DCMedical News: Thursday, April 11, 2019
DCMedical News-DCMN
Washington, D.C.
Thursday, April 11, 2019
DCMedical News is published every day both the House and the Senate are in session. Subscription information below.
HOSPITALS, NURSING HOMES AND OTHER HEALTH FACILITIES
Reductions in Hospital Readmissions Similar in Canada and in the United States, (but only one of these countries has spent tens of millions of dollars on a hospital readmissions reduction program):
Marc Samsky and colleagues find in JAMA Cardiology this week (here) that “Implementation of the Hospital Readmissions Reduction Program was not associated with changes in length of stay for patients with heart failure in the United States between 2005 and 2015, and the reductions in all-cause 30-day readmission rates in the United States were similar to those in Canada in the same time span.” In the same issue, Ashish Jha has a commentary (here), noting “there is mounting evidence that the program [Hospital Readmissions Reduction] is failing to live up to expectations. Three studies have found an increase in mortality because of the program. Two studies have concluded that coding changes were the primary driver of the decrease in readmissions. Now, 1 study has found a comparable decrease in readmission rates in Canada. Is this enough evidence to suggest that we need to make substantial changes to the program?” Echoing Upton Sinclair’s observation in 1935 (“It is difficult to get a man to understand something, when his salary depends upon his not understanding it”), Jha writes “For the architects and advocates of the HRRP, who have a substantial interest in maintaining the status quo, this evidence may not be enough to sway them.” Gerard Anderson wrote this (in 1984, here) about the potential impact of prospective (DRG-based, prix fixe) hospital reimbursement: “The recently enacted prospective-payment legislation, however, creates economic incentives that could increase readmission rates.”
The “System-ness” of Hospital Systems
The Agency for Healthcare Research and Quality has updated its Compendium of U.S. Health Systems (introduction here, Excel file here, infographic on health system-sponsored MA plans here). Among other findings, 44 percent of hospitals that belonged to health systems in 2016 participated in accountable care organization (ACO) contracts, while only 12 percent of non-system hospitals participated in ACOs. JAMA Surgery had a report (here) on the consistency of surgical quality across the individual member hospitals of a system, namely that there isn’t much: “The quality of complex surgical care varies widely across hospitals affiliated with the US News & World Report Honor Roll hospitals.”
Eating Hospital Profits:
Ambulatory surgery centers are doing that, according to Becker’s report (here) based on an Advisory Board report (here). In 2005 inpatient surgery accounted for 42% of all surgery; in 2015 it was 37%. In 2005, hospital outpatient departments accounting for 59% of outpatient surgery; in 2015 that was 43%.
Moreover, the Advisory Board notes these big CMS moves: in January 2018 CMS removed total knee arthroplasty from the “inpatient only” list. (See, for example, this list, from Becker’s, of the eleven ambulatory surgery centers in New Jersey doing total joint replacement.) This year CMS has added 12 cardiac catheterization procedures to the ASC-covered procedures list.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Strange Bedfellows:
The American Enterprise Institute and The Brookings Institution jointly (here) offer ideas to contain the high cost of health care. Senator Lamar Alexander (Chair of the HELP Committee) had invited these and other ideas.
The think tanks propose a “Chevrolet tax,” limiting the exclusion of health insurance cost from taxable income; enforcing existing antitrust laws (“the Federal Trade Commission has yet to challenge a hospital acquisition of a physician practice on vertical grounds, despite growing evidence that consolidation of this kind tends to lead to higher prices and less competition in other areas of the market”); elimination of any willing provider and CoN laws, both of which might, however, increase market concentration; attacking surprise bills by prohibiting independent physician billing for hospital-based physicians, bonded indenture for those doctors; pump up physician E & M payment rates, deflate others; combine the Medicare deductibles and copayments, limit their total and prevent gap insurance from covering them, and so forth.
READINGS AND REFERENCES
Surprise Bills: Summary (Health Affairs) of initiatives in the 115th (last) Congress, here.
Malpractice Laws and Health Spending: a CBO working paper (here) asks, “How Do Changes in Medical Malpractice Liability Laws Affect Health Care Spending and the Federal Budget?” They answer is, they don’t.
Guesstimates of Medicare-for-All Cost: here, from The New York Times, and six economists. Gail Wilensky checks in (here) on this issue via a JAMA blog, observing “estimating whether particular individuals would be better off with Medicare-for-all legislation is complicated, because it depends on the coverage they currently have and who pays for it. The issues the public remains focused on are making sure that people with pre-existing conditions are protected and that prescription drug costs are lowered.”
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
April publication dates: 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.