DCMedical News: Tuesday, May 11, 2021
DCMedical News-DCMN
Washington, D.C.
Tuesday, May 11, 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
Congress Returns
Today at 10:00 a.m. the Senate Health, Education, Labor and Pensions Committee (HELP) will hold a hearing on the federal response to the COVID-19 pandemic, with testimony by top officials of the Department of Health and Human Services.
IPPS Rule for FY2022 Proposed
CMS has published (721 pgs., here) the proposed rule for the Medicare Inpatient Prospective Payment System (IPPS) for the fiscal year beginning October 1, 2021. Arguably the most important “health policy” publication each year, the document establishes “rules” for the payment of tens of millions of Medicare bills, and provides a template for similar payment rules by commercial health insurers. Medicare provides health insurance for 60 million people, covering approximately half the cost of healthcare expenses of those enrolled, costing (in 2020) $776 billion. In addition to paying bills and setting rules for such payments, Medicare serves as the largest source of financial support for graduate medical education in the U.S. Details below.
Nation’s Health Not Well
Three researchers publish (here) a commentary on the new National Academies of Medicine report on the health of working age adults in the U.S. Mortality in this group is increasing, causation (alcohol, drugs) is difficult to address, remedies uncertain. In a separate report, the CDC published (here) an analysis of “excess mortality” in the U.S. in 2020, finding that the number of COVID-19 related deaths is nearly twice that which had been regularly reported during the height of the pandemic (“approximately one half to two thirds of one million excess deaths occurred during January 26, 2020–February 27, 2021, suggesting that the overall impact of the COVID-19 pandemic on mortality is substantially greater than the number of COVID-19 deaths.”) The Guardian (here) examines why Europeans live longer than Americans. And the birth rate is down: The New York Times reports (here) that “The birthrate declined for the sixth straight year in 2020, the federal government reported on Wednesday, early evidence that the coronavirus pandemic accelerated a trend among American women of delaying pregnancy . . . December had the largest decline of any month. Over the entire year, births declined by 4 percent, the data showed. There were 3,605,201 births in the United States last year, the lowest number since 1979. [1979 Vital Statistics here; the population was 100 million less than today.] “The birthrate — measured as the number of babies per thousand women ages 15 to 44 — has fallen by about 19 percent since its recent peak in 2007.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Unnecessary Hospital Procedures
The Lown Institute has published (Fierce Healthcare summary here) a guide to what it believes to be unnecessary procedures in hospitals, finding that Southern and for-profit hospitals do more than others. “Hysterectomies for benign disease were among the worst offenders, with 64% of those conducted across the nation meeting the criteria for overuse. Similarly, 44% of carotid endarterectomies (a procedure removing plaque from a neck artery) and 24% of coronary stent procedures were also found to be unnecessary. Diagnostic imaging services also made up a substantial portion of overuse identified during the study period. Here, the researchers spotted nearly 380,000 instances of unnecessary head imaging for fainting—the single highest volume service included in the analysis—and more than 130,000 instances of unnecessary neck artery imaging for fainting.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
IPPS Rule
The proposed Inpatient Prospective Payment System rule for FY 2022 (see above) covers, in addition to Medicare’s operating and capital payments for acute care hospitals, new rules for Medicaid providers, quality assurance programs and payment for services in long term acute care hospitals (LTCHs). Special rules for children’s and cancer hospitals and for religious nonmedical health facilities are also included. Among the more important provisions:
The 3200 acute care hospitals paid under IPPS would see payment increases of 2.8%, or about $3.4 billion, which includes operating and capital, new medical technology and other add-on payments. With uncompensated care declining by $.9 billion (according to CMS), the actual overall increase will be $2.5 billion.
Hospitals that do not participate in or submit data for the Inpatient Quality Reporting Program will lose .625% (one quarter) of the 2.5% update. Hospitals that do not have a “meaningful” Electronic Health Record program will lose three-quarters of the market basket update or 1.875 percentage points.
According to an analysis of the rule by the Healthcare Financial Management Association (here) “The update for hospitals that neither successfully participate in the IQR and are not meaningful EHR users is reduced by the full market basket increase or 2.5 percentage points.”
There are also several requests for information (RFI) on areas where CMS is seeking input, including quality, electronic health record interoperability and health care inequities.
Healthcare Financial Management also reports (here), as part of the proposed rule, a boost for graduate medical education funding. “The 2020 year-end Consolidated Appropriations Act requires Medicare funding for 1,000 additional medical residency positions. In the newly released rule, CMS proposed to phase in those slots at no more than 200 positions per year beginning in FY23 for hospitals in rural areas and areas with a shortage of healthcare professionals. Funding for the positions will total approximately $1.8 billion through FY31.”
Transparency erosion: An FY22 requirement for hospitals to disclose privately negotiated Medicare Advantage rates on their Medicare cost reports has been rescinded.
The public comment period on the proposed rule ends June 28.
Medicaid in the Pandemic
Khorrami and Sommers find (here) in JAMA Network Open that “Medicaid enrollment increased as the US’s COVID-19 pandemic and economic shutdown began in March 2020, with approximately 5 million more people covered nationally by September 2020. This increase occurred in both expansion and non-expansion states.”
PPACA Benefit and Payment Parameters
A final rule was published (473 pgs., here) in the May 5 Federal Register on “benefit and payment parameters” for policies issued on “Exchanges” under the Patient Protection and Affordable Care Act. The document (“fact sheet,” here) sets forth rules for risk adjustment and cost-sharing; special enrollment periods; direct enrollment entities; the administrative appeals processes with respect to health insurance issuers and non-federal governmental group health plans; the medical loss ratio program; income verification by Exchanges; and other related topics. It also revises the regulation requiring the reporting of certain prescription drug information by qualified health plans or their pharmacy benefit managers.”
DRUGS & DEVICES
Real World Evidence
The FDA has published a guide to real world evidence used in medical device regulatory decisions, “Selected examples with file summaries, details on real-world data source, populations and descriptions of use.” (183 pgs., here).
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 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.