DCMedical News: Friday, December 6, 2019
DCMedical News-DCMN
Washington, D.C.
Friday, December 6, 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
$3.6 Trillion, Still Growing
The CMS Office of the Actuary reported (CMS announcement here) and also published in Health Affairs (here) an analysis of 2018 health spending. Highlights: total of $3.6 trillion, $11,172 per person, growth rate 4.6%, up from 4.2% in 2017, partially due to an Obamacare insurance tax. But prices also increased (2.1%), offsetting a modestly slowing growth (1.3%) in use of medical services. The cost of health insurance grew more than 15%, fastest rate since 2003. Spending for hospitals was $1.2 trillion, for doctors $726 billion, for drugs $335 billion.
How Much Pharmaceutical Innovation Can We Afford?
House Speaker Nancy Pelosi of California announced the House will vote next week on legislation (HR 3, here) that would allow Medicare to negotiate prices for up to 250 prescription drugs a year. The Administration opposes the measure and released a white paper (here) Monday, arguing that the legislation could lead to as many as 100 fewer new drugs being developed in the next decade.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Doctors and Rural Hospital Closure
A study of physicians and rural hospital closures in the December Health Affairs concludes that an important run up to hospital closures is a reduction in the number of general surgeons, and an important consequence of rural hospital closure is the further decrease in the supply of surgical and medical specialists, as well as primary care practitioners.
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Are You Ready for the Year of the Nurse? Florence and the Machine
The World Health Organization (see The Economist, here) has designated 2020 as the “Year of the Nurse,” 200 years from the birth of Florence Nightingale. The Economist notes that “Like doctors, nurses specialize in myriad clinical disciplines, such as neonatology, cardiology” and many others. The “The World in 2020” annual publication of the newspaper says, “In 2020 and beyond nurses will be doing a growing number of tasks conventionally reserved for doctors, both in acute and chronic care. Already, nearly two-thirds of anaesthetics given to patients in America are administered by certified nurse anaesthetists. In Britain specialised nurses now perform some types of abdominal, orthopaedic and cardiac surgery. In parts of sub-Saharan Africa nurses are being trained to do emergency caesarian sections, with results comparable to those achieved by doctors.”
But the article notes that “although nurses make up nearly half of the world’s health-care workforce – and 90% of patients’ contacts with health workers – they are often not at the table when health-policy decisions are made.” (Italics added).
What Happens to Rural Hospitals “Affiliating” with Health Systems?
A study in the December Health Affairs notes that operating margins go up and availability of services goes down, in rural hospitals which affiliate with larger health systems. In particular, diagnostic imaging, obstetrics, primary care, and outpatient non-emergency visits disappear, while operating margins improve by 1.6 to 3.6 percentage points.
CDC Reports 800,000 per Year Increase Over Five Years in Antibiotic Resistant Infections; New TJC Standard for Ambulatory Care
“According to the report (here), more than 2.8 million antibiotic-resistant infections occur in the U.S. each year, and more than 35,000 people die as a result. In addition, 223,900 cases of Clostridioides difficile occurred in 2017 and at least 12,800 people died. In 2013, CDC published the first AR Threats Report (here), which sounded the alarm to the danger of antibiotic resistance. That report stated that each year in the U.S. at least 2 million people get an antibiotic-resistant infection, and at least 23,000 people die. The 2013 AR Threats Report helped inform the National Action Plan for Combating Antibiotic-Resistant Bacteria. The 2013 and 2019 reports do not include viruses (e.g., HIV, influenza) or parasites.”
The Joint Commission announced that “Effective Jan. 1, 2020, the Ambulatory Health Care Accreditation program will have a new standard – MM.09.01.03: Antimicrobial stewardship is identified as an organizational priority.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Open Enrollment Ends Tomorrow, December 7
“Open season” on enrollees in traditional Medicare - - the annual hunt for new Medicare beneficiaries by companies attempting to enroll them in Medicare Advantage plans - - ends tomorrow, for coverage starting January 1, 2020.
DRUGS AND DEVICES
Meeting for Medicare Add-On Payments for New Medical Devices
Registration is required by 5:00 p.m. December 9 for the FY2021 applications for add-on payments for new medical devices and technologies under the hospital inpatient prospective payment system. The meeting will be held December 16 at 9:00 a.m. (notice here), and registration takes place at this address: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/newtech.html
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.