DCMedical News: Thursday, December 5, 2019
DCMedical News-DCMN
Washington, D.C.
Thursday, December 5, 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
Hospitals Sue to Avoid “Transparency”
Four hospital associations and three hospitals filed suit (here) to avoid the January 1, 2021 requirements for “transparency” in billing. The group opposes the “Final Rule” (here), “requiring that hospitals post on the internet a file containing five types of pricing information for every item and service they provide. The types of information are each hospital’s ‘gross charges,’ ‘payer-specific negotiated charges,’ ‘discounted cash price,’ and ‘de-identified’ minimum and maximum negotiated charges.
The Complaint continues, “The Final Rule also mandates that hospitals publicly display negotiated charges and certain other information for 300 ‘shoppable’ services (i.e., a health care service that can be scheduled by patients in advance). In plain English: The Final Rule requires each hospital in the nation to publicize on its website a huge quantity of confidential pricing information reflecting individually negotiated contract terms with all third-party payers, including all private commercial health insurers, with which the hospital contracts. The Final Rule is unlawful, several times over.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Location Matters
Looking back, researchers find that Medicare payment rates shot up for noninvasive cardiac tests when those tests “moved” from physician offices to physician offices owned by hospitals. In a commentary, Figueroa and Joynt Maddox note that “for every action there is a reaction.” The lowering of payment in physician office settings for cardiovascular tests “actually led to increased total costs, including higher costs paid by patients, and likely encouraged consolidation among providers for monetary gain.” (Report, here, commentary, here.)
Multi-tasking or Serially Uni-tasking?
A report in JAMA Internal Medicine (here) notes that the National Coordinator for Health Information Technology and The Joint Commission have both recommended limiting the number of electronic medical records that a clinician can open to one at a time.
However, a randomized clinical trial demonstrated that this restriction did not reduce wrong patient orders. The trial report noted that common practice differs from The Joint Commission recommendation: “Among health care facilities with EHRs capable of displaying multiple records at once, 42% allowed ≥3 open records…”
The study notes Wachter’s warning of potential unanticipated consequences associated with “logical patient safety fixes.” In fact, the restrictions of EHR displays to one record at a time “led some clinicians to devise work-arounds that could pose risks to patient safety.”
WHO Says Maternal Birth Rate in U.S. Now Below That of Russia, Ten Times Italy’s Rate
The World Health Organization (Financials Times, 12-2-2019) reports (full report here, evidence brief here, executive summary here) on maternal deaths per 100,000 live births. Since the turn of the century, China’s numbers have plummeted from 60 to 30, while the U.S. has risen from 10 to 20, now above Russia and, as noted, approximately ten times the two deaths per 100,000 live births in Italy.
Abortions Down in 2016 Says CDC
A total of 623,471 abortions for 2016 were reported to the CDC (here) from 48 reporting areas. From 2015 to 2016, the total number of reported abortions decreased 2% (from 636,902). From 2007 to 2016, the total number of reported abortions decreased 24% (from 825,240). In 2016 and throughout the period of analysis, women in their 20s accounted for the majority of abortions and had the highest abortion rates.
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
ACSCs Go Down, Observation “Admissions” Go Up
Pressure to reduce hospitalizations related to ambulatory care-sensitive conditions (ACSCs) have had some success, and measures of reduction in hospital admissions related to ACSCs are “used with increasing frequency to assess and incentivize the performance in the ambulatory setting of health care professionals participating in national Medicare alternative payment programs,” according to a study in JAMA Internal Medicine (here). However, during the same period of somewhat falling ACSC rates, the rates of hospital admissions “for observation” have been increasing.
Hospitals Suffer Decline in Consumer Satisfaction
Health blogger “Healthpopuli.com” reports (here) a decline in patient satisfaction with outpatient, inpatient and emergency room settings in hospitals, based on analysis of the ACSI Finance, Insurance and Health Care Report, a poll of 300,000 consumers to gauge satisfaction in 46 industries.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Thought Leader on “Medicare for More”
Modern Healthcare’s Merrill Goozner wonders (here) why hospitals are opposed.
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
December 6, 9, 10, 11, 12
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.