CBO Reports on Its Previous Overestimates of Annual Health Spending in the U.S.
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The Congressional Budget Office has reported (here) that “The rate of growth in federal mandatory spending on health care per beneficiary has slowed sharply since 2005. For example, Medicare spending per beneficiary grew at an average annual rate of 6.6 percent between 1987 and 2005, 3.1 percent between 2007 and 2012, and 2.2 percent between 2013 and 2019.”
Also, CBO reports that “The United States spends a larger share of its gross domestic product (GDP) on health care than other advanced economies and performs worse on various measures of health outcomes than many of those same countries. In 2019, U.S. health expenditures were 17.6 percent of GDP, nearly 7 percentage points higher than the average of other comparably wealthy countries.”
AHRQ Reports on Causes of Death
The Agency for Healthcare Research and Quality reports that “Heart disease and cancer accounted for 168.2 and 144.1 deaths per 100,000 individuals, respectively, in 2020, making them the leading cause of death that year. COVID-19 was the third most common cause at 85.0 deaths per 100,000 people,” as noted in the just-released AHRQ 2022 National Healthcare Quality and Disparities Report, here.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Independent Dispute Resolution a Mess, Resumes
Healthcare Finance reports that “The Centers for Medicare and Medicaid Services has issued revised guidance for the independent dispute resolution (IDR) process that is part of the No Surprises Act implementation.” The hiatus followed August 2022 “final rules,” a modification of those rules by a District Court in Eastern Texas, February 6, CMS directives on March 17 pursuant to that Order, automation of the process through the “IDR portal,” and instructions from CMS that “Effective immediately, certified IDR entities should not issue new payment determinations until receiving further guidance from the Departments and certified IDR entities also should recall any payment determinations.”
The lawsuit involved findings that HHS put a “thumb on the scale,” in determining what information the “independent” resolver must consider. “The interim final rule stipulated that the arbitrator must select the offer closest to the Qualifying Payment Amount, which is set by the insurer.”
Cardiologists Speak, a Lot
Cardiovascular Business reports (here) that “Cardiologists in the United States received more than $1 billion in speaker fees and other industry payments from 2014 to 2019, according to new findings published in Circulation: Cardiovascular Quality and Outcomes. Although industry-physician collaborations can drive crucial scientific discoveries, ‘indiscriminate financial relationships may introduce bias and overutilization in patient care,’ wrote first author Ruina Zhang, MD, with the department of medicine at Weill Cornell Medicine in New York City.”
Mr. ChatBot to Decide Which Clinical Conversations are Relevant to Care Plans
Modern Healthcare reports that “Nuance Communications, a clinical documentation software company owned by Microsoft, is adding OpenAI’s ChatGPT successor GPT-4 to its latest application...called Dragon Ambient eXperience Express.” Nuance “said this version of Dragon can summarize and enter conversations between clinicians and patients directly into electronic health record systems using OpenAI’s GPT-4 generative AI capabilities . . . Along with entering relevant information into the health record, Nuance’s application can also change the language and remove conversations not relevant to the care plan.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
BMJ Reports on the Industrialized Country with the Worst Maternal Mortality Record, Now Higher
BMJ reports (here) that “Two studies show that maternal mortality in the US dramatically increased during the covid-19 pandemic and was especially severe among racial and ethnic minorities and in rural areas and small cities. The US already has the worst maternal mortality rate among industrialised countries . . . Before the pandemic the US ranked last of 10 industrial countries, with 17.4 deaths per 100 000 live births, which compares with 1.7 in New Zealand, 3.2 in Germany, 4.8 in Australia, and 6.5 in the UK.”
“The new study from the US Centers for Disease Control and Prevention showed that, in 2021, there were 1205 deaths from maternal causes in the US, up from 861 in 2020—a 40% increase—and 754 in 2019. The maternal mortality rate for 2021 was 32.9 deaths per 100 000 live births, up from 23.8 in 2020 and 20.1 in 2019.”
“Maternal mortality rose from 2020 to 2021 in all racial and ethnic groups. It was much worse in black groups, with 69.9 deaths per 100 000 live births, more than two and a half times the rate in white groups (26.6) . . . Most of the people who died in pregnancy were not vaccinated against covid-19. It was not until August 2021 that vaccinations were recommended for pregnant women.”
A study from the Schools of Public Health at the University of Maryland and Boston University looked at pregnancy related deaths that occurred up to one year after the end of pregnancy. It found that pregnancy related deaths were significantly higher in 2021, at 45.5 per 100 000 live births, than during the pandemic in 2020 (36.7 deaths per 100 000 live births) and before the pandemic (29.0 per 100 000 live births).”
Pennsylvania Court Finds Hospital Management Compensation and Practices Relevant to Tax Exemption
A prominent Pennsylvania law firm (here) discusses a recent decision of Pennsylvania courts concerning the tax exemption of Tower Health. “On February 10, 2023, the Commonwealth Court of Pennsylvania (Court) issued a series of en banc opinions affirming the Chester County Court of Common Pleas (Trial Court) denials of tax-exempt applications for Brandywine Hospital, Jennersville Hospital, and Phoenixville Hospital ‒ three hospitals acquired by Tower Health LLC . Although the Court ultimately dismissed the cases on appellate procedural grounds, the Court addressed fully the Trial Court’s determinations that Tower’s applications failed . . . The Court’s decisions, however, focused not on each of the applicants but on the activities of the applicants’ management company.”
“The Court focused most intensely on whether Tower (as opposed to each separate LLC) met the prong of the HUP Test that requires a purely public charity ‘[o]perates entirely free from private motive.’ The Court found three of Tower’s practices to be grounds to uphold the trial court’s decision that Tower ‘failed to sustain its burden of demonstrating the absence of a profit motive,’ namely, (1) Tower’s ‘improperly exorbitant management fees;’ (2) Tower’s investment of interest payments on the bonds for the acquisition of hospital properties in areas other than the efficiency and facilities of each hospital; and (3) Tower’s executive compensation.”
Vertical Consolidation the Focus of Workers Compensation Payers
The Workers Compensation Research Institute (here) reports that “Medical markets are increasingly concentrated. This means that patients are more likely to be treated by physicians at sites owned by hospitals and health systems. This raises a policy concern that the increasing concentration of medical providers may lead to higher payments for medical care without corresponding improvements in patient outcomes.”
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Notes to Fred Hyde, MD, JD, MBA, news@dcmedicalnews.org
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