DCMedical News: Wednesday, March 10, 2021
DCMedical News-DCMN
Washington, D.C.
Wednesday, March 10, 2021
DCMedical News is published every day both the House and the Senate are scheduled to be in session. Subscription information and archives here.
THE BIG STORY IN HEALTH CARE
Coronavirus
Tracking: Johns Hopkins (here) shows at 8:00 p.m. on 3-9-21 worldwide 117,514,832 COVID-19 cases, 29,092,305 U.S. cases, 25%. Deaths worldwide are 2,610,591, of which 527,612 are in the U.S., 20%.
Treatment: Tamiflu for COVID-19? Medscape reports (here) on the “Investigational drug molnupiravir [which] taken twice a day for 5 days eliminated SARS-CoV-2 from the nasopharynx of 49 participants.”
Policy: The House has its final vote on the coronavirus relief (plus) bill today. (See DCMN 3-9-2021, here.)
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Optum Now Owns 5% of American Doctors
Bloomberg’s report on Optum’s most recent acquisition (here) notes that “The health-care conglomerate that owns the biggest U.S. medical insurer, UnitedHealthcare, has assembled one of the country’s largest collections of doctors -- more than 53,000, or about 5% of U.S. physicians. UnitedHealth wants to add at least 10,000 this year.” ASC adds (here) “St. Louis-based Ascension ranked No. 2 with 49,000 physicians, and Nashville, Tenn.-based HCA Healthcare was No. 3 with 47,000 physicians.”
Radiologists Concerned That They Are Owned by Private Equity Firms
An article in The Journal of the American College of Radiology (here) asks “Will Venture Capital–Supported National Entities Change Radiology From a Specialty of Independent Owners to Employed Shift Workers?” A report appears in Radiology Business, here.
Lumbar Punctures, Changing Professional Practices
A study in the American Journal of Neuroradiology (announcement here, abstract here) notes that “radiologists performed 54% of lumbar puncture procedures (LPs) in 2017, representing significant growth over the 14 year longitudinal study. Lumbar punctures are a common procedure that can be performed by physicians in a variety of specialties. However, fluoroscopic guidance performed by a radiologist may be necessary in more complex cases. This study evaluated trends in performance of LPs by various medical specialties from 2003 to 2017 and raises the question of whether the shift of LPs from other specialties to radiology is justified. The results were also featured at the annual meeting of the Radiological Society of North America, 2021.” The study noted that “As recently as 1991, only about 10% of lumbar punctures in the Medicare population were performed by radiologists.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
West Virginia University Health System Features in Senator Manchin’s Rural Hospital Initiative
STAT (here) profiles the importance of Senator Joe Manchin’s support in a 50-50 Senate. “Unexpectedly, the hospital chain and others in the state are part of the reason that rural hospitals across the country will get a last-minute cash influx of more than $8 billion from Congress in the Covid-19 package that represents President Biden’s first major legislative push.” The STAT profile continues, “West Virginia’s hospitals are an unlikely team to make the case. The state hospital association employs only one lobbyist; he just registered in November. New York’s state hospital association, in contrast, employs or contracts with 23 lobbyists. But the hospitals have Manchin’s ear in part because they are some of the largest employers in the state — WVU Health System overtook Walmart in 2016 to become the state’s single largest private employer. It owns, operates, or manages18 hospitals.”
Site of Service Differential Increases Physician Compensation, Likelihood of Physician Practice Acquisition
A study in Health Services Research (here) found that a large pay gap exists between independent and hospital-employed doctors, $63,000 for primary care doctors, $178,000 for medical specialists and $150,000 for surgeons. Doctors who work for hospital outpatient facilities get much higher payments. Based on Medicare claims data from 2010-2016, the study found that the program's payments for doctors' work were, on average, $114,000 higher per doctor per year when billed by a hospital than when billed by a doctor's independent practice, further incentivizing physicians to sell their practices to hospitals, and providing hospitals with the means to pay for those practices.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
MedPAC Tackles the Big Questions
At its March 4-5 meeting the Medicare Payment Advisory Commission looked hard at Medicare Advantage (here). MedPAC contends (against the views of AHIP and MA plan supporters) that Medicare Advantage programs had always been paid more than traditional fee-for-service Medicare. During the past five years, the MA share of total Medicare enrollment has increased from 33% to 46%, the share of MA beneficiaries with zero premium increased from 81% to 96%. The tradeoff (slide 6) is unrestricted provider networks and less “utilization management” in traditional Medicare programs, versus reduced cost sharing and supplemental benefits in MA plans. While payments to MA plans are 4% greater than the cost of traditional Medicare this year, actual expenditures by MA plans average only 87% of traditional Medicare, the remainder being spent on supplement benefits and plan sponsor (commercial health insurance) profit.
READINGS & REFERENCES
The Source Meets the Office of Health Strategy, State of Connecticut
Katherine Gudiksen of The Source presented (here) an update on “State Efforts to Address Health Care Consolidation and Costs.”
Blendon on Partisan Division and Health Policy
Noted Harvard pollster Robert Blendon and colleagues write (here) in JAMA about the impact of partisan political division on health policy. “In 2019, average Democrats differed from average Republicans in their views across 30 policy-related issues about what government should do in the future by 39 percentage points, more than double the gap in 1994. What is not often recognized is how profoundly divided those who identify as Democrats and Republicans are on key issues of health care policy today, such as Medicaid spending and abortion.” An example is COVID-19 policy: “In a survey from April 2020 that included 5047 participants, a majority (53%) of Democrats expressed ‘a great deal’ of confidence in medical scientists to act in the best interests of the public compared with 31% of Republicans.” Another survey from November to December 2020 that involved 2150 participants found that 90% of Democrats reported that they believe that federal government spending to prevent the spread of infectious diseases should be increased compared with 44% of Republicans.”
Leemore Dafny on how to address concentration in health care (here), Robert Kocher and colleagues on how to contend with the market dominance of large hospital systems (here), both in JAMA.
KFF provides an update on a 50-state survey of “Medicaid and CHIP Eligibility and Enrollment Policies as of January, 2021,” here.
Select Coronavirus Public Health Resources and References (alphabetical) may be found here.
2021 CQ Congressional Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
March 11, 12
April 13, 14, 15, 16, 19, 20, 21, 22
May 11, 12, 13, 14, 17, 18, 19, 20
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.