DCMedical News: Monday, January 27, 2020
DCMedical News-DCMN
Washington, D.C.
Monday, January 27, 2020
DCMedical News is published every day both the House and the Senate are in session.
THE BIG STORY IN HEALTH CARE
Sparks From the “Third Rail” in Election Year
The President has raised the issue of “entitlement” reform.” He told USA Today (here) that the “tremendous growth” in the economy would make it easier to change entitlement programs. A group composed of doctors and medical professionals (here) denounced possible cutbacks. The President has described such proposals (here) as “second term” possibilities.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Doctors Concentrate in Larger Groups, Hospitals
A study in the Annals of Internal Medicine (here) found that 26% of physicians worked in hospital-owned practices in 2016, an increase from 19% in 2009; that the percentage of physicians in the largest practices (more than 50 physicians) rose from 32 to 49% from 2009 to 2016; that 58% of new physicians and 35% of existing physicians practiced in large groups; and that 38% of new physicians worked in hospital-owned practices.
South Africa Moves to Nationalize Health Services
“Some doctors have threatened to leave the system,” says one observer, but "where are they going to go? Most developed countries already have the same system-except the U.S.” A report, in Bloomberg (here) says 16% of the country has private health insurance and that 70% of the doctors care for that portion of the population, consuming 50% of all health resources. Now the public crisis (resources) is being met by a private crisis (prices). “But with the country's biggest labor group behind it, the bill's fate is clear: South Africa will soon join the majority of the developed world in providing some form of nationalized health care,” says the report.
One Trouble with Guidelines: Patients Lost to Follow Up
A study in Circulation: Cardiovascular Quality and Outcomes (here) finds that “The robustness of the findings that support current myocardial revascularization guidelines [AHA, ACC, European] is tenuous and vulnerable to change as new evidence from RCTs [randomized controlled trials] appears.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
More Evidence of “Coding Treatment” Found in Examination of Massachusetts Hospital Bills
The Health Policy Commission has discovered (report in Modern Healthcare here) that despite a 14% decline in commercial inpatient hospital utilization in five years, inpatient spending grew by 11%. The anomaly is caused, according to the HPC, by higher prices in the Partners HealthCare and Beth Israel Lahey Health systems, as well as unnecessary or low value treatment in those systems, and more aggressive coding. An example would be aggressive coding to “achieve” a diagnosis of septicemia, reminiscent of the outbreak of “Kwashiorkor” in Prime California hospitals, unmasked by SEIU.
Aiding and abetting the large systems are their “new or improved EHRs that have increased ability to document diagnostic information,” a major factor in rising acuity levels and risk scores. The Commission reports that 40 cents of every additional dollar earned by Massachusetts families in the last three years went to health care. The Commission proposed no remedy or new measures addressed at the powerful consolidated health systems.
Act First, Study Later
37 years later, researchers publishing in Health Policy (here) analyze the effects over time of hospital payment based on Diagnosis-Related Groups (DRGs). They reviewed 18 “Cochrane approved” studies and reported that DRG-based payment lowered length of stay, raised readmission rates, and had only uncertain and imprecise effects on health. They note that DRG-based payment, begun in 1983 in the U.S., is “increasingly used worldwide to control hospital costs instead of pre-existing cost-based payment, but the results of evaluations vary.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
MedPAC Materials from that Congressional advisory group’s meeting of January 16 – 17 are here, including:
Hospice Payment Update, here; Hospital Inpatient and Outpatient Payment Update, here; Improving Medicare Pay for Post-Acute Care, here; Outpatient Dialysis Payment Update, here; Physician, Other Professionals, Payment Update, here;
Prescription Drug, Part D Status Report, here; Redesigning Medicare Advantage Quality Bonus Program, here; 340B Program, Hospital Drugs Use, here; and Improving ACO Beneficiary Assignment, here.
At the meeting, MedPAC recommended that Congress raise payments for acute care hospitals by 2 percent in 2021; create a “value incentive program” with an additional 0.8 percent in bonus payments; and eliminate the 0.5 percent quality penalty, a 3.3 % increase overall. Hospitals are currently scheduled to receive a 2.8 percent raise in 2021. CQ reports that “Medicare paid hospitals $201 billion in 2018, with for-profit hospitals sustaining a 0.9 percent Medicare loss and nonprofits averaging a 10.6 percent loss.” The Chair announced a wide-ranging review of hospital payments in 2020.
Medicare Change Beefs Up DaVita’s and Fresenius’s Prospects
Goldman Sachs has raised a target price for DaVita, based on expanded Medicare Advantage (MA) eligibility for End Stage Renal Disease Rule (ESRD, discussed here) patients. A new rule will expand eligibility in the MA plans to include those with preexisting End Stage Renal Disease. In the current program, MA covers only ESRD patients who develop the disease after enrollment. The bank’s analysts noted that the 516,000 patients on Medicare with ESRD represent 1% of Medicare eligibles, but 7% of total Medicare spending. Goldman Sachs notes that the rate DaVita charges to MA plans exceeds the rate that is reimbursed under Medicare fee-for-service (“traditional” Medicare) by 15%.
Things are looking up for back pain, also: CMS has announced (decision memo here) that it will cover acupuncture for patients with chronic low back pain, up to twelve sessions in 90 days, and an additional eight sessions for those showing demonstrated improvement. Until now, acupuncture was not covered by Medicare. CMS officials indicated they felt acupuncture was an alternative to prescription opioids.
READINGS AND REFERENCES
Health Care Simulation: The Next Trend/Meme/Fad?
Had enough “population health management” and “value-based” everything? Here you go: “Health care simulation,” complete with a health care simulation dictionary (here, new acronyms on pg. 5) from the Agency for Healthcare Research and Quality (press release here), and a Society for Simulation in Healthcare (here) whose members are off to an international gathering in San Diego (IMSH2020!).
Worth a Second Look
From JAMA in November (here), “US life expectancy increased for most of the past 60 years, but the rate of increase slowed over time and life expectancy decreased after 2014. A major contributor has been an increase in mortality from specific causes (e.g., drug overdoses, suicides, organ system diseases) among young and middle-aged adults of all racial groups . . . and with the largest relative increases occurring in the Ohio Valley and New England.”
U.S. House of Representatives:
Members at https://www.house.gov/representatives
Committees and Members at https://www.house.gov/committees
U. S. Senate:
Committees and Members at https://www.senate.gov/committees
CQ 2020 Calendar of Regularly Scheduled Sessions, here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
January 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.