DCMedical News: Wednesday, July 21, 2021
DCMedical News-DCMN
Washington, D.C.
Wednesday, July 21, 2021
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY
Medical Debt Continues Rise; Debt in Collections Affects Nearly One in Five Americans
A study in JAMA (here) of medical debt 2009-2020 finds that “In June 2020, an estimated 17.8% of individuals had medical debt (13.0% accrued debt during the prior year), and the mean amount was $429 ($311 accrued during the prior year) . . . highest in the South and lowest in the Northeast . . . and higher in poor than in rich zip code income deciles. . . Between 2013 and 2020, the states that expanded Medicaid in 2014 experienced a decline in the mean flow of medical debt that was 34.0 percentage points greater than the states that did not expand Medicaid”
DOCTORS, NURSES AND OTHER HEALTH CARE PROFESSIONALS
Anesthesiology Payment Rates
A study in the American Journal of Managed Care (here) found that “Mean in-network commercial allowed amount CFs [Conversion Factors] for anesthesiology services($70) are 314% of the traditional Medicare rate ($22), whereas mean commercial charge CFs($148) are 659% of the Medicare rate. Commercial payments vary widely and are higher to anesthesiologists than to CRNAs and higher out of network than in network. MA plan payments align with traditional Medicare with payment parity between anesthesiologists and CRNAs, both in network and out of network.”
Physician Practice Acquisition
An Avalere Health study for the Physicians Advocacy Institute (here) found that “48,400 additional physicians left independent practice and became employees of hospitals or other corporate entities – 22,700 of that shift occurred after the onset of COVID-19. This represents a 12% increase in the percentage of employed physicians over the two-year study period. Hospital and other corporate entities acquired 20,900 additional physician practices over the two-year period, resulting in a 25% increase in corporate-owned practices.”
Is Grit the Answer to Physician Burnout?
A study in JAMA Surgery examined resident grit, as follows: “A cross-sectional national survey study of 7464 clinically active general surgery residents in the US was administered in conjunction with the 2018 American Board of Surgery In-Training Examination and assessed grit, burnout, thoughts of attrition, and suicidal thoughts during the previous year.” The Grit Scale: “Grit was measured using the 8-item Short Grit Scale (scores range from 1 [not at all gritty] to 5 [extremely gritty]).” The results: “higher grit scores were associated with a lower likelihood of burnout, thoughts of attrition, and suicidal thoughts among general surgery residents.” Oh, and “Mean (SD) grit scores were significantly higher in women.”
Multiple Health Promotion Goals in the Proposed 2022 Medicare Physician Fee Schedule
A CMS Fact Sheet on the CY 2022 Medicare Physician Fee Schedule (here, see also DCMN 7-20-2021) discusses provisions in the 1747 page Rule aimed at health equity, telehealth and mental health coverage and diabetes control, together with the costs of COVID-19, colorectal and other screening programs. Complete proposed Rule here.
HOSPITALS AND OTHER HEALTH CARE FACILITIES
IPPS Proposal May Compromise Organ Transplants
One provision in the FY 2022 Medicare Inpatient Prospective Payment System Rule (here, at pg. 25085, and others) may interrupt current practices concerning organ transplant operations, according to an analysis from the Hospital Financial Management Association (here). “CMS proposes to pull its support from donor community hospitals excising organs for non-Medicare patients waiting on year-long transplant lists. CMS states that unless the donor community hospital tracks and verifies that the excised organ eventually makes it to a Medicare patient, they will no longer support the organ acquisition costs.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Spending Per State on Health Care: Buy Yours in South Dakota ($1,046 per person), Not New York ($3,698)
Census Bureau data analyzed by 24/7 Wall Street Media shows the “top” five (here), all states (here), a threefold-plus difference.
DRUGS & DEVICES
Artificial Intelligence in the Clinical Setting
A Viewpoint in JAMA Surgery (here) holds that in surgical procedures “Adoption of this technology without recognizing and addressing these and other ethical issues risks long-term effects such as loss of public trust, overly restrictive regulation of AI systems, and rejection of the technology by patients and surgeons.”
Value-Priced Drugs
A study in ScienceDirect (here) examines “A Comparison of Value-Based and Net Prices Using Institute for Clinical and Economic Review [ICER] Reports,” finding that “The net price of 81% of drugs exceeded the $100 000 per QALY [Quality -Adjusted Life-Year] VBP [“Value-Based Price”] and 71% exceeded the $150 000 per QALY VBP. The median change in net price needed to reach the $150 000 per QALY VBP was a 36% reduction. The median decrease in net price needed was highest for drugs targeting rare inherited disorders and lowest for cardiometabolic disorders. The reduction in net prices needed to reach ICER-estimated VBPs was higher for drugs evaluated for the first approved indication, rare diseases, less competitive markets, and if the drug approval occurred before the ICER report became available.”
Drug Channels Reports on Largest Pharmacies in the U.S.
Drug Channels reports (here) on the 15 largest organizations, ranked by total U.S. prescription dispensing revenues for calendar year 2020. ”U.S. prescription dispensing revenues reached a record $465 billion in 2020. The largest players all had bigger slices of the revenue pie, due to the growth at specialty pharmacies and multiple transactions that shifted market share among the vertically integrated companies.” The same group has published The 2021 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers,” (here), finding that “Total prescription dispensing revenues of retail, mail, long-term care, and specialty pharmacies reached a record $465 billon in 2020. Specialty drugs accounted for nearly 40% of these revenues – and an even greater share of payers’ net prescription costs.” The publication pred its greater control over patient access, sites of care, dispensing locations, and pricing, due to vertical integration of insurers, PBMs and specialty pharmacies.
More on Alzheimer’s Disease and Aduhelm
CMS has opened a National Coverage Determination (NCD) process (here) on Aduhelm. “NCDs are program instructions developed by CMS to describe the nationwide conditions for Medicare coverage for a specific item or service. This NCD analysis will be applicable to national coverage considerations for aducanumab, which was recently approved by the Food and Drug Administration (FDA), as well as any future monoclonal antibodies that target amyloid for the treatment of Alzheimer’s disease.” There is a 30-day public comment period and CMS will also host two public listening sessions in July to provide an opportunity for public input. The NCD would guide or replace regional determinations: “Currently, coverage determinations for aducanumab are being made at the local level by Medicare Administrative Contractors who represent 12 jurisdictions across the country.
READINGS & REFERENCES
“Health Care Spending and the Medicare Program,” MedPAC July 2021 Data Book, here.
Select Coronavirus Public Health Resources and References (alphabetical) may be found here.
2021 CQ Congressional Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
July 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.