DCMedical News: Thursday, May 20, 2021
DCMedical News-DCMN
Washington, D.C.
Thursday, May 20, 2021
DCMedical News is published every day both the House and the Senate are scheduled to be in session. Publication will resume June 14 when the House and the Senate are both back in session. Subscription information and archives from 2018 to the present at dcmedicalnews.org, here.
THE BIG STORY IN HEALTH CARE
Congress Leaves Town
Both houses of Congress will not be back in session until June 14, although some Senate and some Committee work continues. This morning at 10:30 medical education leaders (AAMC, NMA, others) will take part in a hearing of the Primary Health and Retirement Security Subcommittee of the Senate Health, Education, Labor and Pensions Committee on "A Dire Shortage and Getting Worse: Solving the Crisis in the Health Care Workforce." At 7:30 a.m. the Business Roundtable holds a virtual discussion on "The private sector's COVID-19 response from the perspectives of four of America's leading CEOs whose businesses are on the front lines of responding to the crisis," https://tv.businessroundtable.org/episodes/covid19/.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Cardiovascular Health (CVH): Impact on Life, Disease and Cost
A survey of cardiovascular health in JAMA Cardiology (here) finds that “Higher CVH in younger and middle age is associated not only with lower lifetime risks for CVD, but also lower non-CVD mortality; lower risks for cancer and other chronic diseases of aging, substantially longer healthy longevity, and compression of morbidity, enhanced quality of life; better cognitive function; and lower health care costs throughout the life span.”
Health Care Workers With Mild COVID-19 Suffer Long Term Symptoms
A study in JAMA (here) reports that “A considerable portion of low-risk individuals with mild COVID-19 reported a diversity of long-term symptoms, and that these symptoms disrupted work, social, and home life.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Private Equity (PE) Acquisition of Hospices Concerns Researchers
A paper in JAMA Internal Medicine (article here, commentary here) notes that “Unlike for-profit companies that may have longer-term business plans . . . PE owners might have little experience in hospice care, and may focus on selling acquisitions within a short time horizon, typically in 3 to 5 years. Furthermore, PE firms typically assume large levels of debt to make acquisitions and the acquired agencies are responsible for the loan payments. The short time horizons for returns on investment paired with large amounts of debt may lead to reductions in resources such as staffing, as has been seen in PE acquisitions of nursing homes, which could negatively affect the quality of end-of-life care.”
Information Sharing Deficient in Hospital-to-Skilled Nursing Facility (SNF) Transfers
A study in JAMA Network Open (here) finds that “SNFs reported that key information was often missing (functional, mental, and behavioral status as well as whom to contact at the hospital with follow-up questions), delayed (often arriving after the patient), and difficult to use (discharge documents with duplicative and extraneous information). Having a hospital clinician on site at the SNF was associated with more complete, timely, and usable information sharing,” and that “These shortcomings are likely associated with a suboptimal transition experience. Shared clinicians represent a potential strategy to improve information sharing but are costly.” ACOs improved only the timeliness of information sharing.
Lingering Effects of Pandemic on Hospital Finances
The KaufmanHall “Flash Report” for April (here) finds that “The lingering effects of COVID-19 could drive 2021 hospital margins down 10% to 80%, and 2021 revenues down $53-$122 billion compared to pre-pandemic levels. One-third to one-half of U.S. hospitals may have negative operating margins by year’s end as a result.”
Overuse of Inpatient and Outpatient Tests in Hospitals Greater in Some Hospitals, Study of Medicare Claims
A paper in JAMA Network Open (here) reports that in a “Study of 1,325,256 services performed at 3,351 hospitals, we found that hospitals in the South, for-profit hospitals, and nonteaching hospitals were associated with the highest rates of overuse.”
Hospitals Losing Orthopedic Cases to Ambulatory Surgery Centers (ASCs)
An opinion piece in Beckersspine (here) reports that “Spinal fusions, disc replacements and total joint replacements are among the procedures that have migrated to the outpatient setting, along with many other higher-acuity cases. Today, hospital operating rooms are becoming the location for only the most complex procedures and highest-risk patients.” BeckersASC lists (here) 530+ ASCs (by State) doing total joint replacement procedures. BeckersASC had previously reported (here) cardiology cases moving from hospitals to ASCs, including electrophysiology studies, angioplasties, catheterizations, pacemaker insertions and loop recorder placements, with four new all-cardiology ASCs opening thus far in 2021 (here).
Price Transparency in Hospitals Remains Elusive
Since January 1, 2021 hospitals have been required to provide “clear, accessible pricing information” online about the items and services they provide. Fierce Healthcare reports (here) that “The Centers for Medicare & Medicaid Services has sent its first wave of warning letters out to hospitals breaking federal rules requiring them to disclose payer-negotiated prices. . . CMS has been auditing hospitals’ websites and complaint submissions since the rule went into effect on January 1 and began sending out warnings in April . . . Hospitals that received the warning are given a 90-day window to address shortcomings outlined in the letter. From there, the agency may close its inquiry, deliver a second warning letter or request a corrective action plan from the hospital.” The final rule from the November 27, 2019 Federal Register is here; a March Health Affairs article reported that of the largest 100 U.S. hospitals, 65 were “unambiguously non-compliant” by early February, here; a report from Milliman (here) found that 68% of surveyed health systems had “posted a file containing some degree of information” by early March.
In a “be careful what you wish for” article (here) Wagner Dean Sherry Glied discusses possible unanticipated and adverse consequences of the price transparency push. She notes “Revealing price information might shift negotiating power in the opposite direction . . . The likelihood that price revelation will raise prices is the reason antitrust economists generally disfavor it.” She notes that the (now ten-year-old) New Hampshire experiment with price publication has had only modest effects, and that “Price transparency is not, in itself, a solution. It is best understood as an intermediate stage in the policy process as we confront the reality that prices, not utilization, drive high spending in the US.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Limitations Easing on Hep-C Treatment in State Medicaid Programs
The Center for Health Law and Policy Innovation at Harvard Law School and the National Viral Hepatitis Roundtable have reported (here) on the latest easing of limitations on Hep-C treatment in individual State Medicaid Programs. “Three of the most significant restrictive criteria that Fee-for Service Medicaid programs use as methods of rationing access to the HCV cure [are]: 1) fibrosis (liver damage or disease progression); 2) sobriety (periods of abstinence from alcohol and/or substance use required); and 3) prescriber (prescribing eligibility limited to certain categories of specialist practitioners).” The results: “Since 2017, 32 states have either eliminated or reduced their fibrosis restrictions, 21 have loosened their sobriety restrictions, and 25 have scaled back their prescriber restrictions. There are also now 7 states that, in addition to removing all restrictions, have removed prior authorization entirely: Washington, Louisiana, New York, California, Indiana, Wisconsin, and most recently Michigan.” A report on the Michigan program in Modern Healthcare (here) found that despite advances in treatment for hepatitis C, Michigan has seen a 71% increase in acute cases and that many of the cases are found in rural areas, companion to the increased numbers of opioid use disorder and overdose deaths.
READINGS & REFERENCES
Select Coronavirus Public Health Resources and References (alphabetical) may be found here.
2021 CQ Congressional Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
June 14, 15, 16, 17, 22, 23, 24, 25
July 19, 20, 21, 22, 26, 27, 28, 29, 30
August - none
September 20, 21, 22, 23, 24, 27, 28, 29, 30
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.