DCMedical News: Friday, December 4, 2020
DCMedical News-DCMN
Washington, D.C.
Friday, December 4, 2020
DCMedical News is published every day both the House and the Senate are scheduled to be in session this year. Subscription information and archives here.
THE BIG STORY IN HEALTH CARE
Coronavirus
Tracking: By Johns Hopkins (here) shows at 8:00 p.m. on 12-3 worldwide 65,048,192 COVID-19 cases, 14,102,568 U.S. cases. Deaths worldwide are 1,503,107, of which 275,729 are in the U.S., 18% of the world death total. “The coronavirus death toll in America has hit new, terrible levels. According to the COVID Tracking Project, Wednesday was the single deadliest day of the pandemic across the country so far with more than 2,700 deaths, surpassing the previous April peak,” and more than 100,000 people hospitalized for the first time.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Fee-for-Service Lives in Trade Union-Like Negotiation Models
A multi-institutional group finds that fee-for-service medical payments are an important part of other advanced nations’ health systems, when they include transparent negotiation and volume limitations. In Health Affairs, (here) Gusmano and Columbia colleagues find that in France, Germany and Japan “payers and physicians engage in structured fee negotiations and standardize prices in systems where fee-for-service is the main model of outpatient physician reimbursement”; that “all three countries attempt to balance the interests of payers with those of physician associations”; and that this analysis demonstrates the benefits of structuring negotiations and standardizing fee-for-service payments independent of any specific reform proposal, such as single-payer reform and public insurance buy-ins.” The researchers recount the history of unsuccessful attempts to quash fee-for-service payment, “Beginning in the 1970s, managed care emerged as a way to phase out fee-for-service physician payment and achieve greater efficiency,” and that “US health care policy has been on a fifty-year chase” to substitute other models for fee-for-service, thus far unsuccessful.
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Hospitals as Super-Spreaders for Their Employees
The Boston Globe (here) focuses on efforts by hospitals to reduce employee-to-employee coronavirus transmission, noting “In the spring, hospitals were focused on treating patients with the virus and protecting their workers from infectious ones. Now it’s evident that employees also can spread COVID to each other — especially when they remove their face masks to eat and drink — and hospitals are working to reduce that risk as the pandemic reintensifies.” The Globe noted that hospitals have “removed truckloads of furniture from cafeterias, breakrooms, and conference rooms. They’ve scattered small dining tables throughout their sprawling campuses. They’ve erected heated tents. They’re also asking staff to stagger their breaks so that small break rooms don’t fill up. And they’re constantly reminding their employees to stay 6 feet away from others — even close friends — when they need to unmask. These are not just precautions; COVID outbreaks have been traced back to hospital employees who ate together without maintaining at least 6 feet of distance, at Mass. General, Brigham and Women’s, and many other hospitals.”
Crisis Standard of Care Penalizes Cancer Patients
The “Crisis Standard of Care” (CSC) movement (deprioritizing some patient care during the pandemic) penalizes cancer patients, according to a study (here) in JAMA Oncology. The study notes “Among states with CSC guidelines, most deprioritized some patients with cancer during resource allocation, and one-fourth categorically excluded them. The presence of an in-state CCC [Comprehensive Cancer Center] was associated with guideline availability, palliative care provisions, and lower odds of cancer-related exclusions. These data suggest that equitable state-level CSC considerations for patients with cancer benefit from the input of oncology stakeholders.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
MedPAC Blesses Pay Increases for Some Providers, More to be Considered Today
The Medicare Payment Advisory Commission tentatively approved proposals for pay increases in 2022 for hospitals (2.5% inpatient, 2% outpatient, possible .8% in “quality incentive program” payments), ambulatory surgery centers (eliminate an update, require cost data), as well as dialysis (1% increase), physicians (maintain current payment levels in 2022) and hospice (eliminate 2021 base payment update) providers at its meeting Thursday, with additional categories of providers (nursing homes, home health, inpatient rehab and long term acute care hospitals) up for review at today’s meeting. A formal vote on the recommendations will take place at MedPAC’s January meeting, with transmission of the group’s report to Congress in March.
Other policy comments by members of the group: interest in taking additional steps to equalize payments between hospitals and physicians for the same services, and 11% increased visits by NPs and PAs to fill the 2.4% decline in Medicare beneficiary encounters with primary care doctors.
Self-Employed to Grow, Self-Insured Not So Much
In Health Services Research (here) a University of North Carolina group studied the growth in self-employment, noting that growth in self-employment will outpace overall labor force growth through at least 2026. Using the Medical Expenditure Panel Survey (MEPS), the researchers found that 25.7% of those who transitioned to self-employment in year 1 were uninsured in year 2, while only 8.1% of those who remained employees were uninsured. Furthermore, those who transitioned to self-employment had a much higher rate of delaying needed medical care.”
High Deductible Health Plans Show (Almost) No Reduction in Health Spending Growth
A group of Wharton researchers in the National Bureau of Economic Research papers (here) study “multiple-employer-group claims data from a large national insurer to (i) study whether HDHPs [High Deductible Health Plans] reduce the growth in spending over four years compared to lower deductible alternatives; and (ii) explore the mechanisms behind any reductions in growth by looking at whether HDHPs reduce the use of low- vs. high-value treatments. We find that HDHPs have a limited effect on spending growth, with a statistically significant reduction observed only for prescription drugs. HDHPs are not associated with significantly lower growth in spending on highly cost-effective medicines in a sample of drugs but do reduce spending growth for less cost-effective drugs.”
READINGS & REFERENCES
Select Coronavirus Public Health Resources and References (alphabetical):
AMA resource page for physicians here. AMA guide to medical education and COVID-19, here.
CDC information page for professionals here, Morbidity and Mortality Weekly Reports on Coronavirus, here.
CMS (Centers for Medicare & Medicaid Services) Current Emergencies website, here.
HHS Protect Public Data Hub, https://protect-public.hhs.gov/datasets/state-representative-estimates-for-hospital-utilization/data?orderBy=state_name&page=4
JAMA Network’s COVID-19 resource center here.
New England Journal of Medicine update here, New England Journal of Medicine Journal Watch here.
The Lancet COVID-19 Resource Centre here and real-time dashboard to monitor clinical trials, here.
State actions, Kaiser Family Foundation, here.
The COVID Tracking Project (The Atlantic Monthly), here.
UC Hastings College of Law’s “The Source” (on health care prices and competition) COVID-19 page, here.
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
2021 House Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
December 7, 8, 9, 10
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.