DCMedical News: Monday, January 4, 2021
DCMedical News-DCMN
Washington, D.C.
Monday, January 4, 2021
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: Johns Hopkins (here) shows at 8:00 p.m. on 1-3-21 worldwide 85,068,700 COVID-19 cases, 20,614,190 U.S. cases. Deaths worldwide are 1,842,095, of which 351,452 are in the U.S., 19% of the world death total.
Medical Care: Hospitals throughout the U.S. report record or near record COVID-19 cases admitted and in ICU beds (e.g., in USA Today, here, Statista here). Los Angeles hospitals (here and here) are described as being broken. More reports occur (national health organizations here) concerning “crisis standards of care,” as described on the National Academy of Sciences web site: https://nam.edu/national-organizations-call-for-action-to-implement-crisis-standards-of-care-during-covid-19-surge and in this NAS abbreviated guide. New Mexico’s Governor issued the first Executive Order concerning crisis standards of care (here), noting that “Normally, providers have an ethical and legal obligation to do whatever is in the best interest of each of their patients; under crisis standards of care, providers instead have an ethical and legal obligation to do what is best for everyone in the state, not just what is best for their individual patients.”
Public Policy: Congress passed (December 21) a 5,593-pg bill (here) impacting the health field, including a surprise bill “ban” which prevents arbitrators from referring to (generally low or lower) Medicare and Medicaid rates when deciding disputes over bills between insurers and providers, but also prevents the arbitrators from considering (generally high or higher) provider “charges.” The AMA provides a guide to the surprise billing ban for its members, here. “Provider relief” at $3 billion in the bill was ten per cent (or less) of the “ask” from provider groups. The bill also responded to other provider requests, however, suspending for another three months the 2% Medicare sequester (reduction of rates), and delaying planned cuts to Medicaid Disproportionate-Share Hospital (DSH) payments through FY 2023 (9-30-2023). The Patient Protection and Affordable Care Act, on the theory that Medicaid expansion would render DSH support unnecessary, would have cut (and might still cut) $43 billion from payments to DSH hospitals. See also Doctors, below.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Year End Bill Reverses Threats to Physician Pay, Provides Increases
The year-end legislation described above also had good news for physicians, the result of intense lobbying campaigns by nearly all medical societies (e.g., the Surgical Care Coalition, here). Impetus for the lobbying was the “final rule” for calendar year 2021 physician fees under Medicare. The “final rule” proved the “final straw” for many physicians, reflected for example in AMA reports (here) that “Physicians averaged a 32% drop in revenue since February,” while “One in five doctors saw revenue drop by 50% or more, while nearly one-third saw declines of between 25% and 49%. Only 19% of physicians reported no drop in revenue.” The CMS final rule would have “rebalanced” (“budget neutrality rules”) the Medicare physician fee schedule, taking away from some (radiologists, surgeons, for example), and giving to others (primary care). Instead, the bill blocked use of a code to be used in the rebalancing (G2211, was to have been used to accommodate complexity in evaluation and management visits); added $3 billion for across-the-board physician pay increases; and moved the goal posts closer (maintaining current scoring for two additional years) for alternative payment method—APM--5% bonus payments). The across-the-board fee increase, 3.75%, is to be paid for by moving general funds into the Medicare trust fund (see AMA news, here).
HOSPITALS, NURSING HOMES AND OTHER HEALTH FACILITIES
Hospitals Lose Appeals Court Fight Against Price Transparency
Hospitals lost a year-end Court of Appeals decision on the posting of prices in categories set by CMS, intended to introduce greater price competition into the purchase of hospital services. The requirements took effect January 1 (final rule, November 27, 2019 Federal Register, here; CMS’ FAQ on the rule here; Rick Louie on COVID-19 nasal swab test sample, showing prices ranging from $1.65 to $1200 for the same test, here; and the MLN on monitoring planned by CMS, here).
Year-End Legislation Adds Medicare-Paid Residency Slots for the First Time Since 1997
The year-end omnibus legislation (above) added 1,000 graduate medical education (GME, resident) slots for Medicare payment for the first time since 1997. Growth in residency positions during the past two decades has been paid for by teaching hospitals themselves, not in the creation of residency positions funded from Medicare, favoring wealthier programs. Modern Healthcare reports that “To curtail Medicare spending, the Balanced Budget Act of 1997 kept the number of medical residents for existing teaching hospitals at 1996 levels. An exception was made in 1999 to fund more slots at rural teaching hospitals,” and that in the new positions “Priority will be given to training programs in rural areas, hospitals that are training residents over their caps, states with new medical schools, and facilities that provide care for underserved communities.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
MACPAC Releases 2020 Data Report
The Medicaid and CHIP Payment and Access Commission has released its 2020 data report (“MACStats,” news release here, report here) finding “Enrollment increased in all states except the District of Columbia and Montana. States where enrollment grew ranged from 0.2 percent in South Carolina to 30.2 percent in Idaho,” that “Medicaid and CHIP combined still account for a smaller share of total health care spending than Medicare or private insurance. Medicaid accounted for a smaller share of the federal budget (9.2 percent) than Medicare (14.5 percent) in fiscal year (FY) 2019 . . . Medicaid and CHIP together accounted for 16.9 percent of national health expenditures in calendar year 2018, less than either Medicare (20.6 percent) or private insurance (34.1 percent)” and that “About half of Medicaid spending for enrollees was for capitation payments to managed care plans.”
Payer Status Counts for Cardiac Surgery Outcomes
A study in The Lancet (here) finds that “Using a national database, we have found evidence of significant beneficial effect of payer status on hospital outcomes following cardiac surgery in favour of private payers regardless their socioeconomic factors.”
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.
STAT COVID-19 Tracker, 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.
2021 House Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
January 5, 6, 7, 8, 21, 22, 25,26, 27, 28
February 8, 9, 10, 11, 23, 24, 25, 26
March 16, 17, 18, 19, 22, 23, 24, 25
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.