DCMedical News: Wednesday, June 23, 2021
DCMedical News-DCMN
Washington, D.C.
Wednesday, June 23, 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.
DOCTORS, NURSES AND OTHER HEALTH CARE PROFESSIONALS
Imaging Numbers Down, RVUs (and Revenue) Up, in Pandemic
A study in Clinical Imaging (here) and a report on the study in Radiology Business (here) note that “COVID-19 has resulted in decreases in absolute imaging volumes” but in comparing “per-patient imaging utilization, characterized by imaging studies and work relative value units (wRVUs), in an emergency department (ED) during a COVID-19 surge to the same period in 2019,” both the number of studies and the RVUs (billings) increased, and in fact “individuals underwent 33% more studies compared to 2019 levels, while per-patient RVUs also climbed 24%.”
Avoiding Burnout, ACOs
A study sponsored by the Agency for Healthcare Research and Quality (AHRQ, summarized here) found “Primary care practices with zero burnout were more likely to use quality improvement strategies and be owned by one or a small number of clinicians, and were less likely to have participated in accountable care organizations, than high-burnout practices.”
HOSPITALS AND OTHER HEALTH CARE FACILITIES
Bundled payment schemes increased the cost of care in the Netherlands.
A study in Health Policy (here) reviews the ten year history of bundled payments for chronic diseases in The Netherlands, expected to “improve integration of care and reduce healthcare expenditure,” but which instead “led to an increase in total healthcare expenditure.”
Nursing Hand Off Techniques May Reduce Falls, Pressure Injuries, Medication Administration Errors
A study in Nursing Health Sciences (summarized here) found that “Safe patient handover from one nursing shift to the next requires complete and accurate communication between nurses. This review aimed to identify which nursing handover interventions result in improved patient outcomes (i.e., patient falls, pressure injuries, medication administration errors). Interventions differed across the included studies, but results indicate that moving the handover to the bedside and using a structured approach, such as Situation, Background, Assessment, Recommendation (SBAR) improved patient outcomes.”
Data Visualization Tool Shows Falls to be the Most Common Injury Seen in Emergency Departments
The tool (report here) shows that falls vastly outnumber other types of injuries causing ED visits for almost every age, community-level income, location and sex. The only group for whom falls were not the most common injury was adults ages 18–29.
Naked Commercialization Seen in U.S. Overseas Efforts
The Guardian and the Kaiser Health Network (here) publish a summary of potential up- and down-side outcomes for U.S. non-profit health systems establishing overseas hospitals and clinics. “Facing the prospect of stagnant or declining revenues at home, about three dozen of America’s elite hospitals and health systems are searching with a missionary zeal for patients and insurers able to pay high prices that will preserve their financial successes . . . But these foreign forays prompt questions about why American non-profit health systems, which pay little or no tax in their home towns, are indulging in such nakedly commercial ventures overseas.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
UnitedHealth Concerned About Sustainability, Will Push Imaging and Surgery to Outpatient Settings
In a “Sustainability” report (here), the nation’s largest (and most profitable) health insurer “Wants its members to receive at least 55% of their radiology services at freestanding imaging centers by 2030. UnitedHealth Group announced the commitment on Tuesday, June 15, as part of its 2020 Sustainability Report, aimed at expanding access, reducing costs and bolstering outcomes. The Minnetonka, Minnesota-based health giant also wants 55% of outpatient surgeries delivered outside of hospitals by the end of the 2020s.” Radiology Business reports (here) that United’s progress to date has come “by equipping referring physicians with shared decision-making tools to help patients select the best site for imaging services. UnitedHealth is also offering other digital tools to help beneficiaries ‘identify the care setting that best suits their medical and financial needs.’ Shifting routine diagnostic imaging from outpatient hospital departments to stand-alone centers or doc offices could reduce U.S. healthcare spending by 62% and save consumers $300 per exam, the report claimed.”
1.2 Million Added to Exchanges in Special Enrollment Period
A “fact sheet” on the SEP February 15 to May 31 (here) notes that 1.2 individuals signed up via healthcare.gov, compared to 501,000 in 2020 and 359,000 when special enrollment was only available for those experiencing “qualifying life events.”
DRUGS & DEVICES
Digital Therapeutics, Pear Now Expanding
The “digital therapeutics” company Pear completed a financing of $400 million (Modern Healthcare, here), enabling it to grow on the basis of three FDA-approved mobile apps, one “clinicians can prescribe as part of outpatient treatment for alcohol, cocaine and stimulant substance use disorders” which “delivers interactive cognitive behavioral therapy and provides a way for patients to report information, such as tracking cravings and triggers, to clinicians,” and two others “for opioid use disorder and chronic insomnia.”
READINGS & REFERENCES
Primary Care, New NAM Report, Will Policy Makers Care?
A new National Academies report on implementing high quality primary care was published in May, here. A commentary on primary care and on the series of NAM publications in JAMA Network (here) reports: “Primary Care: America’s Health in a New Era [1996] produced a primary care definition still used around the world; however, the report’s recommendations received no traction in the US. Similarly, a 2012 Institute of Medicine report on the integration of primary care and public health largely went unheeded.”
“While primary care is uniquely positioned to support COVID-19 testing, tracing, and vaccination and to help address pervasive health and social inequities, primary care was not considered in congressional relief packages in 2020 and many practices may be closed when they are needed most. A new consensus report by the National Academies of Sciences, Engineering, and Medicine emphasizes that while primary care in the US provides more than one-third of all health care visits and more than half of all outpatient visits, it receives a relatively small proportion of resources, has no federal coordinating capacity, has no dedicated research support, has a declining workforce pipeline, and remains inaccessible to large portions of the population.”
The Work of Congress Ahead in 2021, Expiring Provisions of Health Law
The Congressional Research Service publishes (here) a compendium of health legislation which will expire in 2021, if not renewed, together with a summary of provisions which expired in 2020 and 2019. “The expiring provisions included in this report are any identified provisions related to Medicare, Medicaid, the State Children’s Health Insurance Program (CHIP), or private health insurance programs and activities. The report also includes any identified expiring provisions among other health care-related provisions enacted or extended in the Patient Protection and Affordable Care Act (ACA; P.L. 111-148) or extended under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA; P.L. 114-10).”
Select Coronavirus Public Health Resources and References (alphabetical) may be found here.
2021 CQ Congressional Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
June 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.