DCMedical News: Friday, March 1, 2019
DCMedical News-DCMN
Washington, D.C.
Friday, March 1, 2019
The publication schedule and subscription information for DCMedical News will be found below.
THE BIG STORY IN HEALTH CARE:
MedPAC and MACPAC Come to Town, Time for Legislative Recommendations:
The Medicare Payment Advisory Commission and the Medicaid and CHIP Payment and Access Commission both meet next Thursday and Friday, March 7 and 8, preparing recommendations for Congressional action in 2019. The MedPAC agenda is not yet available; payment updates were dealt with at the group’s January 17 meeting. The MACPAC agenda (here) steers away from “heavy” Medicaid subjects (work, waivers, expansion).
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Treating the Patient or the Incentive:
A Boston group studied this question: “Medicare Advantage incentivizes performance on evidence-based care, but limited information exists using reliable clinical data to determine whether this translates into better quality for patients with coronary artery disease (CAD).” The study result (here, in JAMA Cardiology): Among patients with coronary artery disease the Medicare Advantage (MA) patients had more comorbidities than those in a fee for service (FFS) Medicare group, and were more likely to receive “secondary prevention treatments.” But these made no difference in outcomes, suggesting that “MA plans may drive improvements in process-based quality measures for Medicare beneficiaries, although this may have a limited effect on improving patient outcomes over FFS Medicare.”
Ten Years After:
An essay in JAMA this week (here) on “usability” of IT in health care proposes a national database on problems with IT in health services, establishment of basic design standards, the addressing of “unintended harms,” simplifying mandated documentation, and the development of standard usability and safety measures, and their measurement. The lead author was formerly employed by HHS and by Allscripts.
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Post-Intensive Care Syndrome (PICS):
A report in JAMA this week (here) discusses PICS (“Muscle weakness, cognitive impairment, depression, anxiety, and posttraumatic stress disorder (PTSD) are among the constellation of symptoms that may make it difficult for patients with PICS to resume their prehospitalization lives”) and the twenty-one hospital clinics already in place to treat it. Six years ago (here) Krumholz described a “post hospital syndrome,” an acquired, transient condition of generalized vulnerability; he noted then that the causes for “readmission” of patients with heart failure, pneumonia, chronic obstructive pulmonary disease or GI disease were two-thirds or more likely to be something other than the cause of the original admission. Unaddressed in this week’s report on PICS is whether yet another hospital clinic will help.
10-K for Universal Health, 12-31-2018:
The nation’s leading provider of behavioral health services (324 of its 350 inpatient facilities are providers of behavioral health, of which 133 are in the United Kingdom) reported (here) on its financial results through the period 12-31-2018. Interestingly, only 47% of Universal’s net revenue comes from behavioral health; the remainder comes from its 26 inpatient general acute care, outpatient and insurance activities. CEO Alan Miller, now 81, has been in that position for the complete life of the company; his son, Marc, now President, is 48. Net revenues in 2018, $10.8 billion ($8.2 billion in 2014), net margin 7.2%.
The Stars Come Out, Again:
Yesterday Medicare released its update of the “star” quality rating system for hospitals, the first in 15 months, found at https://data.medicare.gov/data/hospital-compare, archived data found at https://data.medicare.gov/data/archives/hospital-compare. Medicare is in a dispute with the American and “Essential” Hospital Associations over the model weighting and the sudden shifts in individual hospital ratings the last time they were updated. “Ratings for hospitals saw little change between December 2017 and February 2019.”
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
March publication dates: 4, 5, 6, 7, 8, 11, 12, 13, 14, 15, 25, 26, 27, 28, 29
April publication dates: 1, 2, 3, 4, 5, 8, 9, 10, 11, 12, 29, 30
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.