DCMedical News: Thursday, March 14, 2019
DCMedical News-DCMN
Washington, D.C.
Thursday, March 14, 2019
DCMedical News is published every day both the House and the Senate are in session. Subscription information below. Tomorrow begins a recess, publication of DCMN resumes March 25.
THE BIG STORY IN HEALTH CARE
Budget Presentation Finale:
HHS Secretary Alex Azar makes his final presentation today on the FY2020 budget to the Senate Finance Committee. The HHS budget is here.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Advanced Care Planning Codes:
This week’s edition of JAMA Internal Medicine has two research letters (here and here) and a commentary (here) on Medicare’s Advanced Care Planning codes. Bottom line: new payment for important care, but not used often. “Advance care planning (ACP) is the cornerstone to ensuring goal-concordant care by enabling persons to state their treatment preference prior to potential mental incapacity. Beginning in January 2016, the Centers for Medicare & Medicaid Services (CMS) introduced Current Procedural Terminology (CPT) reimbursement codes for ACP visits (99497 and 99498). Introduction of these codes represents recognition of the value of ACP for respecting patients’ preferences. Early indications from physician surveys and CMS reports indicate that there may be minimal use of these new CPT codes.” Also, “In 2016, 26,522 ACP claims were billed by 1996 health care professionals in New England . . . representing fewer than 1% of the total beneficiaries in New England.” Finally, “Now defined as a process, ACP discussions focus on eliciting patient values based on personal experiences, choosing a proxy that understands their role, and communicating their decisions to family members. More than 70%of patients are unable to participate in their own end-of-life care decisions and values and preferences are known to change over time, so ongoing discussions with patients about their wishes are imperative.”
Maternal Mortality, Front Page of USA Today, Legislative Solution Proposed:
Senator Richard Durbin and Representative Robin Kelly have sponsored legislation (section-by-section summary here) to address maternal morbidity and mortality, especially for African American women. The front page of USA Today (here and here) has, in recent weeks, frequently featured stories about what is generally characterized as the worst performing “advanced” nation in maternal morbidity and mortality.
HOSPITALS AND OTHER HEALTH CARE FACILITIES
Big Name Health System Means Little for Member Hospitals:
A study of variation in surgical care outcomes (here) among hospital members of a “network,” published in this week’s JAMA Surgery, demonstrates that “[O]utcomes were not consistently better at Honor Roll [U.S. News rating] hospitals. Within networks, the risk-adjusted rates for all outcomes varied widely across affiliated hospitals . . . to as much as 4.9-fold.”
Patient Safety Measures Improve Overall:
The Agency for Healthcare Research and Quality (AHRQ) has issued a report (here) indicating that two-thirds of commonly used patient safety measures collected by AHRQ were improving overall.
Inpatient Stay Changes Over 20 Years, HCA Bucks Downward Trend:
AHRQ has also released an updated “HCUP Fast Stats” on trends in inpatient stays. These excerpts, from the National Hospital Utilization and Costs Report, adds 2016 information to that previously available. The AHRQ material shows (here) a 20-year trend in inpatient stays (from approximately 33 million to approximately 39 million back to approximately 37 million) and costs (from $6,000+ in 2000 to $12,000+ in 2016). The material also shows (here) a plot of inpatient stays over ten years (down modestly) against costs (up). The AHRQ report shows the trend (here) of the rate of inpatient stays (per 100,000 population) vs. costs, with the rate on a reasonably steady downward trend from approximately 12,750 to approximately 11,000 during that twenty-year period. Finally, the “interactive” posting (here) shows in-hospital mortality changes over twenty years (down from approximately 2.4 per 100 stays in 1997 to approximately 1.9 in 2016), but essentially flat since 2007, with length of stay flat from 2000 to 2016.
Notwithstanding modest declines in the industry, HCA (as reported in a Healthcare Dive report, here) has defied such trends with 19 consecutive quarters of rising admissions. Population growth (HCA having a “large footprint” in Nashville, Houston and Dallas) appears to have played a role, together with services for higher acuity patients, such as bone marrow transplant programs, outpatient growth (130 urgent care facilities, 84 freestanding emergency departments), further aided by setbacks to one of HCA’s largest rivals, Community Health Systems, following CHS’ acquisition of Health Management Associates in 2014.
MEDICARE, MEDICAID, COMMERCIAL HEALTH INSURANCE
Who Gets the Rebates?
UnitedHealth has taken a major step (with new customers) to require that employers and plans pass pharmaceutical rebates on to individual consumers, covered here in STAT+ and here in The Wall Street Journal.
DRUGS & DEVICES
“Informal” Reporting of Device Problems Defeats MAUDE:
Kaiser Health News reports (here) on a “[V]ast and hidden repository of reports on device-related injuries and malfunctions,” with more than a million incidents filed in “alternative summary reporting” instead of being recorded in the public database, known as Manufacturer and User Facility Device Experience (MAUDE).
READINGS AND REFERENCES
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: 25, 26, 27, 28
April publication dates: 1, 2, 3, 4, 9, 10, 11, 12, 29, 30
May publication dates: 1, 2, 7, 8, 9, 10, 14 15, 16, 17, 20, 21, 22, 23
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.