DCMedical News: Monday, May 17, 2021
DCMedical News-DCMN
Washington, D.C.
Monday, May 17, 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
Congressional Work Month
The Congressional work month will last through this Thursday. Both houses resume June 14.
Hospital Recovery Uneven, Stronger for Larger Systems
Modern Healthcare reports (here) that many of the larger hospital systems have reached only modest profitability in the first quarter of 2021, and some continue to experience operating losses. Profit for many of those in the black was dependent on federal grants under the CARES program. Systems with long term care facilities did not do as well as those focused primarily on acute care.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Exporting U.S. Health Care, Encountering the UK Physician Compensation System
The Financial Times reports (here) that “Cleveland Clinic, the US based healthcare group, is to employ its own doctors when it opens its first British hospital later this year, marking a major shift for the UK’s health sector and triggering a war for top talent . . . private hospitals in the UK generally use doctors employed by the state-funded NHS, who work in their spare time on a fee-for-service basis . . . Next Spring it plans to open a 184-bed general hospital on a site overlooking Buckingham Palace which, once operational, will be one of the largest private hospitals in central London. It plans to employ 1,250 staff in the UK and said it had been inundated with applications from medics and had already signed up 200 consultants on part-time, fixed salaries.”
Does Telemedicine Cost More, Less or the Same as In-Person Care?
A study in Healthcare Financial Management (here) from the Department of Orthopedics of the University of Pennsylvania studies time-based costing for telemedicine visits, concluding that, with substitution of telemedical for in-person visits (stable volume), cost savings are insufficient to overcome lower reimbursement.
Primary Care Practice Acquisition by Hospitals: Do Acquisitions Pay for Themselves Through Increased “Acquired Physician” Use of Hospital Imaging and Lab Facilities?
In Health Affairs (here) a RAND-led research group argues that “Hospital and health system ownership of physician practices was associated with changes in site of care and Medicare reimbursement rates for ten common diagnostic imaging and laboratory services. After vertical integration, the monthly number of diagnostic imaging tests per 1,000 attributed beneficiaries performed in a hospital setting increased by 26.3 per 1,000, and the number performed in a nonhospital setting decreased by 24.8 per 1,000. Hospital-based laboratory tests increased by 44.5 per 1,000 attributed beneficiaries, and non-hospital-based laboratory tests decreased by 36.0 per 1,000. Average Medicare reimbursement rose by $6.38 for imaging tests and $0.57 for laboratory tests, which translates to $40.2 million and $32.9 million increases in Medicare spending.”
Communication About Risk of Abdominal Aortic Aneurysm Improved With Project
Radiology Business reports (here) on a performance improvement project which recognizes that “Sometimes communication can breakdown between referrer and radiologist, derailing follow-up imaging and increasing the rates of rupture or death.” Research published in the Journal of the American College of Radiology found (here) that follow up protocols were dramatically improved by standardization when “Rad Partners integrated a structured reporting template into its dictation software.”
Coated v. Bare Metal Stents for Fem-Pop Revascularization: No Differences Detected, Except There Are Too Many of Them
Original research in JAMA Internal Medicine (here) reports that, for femoropopliteal artery revascularization, drug coated stents appear roughly equivalent to bare metal, without early mortality noted in smaller studies. But Redberg and McDermott, in an editorial in the same edition, point (here) to what they feel to be a larger problem—too many procedures, all of them leading to 50%+ mortality in less than three years.
They write, “This retrospective cohort analysis of 168,553 Medicare fee-for-service beneficiaries who underwent femoropopliteal artery revascularization found that the weighted cumulative incidence of mortality at a median of 2.7-year follow-up was 53.8% among those treated with drug-coated devices and 55.1% among those treated with non–drug-coated devices. Thus, this analysis did not confirm the signal of harm seen in the RCTs. However, it raises a new and important question about the high rates of mortality in Medicare beneficiaries with PAD [Peripheral Artery Disease] undergoing endovascular revascularization. More than half of the patients with PAD died during just 2.7 years of follow-up regardless of the type of device they received. It is well documented that people with PAD have increased rates of death from cardiovascular events compared with those without PAD, and recent evidence shows a high rate of death from cancer and infection in people with PAD. Peripheral revascularization does not address any of these causes of death. Thus, while this well-done observational study provides new information on the association of paclitaxel stents with mortality, a major conclusion should be that mortality is high among Medicare beneficiaries undergoing revascularization with any devices. Physicians should continue to focus on conservative treatment, including smoking cessation and exercise therapy for improving quality of life, in patients with PAD.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Tales of Hospital Planning: NIMHBY, and the Protective Effects Lingering After CON
“Not in My Hospital’s Back Yard”: this is the message from efforts in Illinois, Kansas and Massachusetts opposing Ambulatory Surgery Center developments, collected by Becker’s (here). Florida hospitals, nominally relieved of most certificate-of-need requirements by recent action of the legislature, are finding (here) that even “end game” rules on transplant and pediatric cardiac service-required volumes court controversy.
DRUGS & DEVICES
Automatic Medicare Coverage of “Innovative Technology” Pushed to End of 2021
Tomorrow’s (May 18) Federal Register will contain a “final rule” (here) pushing mandatory CMS payment for devices approved by the FDA as “innovative technology” to December 31, 2021. The document is essentially a discussion of long-standing differences between standards for FDA approval (“safe and effective,” although not necessarily more effective than existing alternatives), and CMS approvals for payment (“medically reasonable and necessary” for the Medicare beneficiary). In sum, “At the time a device is granted breakthrough status by the FDA, little may be known about the benefits and harms of the device.” A previously published “final rule” in the January 14, 2021 Federal Register would have provided for “faster access to new, innovative medical devices designated as breakthrough by the Food and Drug Administration (FDA). Under the final rule as currently written, there would be 4 years of national Medicare coverage starting on the date of FDA market authorization, or a manufacturer chosen date within 2 years thereafter.”
Comments from some physicians addressed “the promise of breakthrough devices for their specialties or disease states,” while others suggested that the January rule “provided automatic coverage for breakthrough devices without adequate evidentiary support.” In fact, said CMS, “review of claims data showed that breakthrough devices have received and are receiving Medicare coverage when medically necessary.” CMS wrote that “We share commenters’ concerns that guaranteeing coverage for all breakthrough devices receiving market-authorization [from the FDA] . . . with possibly minimal or no evidence on the Medicare population . . . could be problematic in ensuring these devices are demonstrating value and do not have additional risks for Medicare beneficiaries.”
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 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.