MD, JD, MBA, news@dcmedicalnews.org