DCMedical News: Thursday, July 22, 2021
DCMedical News-DCMN
Washington, D.C.
Thursday, July 22, 2021
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY
Life Expectancy Falls in 2020, Unevenly
The Centers for Disease Control and Prevention’s National Vital Statistics System reported Tuesday that life expectancy fell in 2020, by 14 months for the white population, three years for Latino Americans, and three years for Black Americans, a greater toll than in any year since the Great Depression. In Newsweek, University of Texas Sociology Professor Mark Hayward, who studies U.S. mortality, said the decline was “basically catastrophic.” The CDC report is here, coverage in The Wall Street Journal is here.
Public Health Emergency Continues
The declaration of a public health emergency (PHE) due to the COVID-19 pandemic, originally declared January 31, 2020, has been extended for the sixth time, as of July 20, for at least another three months. Some additional resources and flexibilities are allowed to providers caring for COIVID-19 patients under the PHE.
DOCTORS, NURSES AND OTHER HEALTH CARE PROFESSIONALS
Physician Pay Cut of Almost 10% in Medicare Scheduled for January 1, 2022
The AMA wrote to Congressional leaders Wednesday (here) to complain of a cumulative 9.75% cut in Medicare pay rates for physicians, effective January 1, 2022. The cutbacks are included in the proposed Rule for the Physician Fee Schedule (here, scheduled for publication in the Federal Register tomorrow, July 23), and in the negotiation of pay-fors or pay-gos, that is, offsets to new expenditures (in unrelated infrastructure projects) currently under consideration in the Senate.
The AMA’s list of objections includes: “Expiration of the current reprieve from the repeatedly extended 2 percent sequester stemming from the Budget Control Act of 2011 (Congress originally scheduled this policy to sunset in 2021 but it will now continue into 2030); Imposition of a 4 percent Statutory PAYGO sequester resulting from passage of the American Rescue Plan Act, presumably for at least another 10 years (Should lawmakers fail to act, it will mark the first time that Congress has failed to waive Statutory PAYGO); Expiration of the Congressionally enacted 3.75 percent temporary increase in the Medicare physician fee schedule (PFS) conversion factor to avoid payment cuts associated with budget neutrality adjustments tied to PFS policy changes; A statutory freeze in annual Medicare PFS updates under the Medicare Access and CHIP Reauthorization Act (MACRA) that is scheduled to last until 2026, when updates resume at a rate of 0.25% a year.” The AMA notes that all of this is in addition to a potential up-to-9% loss for physicians participating in alternative payment method experiments, and that “Medicare physician payment actually declined 22 percent from 2001 to 2020.”
HOSPITALS AND OTHER HEALTH CARE FACILITIES
Inpatient Only List
The proposed Rule for the 2022 Medicare Hospital Outpatient Prospective Payment System (here) would remove 258 of the 266 procedure codes added to the “ASC covered procedures” list in January. BeckersSpine recalls that “Last year, CMS removed 298 musculoskeletal-related services from the inpatient-only list and detailed its plan to phase out all 1,700 procedures from the inpatient-only list by 2024. But on July 19, under the 2022 Hospital Outpatient Prospective Payment System and ASC Payment System proposed rule, the agency proposed walking back this move and halting the elimination of the inpatient-only list, citing patient safety concerns. The list of 298 orthopedic procedures is here. Comments on the proposed Rule are due on or before Sept. 17.
AHRQ’s H-CUP Publishes Study of the Cost of Hospital Readmissions
The study (here) found that “In 2018, there were 3.8 million 30-day all-cause adult hospital readmissions, with a 14 percent readmission rate and an average readmission cost of $15,200; Index (initial) admissions for septicemia accounted for the largest number of readmissions overall (8.3 percent) and by expected payer. Septicemia also had among the highest average readmission costs for Medicaid and self-pay/no charge stays, accounting for approximately 10 and 9 percent, respectively, of aggregate readmission costs; Index admissions for sickle cell trait/anemia had the highest readmission rate overall (36.1 percent) as well as among Medicare and Medicaid stays (37.2 and 39.4 percent, respectively); Heart failure was among the top five conditions at index admission with the highest number and highest rate of readmissions for Medicaid and self-pay/no charge stays; Overall, the highest average readmission cost was for index admissions for complication of transplanted organs or tissue ($27,000), which also had the highest average readmission cost for privately insured stays ($31,200) and the second highest average readmission cost for Medicare stays ($24,200).”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Medigap Insurer and “Preferred” Hospital Network Can Waive Patient Deductible, Pay Bonuses, Says OIG
Becker’s Hospital Review reports (here) that the HHS Office of the Inspector General has given an advisory opinion (here) which will allow the hospital Medicare Part A deductible to be discounted or waived, in addition to the medigap plan giving members a $100 premium credit for using the network’s hospitals.
MACPAC Publishes Summer Reading
The Medicaid and CHIP Payment and Access Commission has published an updated study (here) of physician acceptance of Medicaid patients. The findings: “Similar to prior analysis, physicians were significantly less likely to accept new patients covered by Medicaid than those with Medicare or private insurance, although acceptance varied by specialty and by state . . . Physicians in faculty practice plans and HMO practices also accepted Medicaid patients at above average rates. Physicians with higher than average existing Medicaid caseloads accepted new Medicaid patients at higher rates. The presence of mid-level providers was also associated with greater acceptance of new Medicaid patients.” MACPAC also publishes a guide to Base and Supplemental Hospital Payment Summary, here.
Four of Fifty-Four “Alternative Payment Models” Succeeded, Fifty Failed
Bloomberg reports (here) that the administration appears to be following advice from MedPAC in scrapping “alternative payment models (APMs),” only four (of fifty four) of which have succeeded in lowering Medicare expenditures, and all of which have added to the administrative burden and expense of physicians and hospitals who have participated in the models, sometimes involuntarily. The latest to be tossed is the Next Generation “Accountable Care” Organization which “has actually increased net spending by $117.5 million and produced ‘no net savings’ for the Centers for Medicare & Medicaid Services.” A CMS report on the program said that, over three years, “The NGACO model achieved a $349 million reduction in gross spending. But after accounting for shared savings and bonus payouts to participating providers, net spending didn’t decrease.” Also terminated was “another five-year Medicare payment model that was intended to trim federal spending for prescription drugs. But the Part D Payment Modernization Model only had two participating health plans when the CMS decided to end the pilot program at the end of the year.” In April, the Medicare Payment Advisory Commission voted to recommend to Congress that the CMS reduce the number of active alternative payment models. “Of 54 APMs tested in the innovation center’s 10-year history, only four have met the CMS’s actuarial standards to be expanded into permanent nationwide programs.”
Employer-Sponsored Wellness Doesn’t Work, Either
Baicker and Song report (here) in Health Affairs on long term follow up in employer-sponsored wellness programs. “At the end of three years, employees at the treatment worksites had better self-reported health behaviors, including a higher rate of actively managing their weight. No significant differences were found in self-reported health; clinical markers of health; health care spending or use; or absenteeism, tenure, or job performance. Improvements in health behaviors after three years were similar to those at eighteen months, but the longer follow-up did not yield detectable improvements in clinical, economic, or employment outcomes.”
READINGS & REFERENCES
Provider Relief Fund Reporting Rules: Useful summary from MGMA, here.
Select Coronavirus Public Health Resources and References (alphabetical) may be found here.
2021 CQ Congressional Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
July 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.