DCMedical News: Monday, February 25, 2019
DCMedical News-DCMN
Washington, D.C.
Monday, February 25, 2019
The publication schedule and subscription information for DCMedical News will be found below.
THE BIG STORY IN HEALTH CARE:
Six Trillion Dollars Projected as Annual U.S. National Health Expenditures in 2027:
CMS’ Office of the Actuary (report here). Half the growth in expenditures according to the report will come from price increases, the other half from higher service utilization.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
More Primary Care Physicians Improves Life Expectancy:
But we aren’t getting more. A multi-center group reports in JAMA Internal Medicine (here) that “Greater primary care physician supply was associated with improved mortality, but per capita primary care physician supply decreased between 2005 and 2015” and that “every 10 additional primary care physicians per 100,000 population was associated with a 51.5-day increase in life expectancy. However, from 2005 to 2015, the density of primary care physicians decreased from 46.6 to 41.4 per 100,000 population.”
Evidence-Based Medicine or Guesswork:
A study in JAMA Internal Medicine (here) pans the clinical guidelines published by the American Thoracic Society, noting that “Among 222 unique recommendations from 16 separate guidelines, 141 (63.5%) were based on low-quality evidence, whereas fewer than 1 in 10 (19 [8.6%]) were based on high-quality evidence. Nonetheless, 86 (38.7%) were designated strong recommendations.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
HCUP Reports on Readmissions:
The Healthcare Cost and Utilization Project (run by AHRQ) reports on readmissions to hospitals (here). “From 2010 to 2016, the readmission rate decreased 7 percent for Medicare patients (from 18.3 to 17.1 per 100 index admissions) and increased 14 percent for uninsured patients (from 10.4 to 11.8 per 100 index admissions). Medicaid and privately insured patients had relatively stable readmission rates. In 2016, the highest readmission rates were among Medicare patients aged 21–64 years and nonmaternal Medicaid patients aged 45-64 years (21.2 and 20.4 per 100 index admissions, respectively) . . . The average cost of readmission was higher than the average cost of the index admission for two-thirds of the types of principal diagnoses.”
DaVita Reports on 2018, Business Developments:
CEO Ken Thiry and colleagues in a Q4/year-end earnings call (transcript here) reported $1.5 billion in annual profit for 2018, decreased use of IV antibiotics in dialysis patients, and growth in home dialysis: “For many of them dialyzing at home may be the best option . . . In fact, in 2018 we trained and educated over 13,000 new home patients. As you know, home growth has an incremental benefit of being more capital efficient.” Also, Thiry reminded the analysts that “the next few years Medicare year-over-year fee for service rate increases will be better than the almost zero increases over the last few years.”
10-K Reports Through 12-31-2018:
From CHS, here, which still has 113 hospitals left; derives 52% of its net operating revenue from outpatient services; had a 2018 net loss of $788 million, down from the previous year’s $2.5 billion net loss; and had negative shareholders’ equity of ($1.5 billion), down from a positive $4 billion prior to the private-equity sponsored acquisition of HMA by CHS.
From HCA, here: with 179 hospitals and 123 ambulatory surgery centers, and net income of $3.8 billion, HCA derived 38% of its net operating revenue from outpatient services in 2018. HCA experienced a 2.5% increase in equivalent admissions, a 3.9% increase in revenue per equivalent admission, and a 6.5% increase in same-facility revenue, compared to the previous year.
MEDICARE, MEDICAID, COMMERCIAL HEALTH INSURANCE
Cost Sharing Reductions, Revenue Raising Silver Loading:
Health plans scored significant victories last week (here, report from InsideHealthPolicy) in federal court decisions awarding them reimbursement for “cost sharing reductions” in the exchange policies of the Patient Protection and Affordable Care Act, an estimated $12 billion per year. Reacting to the loss or threatened loss of CSRs at the beginning of the Trump Administration, the plans persuaded state regulators to allow them to make up the difference through “silver loading,” that is, ramping up the premium on the second least expensive “silver” exchange plan, the marker in PPACA for higher premium subsidies. As yet no Congressional leaders have called for a “give back” or denounced “windfall profits,” since the additional money is supposed to offset premium expense.
CMS at Work:
Last Wednesday’s Federal Register saw publication (here) of the quarterly (Q4 2018) activity of CMS in “manual instructions, substantive and interpretive regulations, and other Federal Register notices that were published from October through December 2018, relating to the Medicare and Medicaid programs and other programs administered by CMS.”
READING AND REFERENCE
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.cfm, Committees and Members at https://www.senate.gov/committees/membership_assignments.htm
House and Senate 2019 Calendar of Regularly Scheduled Sessions, here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
Remaining February publication dates: 26, 27, 28
March publication dates: 1, 4, 5, 6, 7, 8, 11, 12, 13, 14, 15, 25, 26, 27, 28, 29
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.