DCMedical News: Tuesday, January 7, 2020
DCMedical News-DCMN
Washington, D.C.
Tuesday, January 7, 2020
DCMedical News is published every day both the House and the Senate are in session.
THE BIG STORY IN HEALTH CARE
Congress Returns
The Senate and House both are back in session this morning for the first of ten legislative days in January, with impeachment, war and election-year issues overshadowing possible health or other domestic issue legislation. The Kaiser Family Foundation’s Drew Altman opines (here) that most health care policy activity in 2020 will take place in the states.
Supreme Court Considers Action on Patient Protection and Affordable Care Act
The Court has set Friday as a deadline to hear from the “red” states who prevailed in the 5th Circuit decision (Texas v. U.S.) as to why the Court should not grant certiorari to “blue” state Attorneys General seeking high court review. The Kaiser Family Foundation has published a summary (here) of the implications of the 5th Circuit decision, and a second review (here) summarizing how the loss of an “individual mandate” did not disrupt the individual insurance market in 2019.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Primary Care Doctors in the U.S. Less Likely to Coordinate Care, More Likely to Send Patients to the Web
The Commonwealth Fund (announcement here, Health Affairs report here) finds that, compared to primary care physicians in other economically well-off countries, “Only 37 percent of physicians in the U.S. reported making frequent or occasional home visits, compared to 70 percent or more in the other countries. Practices . . . were also much less likely than those in other countries to provide after-hours care to patients without having to visit an emergency department (ED).” Also, “U.S. providers trail their counterparts in coordinating care with other doctors. Fewer than half (49%) of U.S. primary care providers receive information from specialists about changes to their patients’ care plans or medications . . . Similarly, about half of U.S. physicians said they are usually notified when a patient visits an ED, compared to more than 80 percent in New Zealand and Norway.”
Social determinants? “Seventy-four percent of physicians in Germany and 65 percent in the U.K. said they frequently coordinated patients with social services or other community providers. In contrast, only about four of 10 in Australia, the U.S., and Canada reported the same.”
Communication via IT, but not very good IT: “Overall, U.S. physicians are among the most likely to offer health IT tools to better communicate with patients. However, problems of interoperability have led to challenges: just over half of U.S. providers said they could exchange patient summaries, test results, and medication lists with physicians outside their practice, compared to 80 percent or more in New Zealand, the Netherlands, and Norway.”
Residents Change Specialty Choices and Practice Location Choices, AAMC
The Association of American Medical Colleges reports on resident choices in training (announcement here, executive summary here). Highlights of the 2019 report, published Monday: “More than half (54.6%) of those who completed residency training from 2009 through 2018 are practicing in the state where they did their training. Physician retention among states is highest in California (77.5%) and lowest in Delaware (36.4%).” Also, “As students go through medical school, chances are good that they’ll change their minds about what to specialize in. When they finish their residencies, most will enter practice not far from where they trained.” Complete information at https://www.aamc.org/data-reports/students-residents/report/report-residents.
Opioid Death, Fast and Slow
A report in JAMA Psychiatry (here) notes that “Considerable attention has been directed toward the epidemic of overdose deaths in patients who use opioids outside of a prescription. In a systematic review and meta-analysis of 124 publications addressing extramedical opioid use in 28 countries, researchers highlight the additional mortality associated with such use. In analyses of standardized mortality ratios, users of illicit opioids had 10 times the expected mortality from all causes . . . Increased risk for death was noted for suicide (7.9 times that in the general population), accidents (6.9 times), interpersonal violence (9.8 times), AIDS (18.5 times), and cancer, cardiovascular disorders, and respiratory disease (2.7, 4.4, and 10.6 times, respectively). The most common causes of death in this population were poisoning (including from substance use), noncommunicable diseases, infections, and trauma.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Hospital-Based Specialists Tagged as Biggest Surprise Billing Source
Cooper, Morton and colleagues report (Health Affairs, here) that hospital-based specialists were major offenders in surprise billing of patients, adding $40 billion to the national health tab. Modern Healthcare reported (here) that “They found that at in-network hospitals, 12.3% of cases involving a pathologist, 11.8% involving an anesthesiologist, 11.3% involving an assistant surgeon and 5.6% of cases involving radiologists were billed out-of-network. In contrast, orthopedists performing knee replacements—a service for which a patient could choose an in-network physician ahead of time—billed out-of-network less than 1% of the time . . . Researchers found that assistant surgeons billed the highest out-of-network rates at 2,652% of Medicare, while anesthesiologists' out-of-network charges averaged 802% of Medicare. Pathologists and radiologists' out of network charges were 562% and 452% of Medicare, respectively.”
Congress, unsuccessful in 2019 efforts to control surprise bill, especially due to push-back from physician groups (here), has expanded its inquiry of private equity-backed physician staffing firms behind surprise billing (here), with letters (here to Cigna, here to Envision).
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
MACPAC Reports on IMDs
The Medicaid and CHIP Access Commission submitted its report (here) December 30 on Medicaid payment for “Institutions for Mental Diseases.” In a report heavily focused on process and licensure, MACPAC found (reviewing programs in seven states) that there was little oversight or coordination (federal or state) in the IMD world. “Since Medicaid was established in 1965, federal statute has largely prohibited payments to IMDs . . . Facilities that are considered IMDs include a variety of residential and inpatient facilities providing substance use disorder (SUD) and mental health services that are regulated under different federal and state rules. . . The IMD exclusion is one of the few instances in Medicaid where federal funding is not available for covered services based on the setting in which they are provided . . . Most recently, a provision of the SUPPORT Act allows states to make payments to IMDs that treat individuals with an SUD under the state plan.”
READINGS AND REFERENCES
Under Siege:
Op-Ed piece (here) in the New York Times about the common ground of doctors and nurses, “under siege by the bureaucracy of a failing health care system.” One villain? Electronic medical records.
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 2020 Calendar of Regularly Scheduled Sessions, here; Senate schedule subject to impeachment debate
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
January 8, 9, 10, 13, 14, 15, 16, 27, 28
February 4, 5, 6, 7, 10, 11, 12, 13, 25, 26, 27, 28
March 2, 3, 4, 5, 9, 10, 11, 12, 23, 24, 25, 26, 27, 30, 31
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.