DCMedical News: Monday, November 18, 2019
DCMedical News-DCMN
Washington, D.C.
Monday, November 18, 2019
DCMedical News is published every day both the House and the Senate are in session. Subscription information below.
THE BIG STORY IN HEALTH CARE
Transparency!
A flurry of documents issued Friday (11-15) demonstrate an Administration drive for price transparency from hospitals and health insurers. The initiative took shape beginning with an Executive Order June 24 (here). That document said “With the predominant role that third-party payers and Government programs play in the American healthcare system, however,
patients often lack both access to useful price and quality information and the incentives to find low-cost, high-quality care. Opaque pricing structures may benefit powerful special interest groups, such as large hospital systems and insurance companies, but they generally leave patients and taxpayers worse off than would a more transparent system.”
The June 24 document went on to state that “Of the categories of medical cases requiring inpatient care, 73 percent of the 100 highest-spending categories were shoppable. Among the categories of medical cases requiring outpatient care, 90 percent of the 300 highest-spending categories were shoppable. Another study demonstrated that the ability of patients to price-shop imaging services, a particularly fungible and shoppable set of healthcare services, was associated with a per-service savings of up to approximately 19 percent.”
A previous Executive Order on October 12, 2017 (here) lead to a report (here), “Reforming America’s Healthcare System Through Choice and Competition,” whose thrust was price transparency, as outlined in a cover letter (here) from Secretaries Azar (HHS), Mnuchin (Treasury) and Acosta (Labor). The June 24 document called for proposed rulemaking within 90 days, and a further report within 180 days “describing the manners in which the Federal Government or the private sector are impeding healthcare price and quality transparency for patients, and providing recommendations for eliminating these impediments in a way that promotes competition.”
Now, notwithstanding opposition (here), and delay (here), “(CMS) is issuing two rules that take historic steps to increase price transparency to empower patients and increase competition among all hospitals, group health plans and health insurance issuers in the individual and group markets. One of the rules [here] is the Calendar Year (CY) 2020 Outpatient Prospective Payment System (OPPS) & Ambulatory Surgical Center (ASC) Price Transparency Requirements for Hospitals to Make Standard Charges Public Final Rule. The second rule [here] is the Transparency in Coverage Proposed Rule. Both the final and proposed rules require that pricing information be made publicly available.” CMS fact sheets for coverage here, for hospitals here, CQ coverage here, Kaiser Family Foundation coverage here.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Doctor Burnout, Electronic Medical Records Get a Failing Grade, Cause and Effect?
The National Academy of Medicine issues a report on “Taking Action Against Clinician Burnout.” The 332-page document (here) from the prestigious organization pays extensive attention to contributing factors, including job demands, excessive workload, inadequate staffing, administrative burdens, workflow distractions, and “inadequate technology usability.” Attention is given to “moral distress,” the conflict between professional ethical values and those which may be held by supervisors or health care organizations.
Inadequate Technology Usability
The director of the Clinical Informatics Fellowship at the Yale School of Medicine is lead author of a paper (here) publicized as “Yale study: Doctors give electronic health records an ‘F’.” In descending order of utility, Google searches scored 93%, Amazon 82%, Excel 57% and electronic health records 45%. The study faults the rapid introduction of the Health Information Technology for Economic and Clinical Health Act of 2009, part of the American Recovery and Reinvestment Act, and its largesse for information systems manufacturers and (disappointed) purchasers, as well.
Physician Workforce
The AAMC issues a report, “2019 State Physician Workforce Data Report,” (here), an update on the supply and demand for physicians, the position of undergraduate medical education and of graduate medical education, and issues involved with the retention of physicians. The median “physician supply” among the 50 states is 263 active physicians per 100,000 population. Leading with the richest supply is Massachusetts, at 450. Trailing with 225 or below are (in descending order) Texas, Iowa, Alabama, Utah, Nevada, Wyoming, Arkansas, Oklahoma, Idaho and Mississippi.
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Bad Week for Hospital Reputations in Patient Safety
Leading hospitals and health systems were faulted for patient safety lapses (here); the cover story for Modern Healthcare (here) quotes a hospital CEO saying that “Patient safety is uniquely the responsibility of the C-suite, but CEOs haven’t paid attention to it or acquired the necessary knowledge”; and, confirming most studies, federal quality measures are found to be of little use (here). The most successful of the federal programs, reduction in hospital-acquired conditions, appears (here) to be unrelated to the penalty-driven Affordable Care Act program.
READINGS AND REFERENCES
Wilensky on the Election
Policy leader Gail Wilensky writes in JAMA Forum (here) that “Between now and the November 2020 election, Democrats and Republicans are unlikely to pass any legislation other than budget bills or other ‘must-pass’ legislation.” She includes surprise medical bills and prescription drug costs in her summary.
U.S. House of Representatives:
Members at https://www.house.gov/representatives
Committees and Members at https://www.house.gov/committees
U. S. Senate:
Members at https://www.senate.gov/general/contact_information/senators_cfm.
Committees and Members at https://www.senate.gov/committees
House and Senate 2019 Calendar of Regularly Scheduled Sessions, here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
November publication dates: 19, 20, 21
December 3, 4, 5, 6, 9, 10, 11, 12
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.