DCMedical News: Thursday, April 22, 2021
DCMedical News-DCMN
Washington, D.C.
Thursday, April 22, 2021
DCMedical News is published every day both the House and the Senate are scheduled to be in session. Publication will resume May 11. Subscription information and archives from 2018 to the present at dcmedicalnews.org, here.
THE BIG STORY IN HEALTH CARE
Health Insurers Report Record Profits
Forbes reports that “It’s earnings season, and the nation’s largest health insurance companies are reporting healthy profits. UnitedHealth Group’s first quarter profits of $5 billion beat analyst expectations and were a 40% increase over the same period last year . . . Anthem reported profits of $1.5 billion, a 9% increase over last year’s first quarter, a figure boosted by 1 million new members.” Anthem 10-Q here.
CARES Act Distribution: Who Got What?
InsideHealthPolicy reports (here) on the confusion and conflict in reporting distributions from the various tranches of the CARES Act in 2020 to hospitals and other health care facilities and providers. “HHS last year allocated about $145 billion of the provider relief fund that now totals $178 billion, but the department told the Government Accountability Office that roughly $35 billion of those allocations hadn’t actually made it to providers as of Dec. 31. Medicaid and CHIP providers have experienced the biggest disparities between allocated versus disbursed COVID-19 relief.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Private Equity: One Fund for All
A blockbuster private equity acquisition of radiology practices has put the focus on one firm making substantial inroads into the health field. Radiology Business reports (here) that “Radiology center operator SimonMed has officially announced its partnership with a New York-based private equity firm . . . The Scottsdale, Arizona-based group says it is both one of the largest independent outpatient imaging providers and largest independent radiology practices in the U.S. Altogether, SimonMed operates 147 centers across 11 states and employs nearly 200 radiologists, with 2 million patient visits per year.” Announcement of the transaction takes place a week after reports of declining PE investment in the health field (Pitchbook report here, Modern Healthcare report here, Bain report here).
American Securities, SimonMed’s new partner, has a healthcare investment portfolio which “also includes North American Partners in Anesthesia [NAPA], Aspen Dental, and privately held medical transport firm Air Methods,” prominent in the “surprise billing” controversy.
The Chair of the House Oversight Sub-Committee has announced results of hearings last month (here) on PE in long-term care, writing that “Private equity's growing control of long-term care endangers the underserved . . . researchers found that patients in a private equity-owned home had a mortality rate 10% higher compared to the overall average. In total, over 20,000 senior Americans died from lower standards of care at Wall Street-held facilities. The same study also found that private equity owners increased Medicare billing by a whopping 11%.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Maternal Mortality Reports
Pew reports (here) that “Pregnancy-related deaths among American women have risen markedly over the past 30 years, despite an overall downward trend worldwide. Many of these deaths are preventable, and the risk remains three to four times higher for black women than white women at all levels of income or education.”
A report in JAMA Surgery (here) cites improving rates of rescue in C-section births, but not as much for Black women: “Despite increasing maternal age, degree of maternal comorbidity, and persistent alarming rates of maternal mortality overall in the US, it is reassuring that mortality at cesarean delivery is decreasing in the US . . . decreasing failure-to-rescue rates among women experiencing severe life-threatening pregnancy complications may point to improving perioperative care. While improving, high failure-to-rescue rates in Black women need further investigation.” The “American Rescue Plan” additional incentives for states to increase Medicaid post-partum benefits to one year continues to draw attention, here.
Obstetrics in Rural Hospitals
A report in NEJM Catalyst (here) extols one plan to preserve or reinstate obstetrics in rural hospitals, good for the patients, and good for the hospitals. “Fewer than one-half of reproductive-aged women [live] within a 30-minute drive of a labor and delivery unit. Counties with no obstetrical services have higher rates of infant and maternal mortality, out-of-hospital births, and preterm births. Despite these increased risks, 179 counties in rural America lost their hospital obstetrical services between 2004 and 2014.”
Ironically, some of this loss is the result of rural hospital affiliation with urban health systems, including academic ones: “Although such affiliations can allow for the continuation of local care, they also can lead to shifts in the service lines being offered, including the elimination of rural maternity units.” This paper discusses “a model in which a state public academic health system opened a rural maternity unit and illustrate how maternity care in a Critical Access Hospital (CAH) can be positively positioned to benefit the CAH, the health system, and the community. The program design was based on seven supportive factors that collectively created a robust continuum of maternity services and a strong case for sustainability.”
In the “Control Room”
Quebec has mandated (here) a novel approach to management in complex health systems—a “Control Room.” A report explains, “As part of reforms in 2015, the Ministry of Health and Social Services in Quebec, Canada mandated the national implementation of control rooms, making health system actors accountable for implementing value-based performance management.” The “control room” is “a specialized or virtual space where managers meet according to a structured agenda in order to decide dynamically on current performance of the organization and on ways to improve it.” The necessity for the “control room” is illustrated by the difficulties in achieving alignment of “provider behaviour with system goals . . . and improving experience of care.” Says the report, “large-scale implementation of PMT [Performance Management Tools] tends to produce unexpected effects and off-target results.” Stephen Shortell and colleagues evaluate another tool, Lean, in The Joint Commission Journal on Quality and Safety, (here).
Back on the healthcare safety front, Bloomberg reports (here) that “Nearly half of all employers cited by the Occupational Safety and Health Administration for Covid-19-related violations are appealing the charges, a rate that is five times higher than the average for all federal workplace safety citations . . . That represents about 42% of the 408 Covid-19 cases where OSHA said it cited workplaces from July 1, 2020 through April 12, 2021. Typically, only about 8% of employers cited by OSHA have challenged the allegations . . . About 85% of the contested virus-related cases involve health-care facilities.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Challenges in Development of Health Policy, Guidelines, Variation in Patient Populations, “Real World” Subjects
A report in Health Policy (here) on clinical practice guidelines in Denmark notes “The majority of practice recommendations are weak due to the lack of a strong evidence base in the areas selected for guideline development. By design, the development process does not take the costs of implementing guidelines into consideration, and no mechanism has been established to monitor adherence to the new guideline programme.”
A study of variation (intended to “Assess the extent of underlying clinical differences between clinical trial participants and nonparticipants”) shows the challenges in finding comparable groups of patients (here). Harlan Krumholz comments (here) on the comparability of study and non-study patients, “This single-center study makes a good case that randomized, controlled trials are highly selected. It is plausible that interventions would act differently in patients who were not part of the trials, particularly those with multiple comorbidities. The results remained consistent across the trials in other medical areas. The implication is that to complement randomized, controlled trials, studies of other types are needed to test interventions in patients who may be more typical of those seen in clinical practice.”
READINGS & REFERENCES
Select Coronavirus Public Health Resources and References (alphabetical) may be found here.
2021 CQ Congressional Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
May 11, 12, 13, 14, 17, 18, 19, 20
June 14, 15, 16, 17, 22, 23, 24, 25
July 19, 20, 21, 22, 26, 27, 28, 29, 30
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.