Federal Budget Building
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
Timing: CQ reports that “The Biden administration will send its budget for the next fiscal year up to Capitol Hill on March 9 . . . That's about a month later than the statutory deadline, which is the first Monday in February, though that target is often missed and there's no penalty for doing so.”
The White House typically delivers its budget after the State of the Union address, which in this case is scheduled for Feb. 7. The House Budget Committee typically unveils a budget resolution after the White House submits its budget plan. The statutory deadline for completing action on a congressional budget resolution is April 15.
Content: CQ notes “Republicans are reportedly seeking spending reductions in the form the budget or commensurate fiscal reforms (here, “A Commitment to End Woke and Weaponized Government, 2023 Budget Proposal”) . . . [but] there's little agreement on which programs to cut, and other demands have been discussed such as beefed-up border controls and looser restrictions on domestic energy production . . . The numbers in the House blueprint will be stark — probably $10 trillion to $11 trillion in spending reductions over a decade, assuming room is left for extending former President Donald Trump's tax cuts (PL 115-97) — depending on the Congressional Budget Office baseline expected next month.”
“If Medicare and Social Security are exempt, all other spending would need to be cut by nearly 44 percent, based on CBO data. And with broad opposition within the party to cutting deeply into defense or veterans' programs, the remainder of domestic and foreign aid accounts would likely need to take an even larger hit . . . In order to balance the budget in 10 years without raising taxes as House Republicans have pledged, however, it would require cutting more than 25 percent of all federal spending, based on the most recent Congressional Budget Office forecast.”
“However, McCarthy and others have consistently said in recent days that Social Security and Medicare, the two largest federal programs, aren't on the table for cuts. If Medicare and Social Security are exempt, all other spending would need to be cut by nearly 44 percent, based on CBO data. And with broad opposition within the party to cutting deeply into defense or veterans' programs, the remainder of domestic and foreign aid accounts would likely need to take an even larger hit.”
Process: The major arguing point appears to be the debt limit bill, with the threat of default poised against sought after reductions in spending. However, CQ notes that negotiations over the debt limit are unlikely, at least in the Senate: “But Democrats, whose votes will be needed in the Senate, are pledging not to negotiate. In fact, no major cuts or other concessions have been granted in debt limit bills since 2011, when a divided Congress and the Obama administration negotiated the pact (PL 112-25) that led to 10-year appropriations caps and automatic cuts in Medicare and other mandatory benefit programs.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Diagnostic Error in the Emergency Department
The Agency for Healthcare Research and Quality (AHRQ) publishes (executive summary here, 744-page study here) analysis of adverse patient events in hospital emergency departments.
From the study:
“Overall diagnostic accuracy in the emergency department (ED) is high, but some patients receive an incorrect diagnosis (~5.7%).”
“Some of these patients suffer an adverse event because of the incorrect diagnosis (~2.0%), and some of these adverse events are serious (~0.3%).”
“This translates to about 1 in 18 ED patients receiving an incorrect diagnosis, 1 in 50 suffering an adverse event, and 1 in 350 suffering permanent disability or death. These rates are comparable to those seen in primary care and hospital inpatient care.”
Also, “We estimate that among 130 million emergency department (ED) visits per year in the United States that 7.4 million (5.7%) patients are misdiagnosed, 2.6 million (2.0%) suffer an adverse event as a result, and about 370,000 (0.3%) suffer serious harms from diagnostic error. Put in terms of an average ED with 25,000 visits annually and average diagnostic performance, each year this would be over 1,400 diagnostic errors, 500 diagnostic adverse events, and 75 serious harms, including 50 deaths per ED.”
Reporting on the study, Reed Abelson in The New York Times (here) wrote “As many as 250,000 people die every year because they are misdiagnosed in the emergency room, with doctors failing to identify serious medical conditions like stroke, sepsis and pneumonia, according to a new analysis from the federal government . . . Researchers from Johns Hopkins University, under a contract with the agency, analyzed data from two decades’ worth of studies to quantify the rate of diagnostic errors in the emergency room and identify serious conditions where doctors are most likely to make a mistake.”
“‘This is the elephant in the room no one is paying attention to,’ said Dr. David E. Newman-Toker, a neurologist at Johns Hopkins University and director of its Armstrong Institute Center for Diagnostic Excellence, and one of the study’s authors. The findings underscore the need to look harder at where errors are being made and the medical training, technology and support that could help doctors avoid them, Dr. Newman-Toker said. ‘It’s not about laying the blame on the feet of emergency room physicians,’ he said.”
Abelson added, “In reviewing the studies, the researchers also found that women and people of color had a roughly 20 to 30 percent higher risk of being misdiagnosed. While these results are not surprising, they point to the need to address how different patients are assessed in the emergency room as part of the effort to improve care, said Jennie Ward-Robinson, the chief executive of the Society to Improve Diagnosis in Medicine. ‘Equity must be core and must be fundamental.’”
“Medical societies representing emergency room doctors strongly criticized the study. ‘In addition to making misleading, incomplete and erroneous conclusions from the literature reviewed, the report conveys a tone that inaccurately characterizes and unnecessarily disparages the practice of emergency medicine in the United States,’ Dr. Christopher S. Kang, the president of the American College of Emergency Physicians, said in a statement.”
State Initiatives to Force Hospital Price Transparency
Hospital price consultant Rick Louie is following state actions to compel hospitals to post “transparent” prices in accord with federal statute. The latest is New Hampshire, “taking enforcement of price transparency into its own hands after not being satisfied with CMS enforcement.” CMS has levied fines only against one two-hospital system, in Atlanta.
The New Hampshire bill cited by Louie (here) provides financial relief for patients who received services at hospitals which are not compliant with the federal rules. “A patient or patient guarantor is not responsible for the cost of items or services provided to the patient by the hospital if the hospital was not in material compliance with hospital price transparency laws on a date on or after the effective date of this section that items or services were purchased on or provided to the patient.” Put alternatively, the statement of purpose reads “This bill prohibits a hospital from pursuing a collection action for services provided if the hospital was not in compliance with certain federal price transparency laws.”
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
February 2, 7, 8, 9, 27, 28
March 1, 7, 8, 9, 22, 23, 24, 27, 28, 29, 30
April 17, 18, 19, 20, 25, 26, 27, 28
Notes to Fred Hyde, MD, JD, MBA, news@dcmedicalnews.org