DCMedical News: Wednesday, April 14, 2021
DCMedical News-DCMN
Washington, D.C.
Wednesday, April 14, 2021
DCMedical News is published every day both the House and the Senate are scheduled to be in session. Subscription information and archives from 2018 to the present at dcmedicalnews.org, here.
THE BIG STORY IN HEALTH CARE
Black Maternal Health Week
HHS Secretary Becerra announced (here) that a Medicaid waiver proposed by Illinois to address black maternal morbidity and mortality would be approved, extending Medicaid postpartum coverage in that state from 60 days to one year after an enrollee gives birth, becoming the first state authorized to provide such coverage under its Medicaid program. Becerra, whose wife is an obstetrician-gynecologist, noted that 52% of maternal deaths (80% in Illinois) occur during the first postpartum year.
InsideHealthPolicy reported on similar initiatives from other states, illustrating the mosaic of Medicaid program coverage: “Georgia and New Jersey want to extend Medicaid coverage after beneficiaries give birth from 60 days to 180 days, while Indiana and Missouri are seeking an extension that’s only for those with certain mental health or substance use conditions. Virginia and Massachusetts just recently submitted a request to CMS to extend their postpartum coverage to those with income below 205% of the federal poverty level and 200% respectively.” The recently passed American Rescue Plan provides another alternative, namely adoption of an amended state Medicaid plan which would not, however, take effect until April of 2022. The Illinois program began Monday. The AMA’s daily newscast led with the story, also praised by the American College of Obstetricians and Gynecologist.
Other Black Maternal Health Week initiatives from the administration are described here.
Statista (here) presents maternal deaths per 100,000 live births by country, showing the U.S. rate to be higher than selected OECD countries, double the rate of such deaths in France and Canada, five times the rate of Germany.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Diabetes Care, Quality and Cost
A study in Health Policy (here) of the “cost and quality implications of moving regular monitoring of patients with moderate severity type 2 diabetes (T2D) away from specialized hospital clinics into general practice (GP)” found that the changes brought lower cost, no change in quality, at least as measured by hospital admissions.
Musculoskeletal Expense
A report in the American Journal of Managed Care (here) and a consultant’s study (here) contend that “Representing one-sixth of all spending in the US health care market, the annual cost of musculoskeletal (MSK) care is greater than that of heart disease, cancer, and diabetes. In the past decade, MSK spend has nearly doubled from $10 billion to around $20 billion, although this increase in cost has not led to improved patient outcomes.”
Availability of Abortion With Medication and Without In-Person Dispensing
Janet Woodcock, a leading candidate to be named permanently as FDA Commissioner, wrote on behalf of the FDA’s Center for Drug Evaluation and Research (CDER) (here) that waiving in-person dispensing requirement for mifepristone brought about no new safety concerns: “Although there are limitations to the study designs, the overall findings from these studies do not appear to show increases in serious safety concerns (such as hemorrhage, ectopic pregnancy, or surgical interventions) occurring with medical abortion as a result of modifying the in-person dispensing requirement during the COVID-19 pandemic.”
As a result, she wrote, “Given that the in-person dispensing of mifepristone for medical termination of early pregnancy may present additional COVID-related risks to patients and healthcare personnel because it may involve a clinic visit solely for this purpose, CDER intends to exercise enforcement discretion during the COVID-19 PHE [Public Health Emergency] with respect to the in-person dispensing requirement of the Mifepristone REMS Program, including any in-person requirements that may be related to the Patient Agreement Form.” It is estimated that 40% of abortions in the U.S. now take place through medication.
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Congressional Attention to the Hospital Price Transparency Rule
Four bi-partisan leaders of the House Energy and Commerce Committee wrote (here) to HHS Secretary Becerra to “Urge HHS to enforce the final rule to ensure hospitals are fully compliant with the disclosure requirements so that patients can readily access the price information for all items and services in an easy-to-use format. Given the widespread non-compliance by hospitals, we urge HHS to revisit its enforcement tools, including the amount of the civil penalty, and to conduct regular audits of hospitals for compliance.”
Maryland Moves to Limit Hospital Collection Tools
Analysis of a pending Maryland bill from AHLA (here) proposes limits on garnishment, liens and other tools of collection, at least when practiced by hospitals. The measures “Would require hospitals to notify patients that income-based payment plans would be available. Additionally, hospitals would be required to document and report steps taken to inform patients about financial assistance and further report the number of lawsuits filed annually. Further, as a prerequisite to filing a lawsuit or referring for collection, hospitals will be required to demonstrate that they made a ‘good faith’ attempt to enter into payment arrangements with the patient.”
Kicking the Can
The House will send a bill to President Biden today, extending the “pause” on the 2 percent sequestration reduction in Medicare payments to medical providers through the end of the year, offset by extending the so-called sequester still further into later years. The pause expired March 31 and hospitals have been “holding” claims until the extension is in effect.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Proposed Inpatient Prospective Payment Rules for FY 2022 (October 1, 2021 ff.) for Psychiatric Facilities (here) and Inpatient Rehabilitation Facilities (here).
READINGS & REFERENCES
The Washington Post (here) examines the implications of new rights of hospital patients to read their own medical record, including physician notes.
The AMA Focuses on bullying in medicine, here.
This is How Hospitals Qualified for Various Categories of CARES Funds
Select Coronavirus Public Health Resources and References (alphabetical) may be found here.
2021 CQ Congressional Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
April 15, 16, 19, 20, 21, 22
May 11, 12, 13, 14, 17, 18, 19, 20
June 14, 15, 16, 17, 22, 23, 24, 25
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.