DCMedical News: Thursday, March 11, 2021
DCMedical News-DCMN
Washington, D.C.
Thursday, March 11, 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 3-10-21 worldwide 117,978,628 COVID-19 cases, 29,149,380 U.S. cases, 25%. Deaths worldwide are 2,618,403, of which 529,067 are in the U.S., 20%.
Policy: Universal eligibility for subsidized health insurance (for two years): this is one result to be expected from the American Rescue Plan passed by the House Wednesday, awaiting the President’s signature. Or so says The New York Times (here), reporting that “The American Rescue Plan broadens the subsidies available under the Affordable Care Act for comprehensive health insurance — increasing them for people who are already eligible, and providing new assistance for people with incomes previously too high to qualify.”
Health Care: George Washington University unveiled a “workforce estimator,” attempting to show by county the impact of COVID-19 care in short term shortages predicted for physicians, nurses, aides and technicians. Healthcare Finance (here) reports that “Despite recent declines in coronavirus cases nationwide, many hospitals may still have workforce shortages over the next 30 days due to COVID-19 hospitalizations, according to estimates from George Washington University.” The “estimator” (at https://www.gwhwi.org/estimator.html) takes inputs by county for daily or 30-day projections, adjusted for COVID-19 hospital occupancy, ICU patients per intensivist and intensivist attrition from burn-out.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Mask Manufacturers, Meet Hospitals
CQ reports on a survey by National Nurses United, reporting that 80% of nurses in hospitals are still re-using masks and other personal protective equipment. At the same time, CQ reports that “The American Mask Manufacturers Association, a new group of nearly 50 U.S. mask makers, including many new entrants to the market, together have millions of masks in their warehouses and the monthly capacity to make masks for every American . . . They urged the CDC to revise guidance that recommends the reuse of respirators by health care professionals. A longstanding U.S. manufacturer, Prestige Ameritech, received permission in January to export respirators because of dwindling demand from U.S. hospitals, but has struggled to find international buyers as well.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Emergency Departments Specialized for Geriatric Care Save Money, But Whose Money?
A report in JAMA Open Network (research here, analysis and opinion here) on costs incurred for Medicare beneficiaries following specially staffed emergency department visits found “Mean 30-day savings of $2436 per beneficiary at 1 site and $2905 per beneficiary at the other site. The cost savings persisted at 60 days, with a mean savings of $1200 at 1 site and $3202 at the second site.” The problem, according to the researchers, is that “the savings went to the payer, in this case Medicare, while the costs of sustaining this intervention beyond the grant-funded period were borne by the hospitals. Asking hospitals to spend their own money to save Medicare money is unlikely to be sustainable.”
Union Sponsored Research Group Says 8% of HCA’s Net Income May Come from Excessive Admissions from the ED
MedPage Today reports (here) that “CtW Investment Group, an activist organization sponsored by several large unions, is urging publicly-traded HCA to investigate what it calls a ‘long-standing and continually growing level of excess Medicare emergency department admissions’ at the sprawling health system's hospitals. CtW stands for Change to Win, a coalition that includes the Teamsters and the Service Employees International Union (SEIU). The investment arm works with the unions' pension funds to pursue corporate activism -- using the leverage their investments provide to pressure companies' boards on issues of interest.” The union group reminded HCA of the unhappy outcome of similar investigations a decade ago into incentives provided by Health Management Associates to generate unnecessary admissions from their hospitals’ emergency rooms. On the other hand, MedPage Today reported, CHS, which acquired the HMA hospitals, has “experienced steadily falling rates of excess Medicare emergency admissions.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
MedPAC Tackles the Big Questions, Continued
At its March 4-5 meeting the Medicare Payment Advisory Commission responded (here) to a 2020 request from the House Ways and Means Committee to examine Medicare beneficiaries’ access to health care in rural areas. Their report says rural and urban Medicare populations express similar satisfaction with access, notwithstanding limits on specialist care and night and weekend coverage, lower life expectancy and self-reported fair or poor health. Differences in access measured between and across states were more significant than those between urban and rural populations in the same state. The report noted that the 2021 Appropriations bills created a new category of hospital, Rural Emergency Hospitals (REH), which will not have inpatient care, but will have 24/7 ED service. The REHs will be paid a fixed monthly amount, and OPPS plus 5%. The REH proposal was originally made by the Commission in 2018. MedPAC will make an interim report on rural access this June, a final report in June 2022. Another report, due this July, will cover the relations of clinicians (physicians and other) and other parts of the Medicare program. To date, MedPAC has found (here) a decline in the proportion of Part A and Part B spending on clinicians, as compared to the total spending on clinicians, drugs and laboratory services, and little correlation between the categories of spending, concluding that clinician services are “Neither clear complements to nor substitutes for other Parts A and B services.”
Other topics covered by the group include “value based” experiments in SNF payment (here); “streamlining” of alternative payment schemes (here); Medicare vaccine coverage and payment (here); revisions in indirect medical education payments to teaching hospitals (here); and a proposal to increase absorption of the cost of currently separately payable drugs in hospital OPPS reimbursement (here). In medical education, Medicare currently pays $10 billion per year in indirect medical education reimbursement to 1,100 teaching hospitals supporting 90,000 residents, compared to $3.8 billion in direct medical education expense. The group is discussing extending payment for outpatient care, and also taxing the Medicare Advantage programs with more of the cost. Charts in the presentation show “winners” and “losers” in such reconfiguration, which would require Congressional action.
DRUGS & DEVICES
Hospitals Say They Have AI Policies in Place
Healthcare Dive reports (here) on a Sage/Olive survey which finds “90% of hospital executives reporting they have an AI or automation strategy in place, up from just 53% in 2019.”
READINGS & REFERENCES
Satellite View of Medical Progress and Cost
David Cutler and colleagues publish in the National Bureau of Economic Research (summary here, full paper here) a broad view of the cost of medical progress which “treats each medical condition as an industry, instead of treating each type of provider as an industry. This condition-based approach reflects the idea that patients care primarily about their health and the costs of treating a condition, rather than the specific type of treatment. This approach better captures the productivity gains that occur when a new therapy, such as a pharmaceutical drug, reduces use of an older treatment by a different type of provider, such as inpatient surgical care.”
Select Coronavirus Public Health Resources and References (alphabetical) may be found here.
2021 CQ Congressional Calendar here.
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March 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.