Debate Continues on Lifting That Debt Ceiling
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The Hill’s Health Care Newsletter (here) reports that the official Republican proposal to lift the debt ceiling for borrowing includes work requirements for Medicaid recipients. The report notes that “Medicaid work requirements are not a new GOP policy.”
“The Congressional Budget Office (CBO) previously estimated that work requirements could trim federal spending by $135 billion over 10 years; but mainly because more than 2 million people would lose health benefits for failing to comply with the requirements. The CBO also said the changes would not increase employment much.”
The Hill report adds “As the Kaiser Family Foundation notes, most Medicaid-eligible adults who qualify through non-disability pathways already work. Some states also have programs that support employment for beneficiaries without making it a condition of eligibility. The Trump administration championed work requirements for Medicaid beneficiaries, though the policies were either blocked in court or quietly rescinded by the Biden administration. But in Arkansas, which had the requirements on the books the longest, nearly 17,000 people lost coverage.”
DOCTORS, NURSES, AND OTHER HEALTH PROFESSIONALS
Physicians and Nurses Disappearing
Medscape (here) reports that “The double whammy of pandemic burnout and the aging of baby boomer physicians has, indeed, the makings of some scary headlines. A recent survey by Elsevier Health predicts that up to 75% of healthcare workers will leave the profession by 2025. And a 2020 study conducted by the Association of American Medical Colleges (AAMC) projected a shortfall of up to 139,000 physicians by 2033.”
Retirement of physicians represents a significant factor, according to the AAMC. Michael Dill, AAMC's director of workforce studies, is cited by Medscape as saying “Close to a quarter of the physicians in the US are 65 and over. So, you don't need any extraordinary events driving retirement in order for retirement to be a real phenomenon of which we should all be concerned."
Nurses
The Hill (here) reported on a survey from the National Council of State Boards of Nursing. In sum, “About 100,000 nurses quit due to stress and burnout during the COVID-19 pandemic, and another 800,000 said they intend to leave by 2027 . . . Nurses who are older and more experienced are more likely to envision themselves leaving the industry soon, the survey found. More than 600,000 nurses with more than 10 years of experience see themselves leaving the industry due to stress by 2027, compared to just under 200,000 nurses with less than 10 years’ experience.” The administration has issued a variety of directives (here, from InsideHealthPolicy) concerning staffing, “aimed at shoring up the long-term caregiver workforce, including building off nursing home staffing minimums put forward last year,” but no indication of new money with which to meet such requirements.
Doximity (here) reports that Mass General and other Boston hospitals have turned to mandatory overtime to meet staffing goals. A complete report appears (here) in The Boston Globe (“Mass. hospitals turn to controversial labor practices to stretch beleaguered staff. Nurses say the moves could worsen staffing shortages.”)
The Wall Street Journal reports (here) that “Nurse Shortage Pushes Hospitals Into the Gig Economy.” Becker’s reports (here) on the cost of nurse turnover.
HOSPITALS, NURSING HOMES, AND OTHER HEALTH CARE FACILITIES
Same Day Discharge by Default for Cardiac Cath Patients
Health Policy (here) reports on a study of 10,000 planned same day discharges (SDD) of cardiac catheterization patients in a Belgian hospital. “The proportion of patients receiving catheterization procedure in SDD increased from 28 to 44%. All-cause death and readmission rate remained unchanged . . . Patients satisfaction top box score was 91% . . . The by default SDD strategy was associated with reduction in in-hospital health care spending, on average 3206€ per procedure is saved. This means a 57% decrease in hospital revenues and . . an important decrease in physician income.”
The conclusion: “Implementing a by default SDD cardiac catheterization strategy results in a reduction of societal cost, excellent patient satisfaction and unchanged clinical outcome. Yet, in the given context this approach negatively impacts hospital and physician revenues precluding the sustainability of such protocol.”
USNWR Reports Faulted as Misleading, Inaccurate
An essay in JAMA Surgery (here) notes that “Annual changes in cardiac bypass hospital ratings were not replicable using validated clinical outcomes from a nationwide registry. Nonetheless, patients and hospital executives remain fixated on US News & World Report (USNWR) hospital ratings, which is, to our knowledge, the most popular hospital rating system; changes in USNWR ratings are associated with a 5% average year to-year shift in non-emergency Medicare patient volume. As a result, the sizable influence of USNWR ratings warrants closer scrutiny.”
The scrutiny, in this article, is for ratings of radical prostatectomy (RP) procedures, with the author’s judgment that USNWR ratings of “RP currently miss the mark by . . . failing to include procedure-specific objective end points . . . that matter most to patients.”
MEDICARE, MEDICAID, AND COMMERCIAL HEALTH INSURANCE
Insurance and Preventive Services Under PPACA
Bloomberg Law reports (here) that “Employers Seek Clarity on Cost of Preventive Health Services After Recent ACA Ruling” (see DCMN 4-18-23). “Many Americans who have obtained preventive services such as PrEP or anxiety screenings for children at no cost since the passage of the Affordable Care Act would have to pay out-of-pocket costs unless a recent court ruling is overturned.”
Bloomberg notes, “An analysis of the district court decision by the University of Michigan’s Center for Value-Based Insurance Design revealed that one-third of the 46 preventive services that health insurance plans have been required to cover for free under Obamacare would be affected. This court’s ruling, which potentially affects millions of Americans who receive coverage through employer and other private health plans, has employee benefits and human resources professionals calling for clarity on which services would now require workers to pay copays and deductibles. While a recent guidance from a quartet of federal agencies [here] was seen as helpful...more information is needed.”
DRUGS & DEVICES
Top Ten Predictions for IRA’s Impact on Drug Prices and Utilization
Dr. Adam Fein in Drug Channels (here) makes his top ten predictions for the impact of the Inflation Reduction Act on drugs, including “Part D plans will ramp up utilization management . . . tools [such] as step therapy and prior authorizations”; “Manufacturers will face deeper discretionary rebates, more formulary exclusions, and much lower net prices”; and “Average Sales Prices of provider-administered drugs will decline sharply, accelerating the consolidation of physician practices into health systems and hospitals.”
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Notes to Fred Hyde, MD, JD, MBA, news@dcmedicalnews.org
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