BLS Reports That the Highest Paying Job in Every State is Physician
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
The Bureau of Labor Statistics reports that “The highest paying job in every state is in healthcare. From California to New York, the highest paying job in all 50 states is in healthcare, according to the most recent data from the U.S. Bureau of Labor Statistics,” according to this report in Becker’s. The BLS report is here.
Primary Care Practitioners, an Endangered Species
The Physicians Foundation, the Milbank Fund and the American Academy of Family Physicians report (here) on the state of the primary care practitioner in the U.S. They note that “The United States is systemically underinvesting in primary care,” that “The primary care physician workforce is shrinking and gaps in access to care appear to be growing,” that “The percentage of adults reporting they do not have a usual source of care is increasing,” that “Too few physicians are being trained in community settings, where most primary care takes place,” and that “There are few federal funding opportunities for primary care research, with only 0.2% of National Institutes of Health funding allocated to primary care.”
“Given declining life expectancy,” according to the report, and “racial and ethnic health disparities, the current epidemic of mental health needs, the ongoing COVID-19 pandemic, and other nationwide issues that primary care can help address, these findings represent an urgent call to policymakers and other stakeholders. It is time to accelerate adoption of policies that will demonstrably increase investment in high-quality primary care, create a robust primary care workforce, and enable analysis and learning around the impact of primary care.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
SEP-1, A Failure in Controlling Sepsis, Illustrating the Shortcomings of Process Quality Measures, As Well
A Viewpoint in JAMA (here) notes that “One of the highest-profile measures designed to improve sepsis outcomes is the Centers for Medicare & Medicaid Services (CMS) Severe Sepsis/Septic Shock Early Management Bundle (SEP-1). SEP-1 requires hospitals to report adherence to a strictly defined initial management bundle that includes obtaining blood cultures, measuring lactate, and administering broad-spectrum antibiotics within 3 hours of a patient meeting sepsis criteria, infusing at least 30mL/kg of intravenous crystalloids for hypotension or hyperlactatemia, and rechecking lactate and initiating vasopressors within 6 hours for refractory shock. It is an all-or-nothing bundle; hospitals receive credit only if all components are performed or contraindications documented. SEP-1 is currently a pay-for reporting measure, but CMS recently proposed changing it to a pay-for-performance measure.”
The report notes that “SEP-1was launched in 2015 with high expectations that it would improve outcomes for patients with sepsis. Unfortunately, it has not done so. Four large, rigorous, multicenter time-series analyses now document the disappointing real-world impact of SEP-1 across hundreds of US hospitals. Broad-spectrum antibiotic use has increased since SEP-1 went into effect, but SEP-1 has not lowered mortality rates.”
Unchastened, CMS has doubled down. “CMS is well underway with developing a new sepsis mortality measure that will hopefully replace SEP-1.The new measure is designed to be collected electronically, a promising step forward that has the potential to allow hospitals to shift the substantial resources they currently devote to measuring SEP-1 manually toward optimizing care. Important details, including precise criteria for defining sepsis and how to perform risk adjustment for hospital-to-hospital comparisons, remain in development. However, the forthcoming measure’s focus on outcomes is what matters most. The proposal by CMS to entrench SEP-1 by making it a pay-for-reporting measure, in contrast, is a step backward.”
“SEP-1 helped usher in a new era of accountability and focus on sepsis care, but data from hundreds of hospitals now show that it has not met its core goal of improving outcomes. It is time to shift the focus of sepsis quality metrics from narrowly defined, controversial, and constraining process measures to patient-centered outcomes.”
The Complex Case Discharge Delay Problem
The Hospital Association of New York State publishes a report on this problem (here), noting that “The unintended consequence is a system where hospitals are left bridging gaps between health and social care; serving as a long-term destination rather than as a way station for those who, once their acute care needs are met, are better served in a non-hospital setting.”
The report continues, “Our system of care has a design flaw — it is primarily designed for people with a clear path, for those who do not have complex care needs upon discharge. There may not always be a perfect discharge setting for complex case patients. However, there is a shared responsibility to acknowledge this problem and find the perhaps imperfect but best possible solution. What we are doing now is a disservice to our communities and people who ‘live’ in a hospital.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
The Georgetown University Center on Health Insurance Reforms reports (here) on Medicaid “unwinding,” that is, the end of enhanced Medicaid eligibility measures under the COVID-19 Public Health Emergency, scheduled for May 11. The report notes the current status: “Communications efforts have kicked into high gear; States are shifting from planning to implementation; States were required to submit their state renewal report and system readiness documents by Feb 15; States may initiate the first batch of renewals in February, March or April; Some states have already begun; Most states plan to take full 12-14 months . . . [and] First day terminations can begin: April 1.”
Senator Warren Chides Brokers and Plans for Medigap Plan Sales Gimmicks
In a letter (here) to CMS and to the National Association of Insurance Commissioners, Senator Elizabeth Warren describes the content of a staff committee report (here) on Medigap plan sales inducements. “I am writing to provide you with a report I am releasing today that identifies extensive awards of lavish vacations and other incentives from Medicare Supplement Insurance (Medigap) providers to health insurance agents and brokers. I ask that you act quickly to end these secretive perks, which create inherent conflicts of interest that could cause insurance agents to provide seniors with poor advice about which Medigap product is best for them.”
“Our investigation uncovered the pervasive use of agent and broker incentives in the Medigap market. My staff identified 32 Medigap companies that offer agents rewards for selling their products to seniors. These companies, which together provide coverage to over six million seniors, dangle incentive trips such as a Sunny San Diego trip, the sales reward trip of a lifetime, [the] Ticket to St. Thomas, and Paths to Maui, in front of agents and brokers – all for touting their products ahead of others that might be cheaper or more suitable for the customer.”
MA Plans Line Up “Consumer Advocates” to Lobby Against Risk Adjustment
Medicare Advantage plans have collected consumer advocate groups (here) to lobby against proposed CMS risk adjustment limitations. “We want to express concern over proposed risk adjustment changes jeopardizing progress made in advancing health equity, preventing disease progression, and delivering high-value, high-quality care . . . We are concerned the biggest impact could be on our most vulnerable seniors, including beneficiaries dually eligible for Medicare and Medicaid and those in chronic condition special needs plans.” No mention is made in the letter concerning litigation by CMS initiated to recover undeserved “risk adjustment” awards in the past.
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Notes to Fred Hyde, MD, JD, MBA, news@dcmedicalnews.org
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