DCMedical News: Monday, February 8, 2021
DCMedical News-DCMN
Washington, D.C.
Monday, February 8, 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 6:00 p.m. on 2-7-21 worldwide 106,014,623 COVID-19 cases, 26,990,269 U.S. cases, 25%. Deaths worldwide are 2,313,792, of which 463,212 are in the U.S., 20%.
Policy: The $1.9 trillion Coronavirus-related recovery act (the “American Rescue Plan”) continues on course, with Senate Committees (e.g., Finance Committee, memorandum from the Chair here) proceeding to mark up their respective allocations. “Upon the conclusion of the markup, each Committee will report its recommendations to the House Committee on Budget. The Budget Committee will then combine all committees’ recommendations and report them to the floor as a single budget reconciliation measure.” The Hill reports (here) that Congress is paying attention to inequalities in the distribution of available vaccines.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
“No Medicaid” Found More Commonly in Smaller and Independent Primary Care Practices
A study in Health Affairs (here) finds that “Primary care practices with no Medicaid revenue are different in key ways from practices with low or high Medicaid revenue. Practices with no Medicaid revenue, on average, are smaller, are independent, and have a higher proportion of primary care physicians in the practice.” The practices are also less likely, according to the authors, to have the capability or willingness to cope with multiple governmental penalties and rewards for “quality” and “population health management.” Concerning Medicaid expansion, the authors noted that “Even in expansion states, 15 percent of practices still have no Medicaid revenue, and another 35 percent derive less than a tenth of their revenue from Medicaid. Overall, 21 percent of the US population is covered by Medicaid.”
HOSPITALS, SKILLED NURSING FACILITIES AND OTHER HEALTH CARE FACILITIES
HCA Reports Sicker Patients, Higher Profits
HCA was only one of the chains and larger systems reporting higher profits (here, annual revenue $51.5 billion, net income $3.8 billion) due, in part, to sicker patients, and the higher reimbursement that comes from treating such patients, with multiple co-morbidities, longer lengths of stay, more complications. A multi-center study (here) led by a group from the Center for Cardiovascular Analytics, Research and Data Science, Providence St. Joseph Health, and published in JAMA in December, indicated significant, multi-year “code creep” in the submission of inpatient bills. “Between 2012 and 2016, the proportion of admissions assigned to a DRG with major complication or comorbidity increased for 15 of the top 20 reimbursed DRG families,” without “commensurate increases in disease severity” but which “was associated with increased payment.”
Hospital Posting of Charges May Fall Short of Legislative Requirements
Hospital pricing specialist Rick Louie explains (here) how CMS auditors may view posting only the price of the cheeseburger as inadequate, unless it also includes the prices of the “lettuce, tomatoes, pickles, meat, buns, ketchup, mayonnaise, mustard, [and] onions.” He writes, “CMS is using their adjudicated claims to identify hospitals that are violating the required elements in the machine-readable file.” Posting of a colonoscopy charge of $4,645 for CPT 45378 will also have to include laboratory, pharmacy and operating room charges, for a total of $7,184, to pass CMS muster.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Milbank Encourages Medicaid Managed Care Organizations to Adopt Home-Based Care
The prestigious fund publishes (here) a “Primer” on the subject, noting that “the senior population is expected to double by 2050 and Medicaid enrollment is increasing due to the recent economic downturn,” and reasoning that “The rate paid to managed care plans to cover expected costs for each LTSS [Long-Term Services and Supports] beneficiary is the same for all beneficiaries whether they receive care in an institution or home- and community-based setting, so the latter approach will generate savings for the MCO.”
MACPAC Recommends, as does the President
The Medicaid and CHIP Access Commission recommended changes in the programs, now covering 77 million people, including a 100% federal match for extending postpartum coverage to a full year, with full benefits, and several recommendations to mitigate the impact of estate recovery for nursing home and other Medicaid expenses. MACPAC endorsed a GAO recommendation to provide automatic countercyclical increases in the federal match in times of national economic distress. Also, staff told commissioners that mental health parity requirements have helped raise beneficiaries’ awareness of mental health access but have not improved their ability to use services. InsideHealthPolicy reports that “President Joe Biden issued an executive order Thursday (Jan. 28) directing HHS to examine whether the Trump administration’s controversial Medicaid work requirement waivers undermine the program . . . Biden ordered HHS to suspend, revise or rescind Trump Medicaid policies that make it more difficult for people to obtain Medicaid coverage.”
DRUGS & DEVICES
AWP Price Increase Translate to Higher Consumer Prices Paid, Despite Discounts
A study in JAMA Network (here) shows that drug average wholesale prices (AWP) “increased by 129% from 2010-2016, while median patient out-of-pocket costs increased by 53% and median insurance payments after rebates and discounts increased by 64%,” which “suggest that, after adjusting for inflation, increases in drug list prices are associated with increased patient out-of-pocket costs, which may have implications for cost-related nonadherence, and insurer payments.”
Some of the profit may have been needed to pay fines and settlements due to illegal activities: an unrelated study in JAMA (here) found that “Among the [26] large pharmaceutical companies included in this study, 85% had evidence of financial penalties for illegal activities,” totaling $33 billion during the period 2003-2016.
Medical Device Top Patient Safety Peril for 2021: Emergency Use Authorizations
ECRI, the medical device safety organization, says the top safety issue for medical devices for 2021 is provider use of the plethora of emergency use authorizations from the FDA during the pandemic. The top ten challenges (press release here, executive brief here) includes, in addition to the EUA usages, autopopulation of drug names in EHRs, rapid adoption of telehealth, imported N95 type masks, use of consumer-grade devices, UV sterilization, cybersecurity, misuse of AI in diagnostics, remote operation of devices used at the bedside and the quality of 3D printed devices.
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.
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.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
February 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.