DCMedical News: Thursday, April 15, 2021
DCMedical News-DCMN
Washington, D.C.
Thursday, April 15, 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
Biden to Address Joint Session of Congress April 28th
The invitation from the Speaker of the House is here.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
The Provider Comes to You
Pandemic-related boosts for the “hospital-at-home” were analyzed by Mary Jaklevic in JAMA this week, here. “The ability to treat patients at home for common conditions—heart failure, chronic obstructive pulmonary disease (COPD), asthma, and uncomplicated infections such as cellulitis, for example—has been a tool to expand capacity during the pandemic. But research also suggests that providing acute care at home increases patient satisfaction, reduces costs, and improves quality metrics such as readmissions—benefits that some experts say could make it a fixture in patient care.”
Early experiments, for example the work of Dr. Bruce Jeff in Baltimore (here), had positive reviews from patients and doctors, but suffered from lack of financial incentive under fee-for service reimbursement, as well as the absence of any other payment mechanism available to the Centers for Medicare & Medicaid Services.
A financial solution came as a result of bed shortages in the pandemic, says Jaklevic, in “November 2020, when CMS announced a temporary waiver to let hospitals treat fee-for-service Medicare patients in their homes. Although limited to the pandemic, the waiver marked a huge shift. Existing hospital-at-home programs could be paid for treating all Medicare patients, not just those in managed care plans. It was also the push many health systems needed to start a program. As of April 5, CMS had approved waivers for 116 hospitals in 53 health systems spanning 29 states.” The experiments are closely monitored by CMS, which may bring the “curse of the SNF regulatory scheme” with it, for example the patient must be admitted from an emergency department or inpatient bed, not from their own home.
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
More on Price Transparency
A group of Harvard-affiliated researchers examined disclosures of the cost of cancer care at NCI-designated cancer centers and published their results this week in JAMA Surgery, here. They found “Wide variation in the disclosure of charges for inpatient cancer operations by NCI designated Cancer Centers as required by law. Among centers disclosing charges, there was substantial variation in markup ratios, which reflect hospital billing for charges in excess of estimated Medicare reimbursement. Our findings build on prior work suggesting that chargemasters listing undiscounted prices may provide limited benefit to patients with cancer and could potentially deter them from seeking care. Recent action by the CMS could help address these concerns. In January 2021, the agency began requiring hospitals to additionally disclose payer-specific negotiated charges and discounted cash prices. However, the American Hospital Association has requested that the new US presidential administration rescind the law after unsuccessfully mounting legal challenges to enactment.” The authors conclude, “Our findings underscore the need for better financial information to help patients make informed treatment decisions.”
Concerned About Hospitals Blocking Price Searches, CMS Clamps Down, on Insurers, via GitHub
The Wall Street Journal reports (here) that “Federal regulators said healthcare pricing data that health insurers must post under a new requirement shouldn’t be blocked from web searches.”
“The new guideline, from the Centers for Medicare and Medicaid Services, was released March 23, the day after the Journal’s article revealed that hundreds of hospital pricing-data websites included special coding that kept them from showing up in searches . . . The new CMS guidance was issued in an online technical forum on GitHub, a website and cloud-based service, that focuses on the insurer-pricing rule.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Med-PAC Reports, Meets and Votes
The Medicare Payment Advisory Commission sent one of its two regular reports to Congress, (press release summary here, 531 pg. report here); met April 1-2 and discussed a wide range of Medicare related topics; and voted on its recommendations, recording individual votes (here), as now required by Congress (results, all unanimous when a recommendation was made).
These were the questions on which voting was unanimous:
For fiscal year 2022, the Congress should update the 2021 Medicare base payment rates for acute care hospitals by 2 percent; For calendar year 2022, the Congress should update the 2021 Medicare payment rates for physician and other health professional services by the amounts determined under current law [that is, no increase]; For calendar year 2022, the Congress should eliminate the update to the 2021 Medicare conversion factor for ambulatory surgical centers; The Secretary should require ambulatory surgical centers to report cost data; For calendar year 2022, the Congress should eliminate the update to the 2021 Medicare end-stage renal disease prospective payment system base rate; For fiscal year 2022, the Congress should eliminate the update to the 2021 Medicare base payment rates for skilled nursing facilities; For calendar year 2022, the Congress should reduce the 2021 Medicare base payment rate for home health agencies by 5 percent; For fiscal year 2022, the Congress should reduce the 2021 Medicare base payment rate for inpatient rehabilitation facilities by 5 percent; For fiscal year 2022, the Secretary should increase the 2021 Medicare base payment rate for long-term care hospitals by 2 percent; For fiscal year 2022, the Congress should eliminate the update to the 2021 Medicare base payment rates for hospice and wage adjust and reduce the hospice aggregate cap by 20 percent.
These are the staff presentations (slides) from the April 1-2 MedPAC meetings:
Improving Medicare’s policy for separately payable drugs in the hospital outpatient prospective payment system, (here); Medicare vaccine coverage and payment, (here); Medicare’s Skilled Nursing Facility Value Based Payment Program (a Congressionally mandated report, (here); Rebalancing the Medicare Advantage benchmark policy, (here); Revising IME (indirect medical education) to better reflect teaching hospital costs, (here); Streamlining CMS’s portfolio of APMs (alternative payment methods, here); Impact of changes to lab fee schedule pay rates, (here); and Private equity and Medicare, a Congressional study request, (here).
Commonwealth Studies the Impact of Pandemic on Medicare Spending
The Commonwealth Fund issues a graphic report (here) on Medicare spending by “traditional” (non-MA) patients during the first 10 months of 2020. The findings:
Overall, traditional Medicare spending was 7 percent less in 2020 compared to 2019; Compared to 2019, traditional Medicare spending dropped dramatically between March and May of 2020, before returning to previous levels; Traditional Medicare spending decreased more for white beneficiaries and beneficiaries not also enrolled in Medicaid than for other beneficiaries from 2019 to 2020; Traditional Medicare spending decreased most for beneficiaries ages 65–74 between March and April 2020; Traditional Medicare spending for dually eligible beneficiaries remained steady throughout 2020, while spending for other beneficiaries plummeted from February to April before returning to pre-pandemic levels by summer; Inpatient, outpatient, and other Medicare Part B spending decreased in the early months of the pandemic; Traditional Medicare spending for skilled nursing and home health care decreased since the start of the pandemic; Traditional Medicare spending declined for many chronic conditions early during the pandemic; and Declines in traditional Medicare spending varied across states between 2019 and 2020 (chart, 10th slide).
READINGS & REFERENCES
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.