DCMedical News: Wednesday, September 18, 2019
DCMedical News-DCMN
Washington, D.C.
Wednesday, September 18, 2019
DCMedical News is published every day both the House and the Senate are in session. Subscription information below.
THE BIG STORY IN HEALTH CARE
Site-of-Service Differential Policy Voided
Judge Rosemary Collyer voided the policy (here) of the Centers for Medicare & Medicaid Services which would have eliminated the “differential” or additional payment hospitals receive for outpatient services off campus, compared to payments received by doctors for the same services. A suit was filed (here) by the AAMA, the AHA and three hospitals, shortly after publication of the 2018 final Outpatient Prospective Payment System rule. Judge Collyer’s opinion (here) said “the Court finds that CMS exceeded its statutory authority when it cut the payment rate for clinic services at off-campus provider-based clinics”; that “campus provider-based departments are paid at higher rates than physician offices”; that “MedPAC [the Medicare Payment Advisory Commission)] advised that hospitals were buying existing physician offices and converting them into off-campus provider-based departments, sometimes without a change of location or patients, unnecessarily causing CMS to incur higher costs”; and that “CMS believes it is paying millions of taxpayer dollars for patient services in hospital outpatient departments that could be provided at less expense in physician offices.” Judge Collyer wrote, “CMS may be correct. But CMS was not authorized to ignore the statutory process for setting payment rates in the Outpatient Prospective Payment System and to lower payments only for certain services performed by certain providers.” While the court granted summary judgment to the plaintiffs, however, it did not order a remedy (for example, a refund of amounts already withheld under the rule, as requested by the hospital groups), rather returning the matter to CMS for further consideration.
More on Hospital-Employed Doctors
Vivian Ho and colleagues (here) in the Journal of General Internal Medicine find that “[F]inancial integration between physicians and hospitals raises patient spending, but not care quality. Given that higher spending raises the price of health insurance, policy makers should carefully consider policies that limit consolidation of hospitals and physicians.” They note “Estimates suggest that patients in a preferred provider organization incur spending which is 5.8 percentage points higher when treated by doctors in hospital-owned versus physician-owned practices. Spending is significantly higher for durable medical equipment, imaging, unclassified services, and outpatient care. The spending difference appears attributable to greater service utilization rather than higher prices.”
Add Gasoline to This Fire
Modern Healthcare reports that “Orthopedists, along with gastroenterologists and urologists, are among the newest targets in the rush of private equity firms investing in physician specialty groups over the past few years. These firms are attracted to specialties that promise rich revenue from ambulatory surgery centers, lab, imaging and other ancillary services. The trend is already far along in dermatology, ophthalmology and dentistry. The proliferation of these deals has raised alarm about whether ownership of physician practices by investors eyeing a 400% return on their cash investment within a few years will affect overall healthcare spending and quality of care. It’s set off an emotional debate within medicine about potential pressure to provide unnecessary care and loss of professional autonomy.”
Bloomberg Law reports that “There were 181 private equity deals for all types of physician practices last year,” and that “In dermatology alone, there were nearly 200 practices acquired by private equity firms over the past six years.”
Irritated by press reports of massive lobbying by private equity firms against control of surprise medical bills, the Co-Chairs of the House Energy and Commerce Committee have begun an investigation (here). They wrote,
“"Evidence indicates that these physician staffing firms charge significantly higher in-network rates than their counterparts, thereby driving reimbursement upwards as they enter into staffing arrangements with hospitals. We are concerned about the increasing role that private equity firms appear to be playing in physician staffing in our nation’s hospitals, and the potential impact these firms are having on our rising health care costs." The Committee press release noted “The investigation comes as the problem of surprise billing is on the rise in the United States, one in five emergency department visits and about nine percent of elective inpatient care at in-network health facilities results in a surprise bill.”
Congress Acts on Appropriations Bills
With the end of the current fiscal year (and the beginning of FY2020 October 1) eight legislative days away, Congress is expected to act . . . to delay. CQ reports that a “stopgap funding bill, expected to run through Nov. 21, was also expected to include a package of health care program extensions, such as funding for community health centers. But a House Democratic aide said the package hadn't been finalized yet.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Walmart Health
Forbes reports that Walmart has opened a standalone health clinic in Dallas, Ga. “The 10,000-square-foot health clinic, called Walmart Health, will offer primary care, imaging, lab, dental and behavioral health services. Walmart plans to offer visits, cleanings and lab tests at prices about 30 percent to 50 percent lower than what people are currently paying at physician offices and other retail health clinics. Walmart's clinic will take insurance. The primary care clinic in Dallas, Ga., is different from the other 19 Care Clinics Walmart already operates in Georgia, South Carolina and Texas. The Care Clinics are inside a Walmart store and take up just 1,500 square feet, according to Forbes. And “If the pilot clinics succeed, with a footprint so large, Walmart could quickly become the nation's largest provider of basic healthcare.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Catheter Infections, Better Performance or Change in Measurement?
From Boston University: “Researchers from Boston University School of Medicine have found that although hospitals have reported significantly improved CAUTI (catheter-associated urinary tract infections) rates since 2015, the change is not due to improved patient outcomes or initiatives, but instead to a national guideline change in what defines a CAUTI. [T]he researchers found that CAUTI rates decreased significantly by 42 percent around the time that the value-based incentive programs were implemented . . . the large decline in CAUTI rates was actually due to a concurrent change in which infections ‘count’ as CAUTI. According to the researchers, these findings are important because change in the CAUTI definition likely led to artificial inflation of hospitals' performance scores unrelated to changes in patient safety.”
Hospital Concentration and Price Inflation, Chapter Eight
The Health Care Cost Institute (three insurance companies) reported (here) that a new study of concentration in hospital markets “finds a positive relationship between (those) price increases and increases in hospital market concentration. While these results are descriptive in nature, they align with a wide body of literature demonstrating that more concentrated – less competitive – hospital markets are generally associated with higher prices.” Three quarters of 112 metropolitan areas in the U.S. were found to be “highly concentrated” hospital markets.
READINGS AND REFERENCES
U.S. House of Representatives:
Members at https://www.house.gov/representatives
Committees and Members at https://www.house.gov/committees
U. S. Senate:
Members at https://www.senate.gov/general/contact_information/senators_cfm.
Committees and Members at https://www.senate.gov/committees
House and Senate 2019 Calendar of Regularly Scheduled Sessions, here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
September publication dates: 19, 20, 23, 24, 25, 26, 27
October publication dates: 15, 16, 17, 18, 21, 22, 23, 24, 28, 29, 30, 31
November publication dates: 12, 13, 14, 15, 18, 19, 20, 21
December 3, 4, 5, 6, 9, 10, 11, 12
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.