DCMedical News: Tuesday, June 15, 2021
DCMedical News-DCMN
Washington, D.C.
Tuesday, June 15, 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
Blockbuster Aduhelm Will Strain Medicare Funds
Radiology Business notes (here) that the controversial Alzheimer’s treatment drug, approved without evidence of clinical improvement for patients, and at a cost per patient of $56,000 per year, will have additional (unanticipated) expenses, as well. “Radiology providers see opportunity on the horizon following the approval of Aduhelm, Biogen’s blockbuster new Alzheimer’s treatment, on Monday. Screening patients for access to the drug will necessitate either a PET scan or lumbar puncture, experts noted. And individuals will also require a baseline MRI within one year before treatment and two more exams prior to subsequent infusions. As cases of Alzheimer’s climb, so too will the number of individuals receiving Aduhelm, a controversial amyloid beta-directed antibody purported to attack the underlying cause of the disease. Drugmaker Biogen estimates more than 1.5 million patients will be eligible in the U.S., and instances of the disease are anticipated to double by 2050 . . . Publicly traded imaging center operator Akumin sent an alert to investors Wednesday highlighting the ‘important implications’ and fellow publicly traded imaging operator RadNet saw its stock jump 21%.” Three members of the scientific advisory panel which recommended against approval have resigned, and the selection of a permanent head of the FDA may be affected by the controversy.
The state of the Medicare Health Insurance Trust Fund is also the subject of Congressional attention, with central banker Janet Yellin and HHS Secretary Becerra both noting that they don’t know when the next report on the Fund will be issued. InsideHealthPolicy reports (here) that “Treasury Secretary Janet Yellen is set to testify on the president's budget before the Senate Finance Committee Wednesday as outstanding questions remain on the status of the Medicare Trust Fund report.”
DOCTORS, NURSES AND OTHER HEALTH CARE PROFESSIONALS
Generational Conflict and a Controversy “As Old as Dirt”
The AMA House of Delegates, debating a resolution from the Medical Student Section to expand Medicare to cover beneficiaries aged 60-64, encountered overwhelming opposition, based primarily on low Medicare fees for professional services. As reported in MedPage Today (here), “Former AMA president Daniel ‘Stormy’ Johnson, MD, who described himself as ‘a longstanding Medicare beneficiary and older than dirt,’ also spoke against the resolution, emphasizing that Medicare ‘is not actuarially sound. It's a pay-as-you-go system that depends on the number of people paying into the program versus the beneficiaries like myself, and the number of folks paying in relative to the number of beneficiaries continues to decrease because people like me are living too long.’ Therefore, reducing the eligibility age ‘will further undermine the financial stability of the program,’ said Johnson, an American College of Radiology delegate who is in his mid-80s.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Patients Check in to the Hotel Barcelona, or to Home
A study in the Annals of Internal Medicine (here) notes that “Since the first wave of COVID-19, alternatives to conventional hospitalization have been proposed for the provision of different levels of care, ranging from shelter during quarantine to hospital-level medical care.” In obtaining resources for the pandemic in Barcelona, Hospital Clinic de Barcelona (HCB), a 750-bed, public, tertiary teaching hospital, found that “Medicalized hotels are a safe alternative to conventional hospitals for the care of patients with noncritical COVID-19. In addition to shelter for patients requiring isolation, these venues can provide care for those with low dependency and moderate to severe COVID-19 who require monitoring and treatment. In effect, this approach reduces pressure on hospitals and allows them to focus on patients who are more complex and critically ill.”
The hospital at home also garners attention, for example (here) in Modern Healthcare, where a patient at Adventist Health, Glendale, CA, opined “It was even better than the hospital . . . They were constantly reaching out — it’s time for you to do your vitals, or it’s time for you to take your medications.” The Mayo Clinic and Kaiser have made a $100 million investment in Boston technology company Medically Home. That service, profiled (here) in Radiology Business, builds on existing Mayo and Kaiser at-home services. “Mayo launched its own advanced care-at-home program last summer at its Florida and Wisconsin locations. The service delivers complex care services in patients’ residences, including imaging and lab services, behavioral health and skilled nursing. A network of community paramedics and nurses facilitate the program, under Mayo’s clinical supervision.” The Kaiser model in Northern California and Oregon utilizes “a single command center in each region to support multiple hospitals.”´ Medically Home adds “Imaging via portable scanners, while patients requiring MRI or CT are transported to a facility and then brought back to their residence. Those involved said the Mayo-Kaiser investment will allow the company to build capacity to the home care model, expand access and address any regulatory barriers to its proliferation.”
But Kaiser Health News (here) discusses a significant financial challenge to hospitals—the capital cost of already (and especially recently) built facilities. “Several other well-known hospital systems launched programs last summer. They join about two dozen already offering the service, including Johns Hopkins Medicine in Baltimore, Presbyterian Healthcare Services in New Mexico and Massachusetts General Hospital. But hospitals have other financial considerations that are also part of the calculation. Systems that have built sparkling new in-patient facilities in the past decade, floating bonds and taking out loans to finance them, need patients filling costly inpatient beds to repay lenders and recoup investments.”
Hospitals Continue to Sue Patients, a Small Percentage Accounting for Most of the Suits
An Axios examination of research undertaken at Johns Hopkins finds hospitals suing patients for unpaid bills (here, “How America’s top hospitals hound patients with predatory billing”). Despite collection policy changes at a small number of hospitals—one of which lost its chief executive over the issue—“Medical debt comprises 58% of all debt collections in the U.S. and has caused hundreds of thousands of Americans to file for bankruptcy. Some of the top 100 hospitals are huge contributors to the problem: Between January 2018 and July 2020, they filed tens of thousands of lawsuits and other court actions against patients.” A quarter of the nation’s “top hospitals” in revenue sued patients (here), and “26 of the hospitals filed nearly 39,000 court actions against patients”; three hospitals accounted for three quarters of the amounts sought; and (here) “Big New York hospitals dominate list of hospitals that sue a lot.” Kaiser Health News reports HCA (here) “cashing in” on unnecessary “trauma activation fees.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
MACPAC Publishes Update on Medicaid Supplemental Payments, With Totals by State
The Medicaid and CHIP Payment and Access Commission has published (here) a comprehensive update on “supplemental payments,” the combination of DSH, Upper Payment, Uncompensated Pool, DSRIP and GME payments which “supplement” fee-for-service Medicaid payments to hospitals. Background: “Medicaid spent $206.6 billion on hospital care in 2019. Hospital spending accounted for 34 percent of total Medicaid spending and Medicaid payments to hospitals accounted for 17 percent of all payments to hospitals in 2019. In fiscal year (FY) 2019, about half of Medicaid payments to hospitals were made on a fee-for-service (FFS) basis and about half of payments were made through managed care delivery systems. About half of FFS payments were base payments for services and about half were supplemental payments.”
CMS does not review the payments of “managed Medicaid” insurers to hospitals. The guideline: “Managed care capitation rates are required to be actuarially sound, meaning that they cover reasonable, appropriate, and attainable costs in providing covered services to Medicaid enrollees. Managed care plans typically have flexibility in determining the rates they will pay providers, but must meet state network adequacy requirements.”
The total of 2019 supplemental payments was (in millions) $45,669, of which $14,946 was DSH, $14,268 was UPL, $7,602 was uncompensated pool, $6,316 was DSRIP and $2,535 was GME. The total for California was $10.4 billion, for Texas was $7.8 billion and for New York was $5.4 billion. The total for Florida was $1.2 billion, whose Senator Rubio is promoting legislation (here) which would increase DSH for hospitals in states which have not expanded Medicaid.
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 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.