Almost Biblical In Its Impact
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Almost Biblical In Its Impact
The President of the American Medical Association told MedCity News (here) that the reduction of physician fees proposed by Medicare for 2024 would be “almost biblical in its impact.” The proposal, here, at 2,033 pages, will continue a downward trend of Medicare payments to physicians.
The AMA is objecting to inadequate consideration of practice expenses, although a majority of physicians no longer work for themselves or in private groups. The Medical Economic Index controversy is explained in an AMA publication here. The aggregate Medicare physician payment rate is 26% below the Medicare Economic Index (MEI), a measurement of the annual cost inflation for physician practices.
The various specialty societies have reacted, as well (HFMA here) as hospital groups, many of which will now be directly impacted by reduced payments to physicians whose practices they own. The scale rises because of a new “complexity” code: “One driver would be an inherent complexity add-on code for some office and outpatient E/M visits as CMS seeks to bolster primary care. The addition of this code would benefit some specialties but also would entail an estimated 2% reduction in payments across the fee schedule because of budget neutrality.”
Winner and losers, per the HFMA analysis: “CMS estimates that total allowed charges (including coinsurance and deductibles) in 2024 would rise by at least 2%, on average, for clinical psychologists, clinical social workers, endocrinologists (3%), family practice physicians (3%), general practice physicians, hematologists and oncologists, nurse practitioners, physician assistants, psychiatrists, and rheumatologists.”
The HFMA analysis continues, “Charges would drop by at least 2%, on average, for anesthesiologists, audiologists, cardiac surgeons, chiropractors, colorectal surgeons, diagnostic testing facilities, emergency medicine physicians, interventional radiologists (4%), nuclear medicine physicians (3%), nurse anesthetists, optometrists, oral and maxillofacial surgeons, pathologists, physical and occupational therapists, radiation oncologists, radiologists (3%), thoracic surgeons, and vascular surgeons (3%).”
Without an apparent overall rationale, some charges are greater if levied by a physician within a hospital, and some are the opposite. “For example, critical care specialists would see their charges increase by 2% if they operate in freestanding practice but drop by 2% if they’re facility-based. Conversely, allergists and immunologists would reap a better update if they’re facility-based, with an increase of 2% compared with a decline of 1% if they work in a freestanding practice.” Comments are due to CMS by September 11.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
New Guidelines for Chronic Coronary Disease (CCD)
The new guidelines were published in Circulation (here, 111 pages). One significant change: the American Heart Association (AHA) and the American College of Cardiology (ACC) say that outpatients with CCD should no longer initiate beta-blockers. The new recommendations replace the 2012 guidelines (here) and the 2014 focused guideline update (here) on the subject of treatment for stable ischemic heart disease.
Approximately 20 million people live with CCD in the U.S. From a report (here) in Cardiovascular Business: “‘The good news is that CCD is a very manageable disease now,’ cardiologist Salim S. Virani, MD, PhD, chair of the writing committee behind the guidelines, said in a prepared statement. ‘With healthy lifestyle habits and medical therapy, which has advanced tremendously, the prognosis for patients with CCD has dramatically improved.’”
Communication is emphasized in treating CCD: “‘Management of CCD is a team sport,’ Virani added. ‘Clinicians in both primary and specialty care should fully leverage all members of the cardiovascular care team, including physicians, nurse practitioners, physician assistants, nurses and nursing assistants, pharmacists, dietitians, exercise physiologists, physical, occupational and speech therapists, psychologists and social workers to maximize benefits to patients with CCD.’” Highlights of the new guidelines are also summarized in the Cardiovascular Business report.
New Guidelines for Categorizing Alzheimer’s Disease
Reuters reports (here) that “Alzheimer's disease experts are revamping the way doctors diagnose patients with the progressive brain disorder - the most common type of dementia - by devising a seven-point rating scale based on cognitive and biological changes in the patient. The proposed guidelines . . . embrace a numerical staging system assessing disease progression similar to the one used in cancer diagnoses. They also eliminate the use of terms like mild, moderate and severe.” The guidelines recognize advances in both diagnosis and treatment.
HOSPITALS, ASCs, SKILLED NURSING AND OTHER HEALTH CARE FACILITIES
KFF Charts Employment Changes in Health Services Post Pandemic
The Kaiser Family Foundation (here and here) charts changes, with these highlights: “Unlike past recessions, health sector employment saw a big drop in early 2020 but has rebounded since. As of June 2023, the number of people employed in the health sector was 2.2% higher than in Feb 2020 (the previous job peak), compared to 2.6% in all other sectors. Still, not all health sector employment trends have recovered . . . Nursing care facilities have seen an 11% drop in employment since February of 2020. Health and social assistance job quits are also 29.2% higher than they were pre-pandemic and are currently similar to the peak ‘great resignation’ levels seen in November 2021.”
Death Rates in the Pandemic Varied by Political Party
A report in JAMA Internal Medicine (here) found that “An association was observed between political party affiliation and excess deaths in Ohio and Florida after COVID-19 vaccines were available to all adults. These findings suggest that differences in vaccination attitudes and reported uptake between Republican and Democratic voters may have been factors in the severity and trajectory of the pandemic in the US.”
COVID Relief Funds Boosted Hospital Financial Performance in 2020-2021, But Not in All Hospitals
A study in JAMA Health Forum (here) of more than 4,400 hospitals found that “The large majority had positive financial performance during 2020/2021, partly due to COVID-19 relief funds. However, hospitals serving Hispanic populations had substantially worsened financial performance during 2020/2021, even after accounting for COVID-19 relief. That COVID-19 relief funding aided in operating margins reaching all-time highs indicates funding amounts may have been larger than was necessary for many hospitals.”
Ge Bai and Colleagues Question Tax Exemption for Less Charitable Hospitals; Study Questions 340B Fund Equity
Their study in The New England Journal of Medicine (here) found that “Many nonprofit hospitals don’t provide enough charity care or have a substantial enough Medicaid shortfall (relative to for-profit hospitals) to justify their favorable tax treatment.”
Modern Healthcare publishes (here) a summary of proposed distribution of 340B money to hospitals: “Hospitals that would receive the biggest 340B remedy payments under a new proposal to correct unlawful reimbursement cuts tended to provide proportionally less uncompensated care than other 340B-eligible hospitals.”
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Notes to Fred Hyde, MD, JD, MBA, news@dcmedicalnews.org
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