FY 2024 OPPS Final Rule Pre-Published in Federal Register, With New Price Transparency Rules for Hospitals
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The much-anticipated “final rule” for Outpatient Prospective Payment System for 2024 was pre-published (here) in the Federal Register, with official publication scheduled for July 31. “This proposed rule would revise the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for calendar year 2024 based on our continuing experience with these systems. In this proposed rule, we describe the changes to the amounts and factors used to determine the payment rates for Medicare services paid under the OPPS and those paid under the ASC payment system.” And much more, 963 pages.
The price transparency modifications (here) include a requirement for standardized presentation of both the “machine readable” and the “top 300” hospital price listings and, in emulation of Sarbanes Oxley type certifications, “CMS may require submission of certification by an authorized hospital official as to the accuracy and completeness of the data in the machine-readable file and submission of additional documentation as may be necessary to determine hospital compliance.”
AI Under Scrutiny, Along With Hospital Mergers
Fresh from a fourth antitrust defeat in the courts, the Federal Trade Commission (Bloomberg report) “Is said to have opened an investigation into OpenAI, questioning whether its popular ChatGPT conversational AI bot puts consumers’ reputations and data at risk. The probe into the Microsoft-backed startup marks the first official inquiry into a technology that has the potential to, among other things, change almost every aspect of daily life, trigger the loss of millions of jobs and, according to a not-insignificant number of industry observers, pave the way to oblivion.” Coverage of this story in The New York Times, here.
Also from the FTC, proposed new merger rules may disclose hidden conflicts, and slow or stop some transactions. Modern Healthcare reports (here) that “The Federal Trade Commission proposed, among other things, requiring merging parties to disclose minority investors to potentially weed out conflicts of interest. Healthcare companies pursuing mergers would have to disclose more information about the transactions under a new Federal Trade Commission proposal that could slow healthcare deal-making. The antitrust agency voted Tuesday to publish a proposed rule that would, in part, require merging parties to disclose any minority investors in an effort to weed out any conflicts of interest; information about prior acquisitions; supplier agreements; subsidies from foreign entities; and workforce data, including information on executives and board members.”
HHS Funding for FY 2024, House Republican Version
CQ reports that “House appropriators released draft text of a fiscal 2024 Labor-HHS-Education spending bill. The measure would provide $147 billion in discretionary funding for the departments of Labor, Health and Human Services and Education and related agencies — $60.3 billion, or 29 percent, below the enacted fiscal 2023 funding.” The Bill summary is here. “The summary noted the bill ‘reins in’ bureaucracy, includes anti-abortion provisions and eliminates 61 programs. The Labor-HHS-Education Appropriations Subcommittee is scheduled to mark up the bill Friday.”
HOSPITALS, ASCs, SKILLED NURSING AND OTHER HEALTH CARE FACILITIES
Joint Commission Finds Sentinel Events Up 19% 2021 to 2022, Common Causes Are Well Known
The Joint Commission has reported (here) for 2022 on “Sentinel Events,” voluntarily-reported adverse patient safety events in hospitals resulting in death or severe compromise to patients. Becker’s reports that “Of all reported sentinel events in 2022, 44 percent resulted in severe temporary harm and 20 percent resulted in a patient death. The Joint Commission defines a sentinel event as a patient safety event that reaches a patient and results in death, permanent harm or severe harm.”
“There were 1,441 reports of sentinel events in 2022, up by 19 percent from 2021, according to the report. The increase is above pre-pandemic levels.” The top ten categories included falls, delays in treatment and foreign object retention. “The Joint Commission's report found that the most common causes of these adverse events that result in harmful outcomes are failures in communications, failures in teamwork and failures in consistently following policies.”
Stenting, In Lieu of Carotid Endarterectomy, For Carotid Artery Stenosis
Medscape reports (here) that CMS has published (here) “coverage criteria” which will expand the use of carotid artery stenting (CAS). The decision would expand Medicare coverage of the procedure and remove certain requirements for CAS facilities and operators.
The decision proposal would expand coverage for CAS, first introduced in 1994, "To standard surgical risk patients by removing the limitation of coverage to only high-surgical risk patients." It would limit it to patients for whom CAS is considered "reasonable and necessary" and who are either symptomatic with carotid stenosis of 50% or greater or asymptomatic with carotid stenosis of at least 70%.
The proposal would require practitioners to "engage in a formal shared decision-making interaction with the beneficiary" that involves use of a "validated decision-making tool." The conversation must include discussion of all treatment options and their risks and benefits and cover information from the clinical guidelines, as well as "incorporate the patient's personal preferences and priorities."
Five large studies since 2009 provide evidence which “suffices to demonstrate that CAS and [carotid endarterectomy] are similarly effective" with respect to the clinical primary endpoints of recent trials in patients with either standard or high surgical risk and who are symptomatic with carotid artery stenosis.
High Volume and High Prices in Hospital Pediatric Services
The Massachusetts Health Policy Commission reports (here) that “Current trends indicate that the largest providers of hospital-based pediatric care in the Commonwealth have the highest inpatient commercial prices, even after adjusting for differences in patient acuity.”
“Since 2013, the HPC has evaluated the potential impacts of provider market changes in the Commonwealth, including clinical affiliations, acquisitions, network affiliations, and expansions and closures of services. Many of these changes have involved pediatric services. . . The potential impacts of most of these changes, considered individually, have been limited. However, they have collectively resulted in, and reflect, substantial changes to the pediatric services landscape, with an increasing share of pediatric services being provided by a few provider organizations. These trends are similar to those occurring nationwide.”
A Research Letter in JAMA Pediatrics (here) attributes the loss of less expensive community hospital pediatric services to consolidation. “Fewer US hospitals are providing inpatient pediatric services over time. Hospital consolidation, as measured by newly reported membership in a health system, was associated with closure of existing inpatient pediatric services within 5 years, potentially exacerbating this trend.”
The Menace of Pickleball
The Hill reports estimates (here) of a $500 million annual bill for injuries to seniors in the rapidly growing pastime. “The ‘can-do’ attitude of today’s seniors can pose greater risk . . . leading to a greater number of orthopedic procedures.”
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Notes to Fred Hyde, MD, JD, MBA, news@dcmedicalnews.org
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