IPPS
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The FY 2024 (October 1 ff.) Inpatient Prospective Payment System proposed rule for acute and long-term acute care hospitals has been published in the Federal Register (here, 652 pages), HFMA analysis (here, 198 pages), with key quality reporting items found on these pages of the proposed rule in the FR: Hospital Readmissions Reduction Program (HRRP) pp. 27024; Hospital Value-Based Purchasing (VBP) Program pp. 27024 – 27051; Hospital-Acquired Condition (HAC) Reduction Program pp. 27051 – 27055; Hospital IQR Program pp. 27078 – 27117; PPS-Exempt Cancer Hospital Quality Reporting (PCHQR) Program pp. 27117 – 27138; and Promoting Interoperability Program pp. 27155 – 27173.
Comment on the rule—affecting nearly every aspect of hospital operations—is due June 9, instructions for submitting comments on the first page of the proposed rule. Additional analysis in next week’s DCMN editions. The final rule is expected to be published August 1.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
“Corporate” Practice of Medicine
A research letter in JAMA Internal Medicine (here) chronicles the 724 oncology clinics acquired by private equity companies in the U.S. “We located 715 of 724 (99%) PE-affiliated clinics. The PE-backed transactions spanned 45 states, with many in Florida (19%) and California (16%). The PE-affiliated clinics accounted for more than 20% of all oncology clinics in 7 states, including Tennessee (28%), Florida (27%), and Nevada (26%).”
HOSPITALS, NURSING HOMES AND OTHER HEALTH FACILITIES
Site of Service Differential Payment to Hospitals in Congressional Cross Hairs
Axios reports (here) that “Momentum is building in Congress to address the way hospitals charge more for the same services private doctors deliver in their offices—a sign of broader lawmaker frustration with the industry. Lawmakers on the House Energy and Commerce Committee showed bipartisan interest Wednesday in changing Medicare payment policies to pay the same for some services, regardless of where they're delivered. The idea tracks with past recommendations from MedPAC but is staunchly opposed by industry groups like the American Hospital Association, which says the policy change would be economically ruinous.”
“Medicare lets hospital-owned clinics be designated as outpatient departments and net a higher payment for certain services than if they were owned by clinicians or independent. Proponents of ‘site-neutral payments’ say the current practice is driving more hospital acquisitions of doctors' offices, and that changes could save Medicare billions of dollars.”
In fact, it is the higher reimbursement which enables hospitals executives to promise doctors higher salaries, if they sell their practices to the hospital.
CMS Cracks Down, Sort Of, On Hospitals Non-Compliant with Price Transparency Rule
CMS has doubled (from two to four) the number of hospitals fined (Civil Monetary Penalties, CMP) for noncompliance with two-year-old rules on posting prices.
MedCity News reports (here) that “The Centers for Medicare & Medicaid Services appears to be enforcing its price transparency rule more seriously. The agency recently fined two hospitals for alleged violations of the rule.”
“Last week, CMS issued fines to Frisbie Memorial Hospital in Rochester, New Hampshire and Kell West Regional Hospital in Wichita Falls, Texas. The former was fined $102,660, and the latter received a $117,260 fine. These fines are only the third and fourth penalties issued by CMS since its price transparency rule took effect on January 1, 2021. The other two came nearly a year ago, in June 2022 — Northside Hospital in Atlanta was fined $883,180 and Northside Hospital Cherokee in Canton, Georgia was fined $214,320. Both hospitals were issued warnings from the agency in the past — Frisbie in August 2021 and Kell West in July 2022.”
DRUGS & DEVICES
Troyen Brennan Calls for Comprehensive Drug Price Negotiation
Harvard’s Troyen Brennan, MD, JD, MPH, a pioneer in patient safety studies, later CMO at Aetna and CVS, writes (here) in JAMAabout the role of insulin price changes in presaging larger efforts at prescription drug price control. “The crisis in cost of medications has increasingly focused on insulin. The Inflation Reduction Act caps insulin out-of-pocket costs for Medicare recipients at $35 per month. More than 20 states now have similar caps for the cost of insulin in place for state-regulated plans. Meanwhile, in California, the Newsom administration has launched an initiative to begin to manufacture low-cost insulin.”
“Does this public focus on insulin, and the manufacturers’ reaction, suggest a path forward for reduction of costs of other branded medications? Unfortunately, the answer appears to be no.” Brennan discusses market, political and regulatory forces behind the insulin price reductions, and concludes that it is not a model, that only more comprehensive regulation will suffice, and, in fact, that such regulation is the norm in other countries.
“Political pressure on insulin pricing might have hastened these steps by Lilly and other manufacturers, but they likely would have occurred anyway because of the market dynamics and regulatory changes . . . Spot legislative efforts, such as the change in the Medicaid rebate rules, will also help make affordable a limited number of products.”
“But the point is that although pressure on individual classes of medications may bring palpable relief for some patients, if we are going to comprehensively address the high cost of drugs, comprehensive price negotiation is the only option. Government price setting dominates in other areas of health care, including for hospitals and physicians. Moreover, such negotiation is the rule in every other developed country, no matter whether the ruling party is liberal or conservative. The activism around insulin is laudable but does not represent an encompassing solution to the high costs of medications. That can only come with broader government price negotiation.”
Dose-Response: Higher Manufacturer Payments to Physicians Correlated with Higher Incidence of Useless Knee Injections
A research letter in JAMA Internal Medicine (here) examined this issue: “Pharmaceutical industry marketing payments have been associated with greater brand-name drug use, but whether payments are associated with procedural use remains unclear. Intra-articular hyaluronic acid is approved for treatment of knee osteoarthritis, although metaanalyses have found a lack of benefit . . . Thus, we examined the association between industry payments to physicians and administration of hyaluronic acid to Medicare beneficiaries.”
The study found that “Across all specialties and procedural volume levels, there was a dose-response association of payment value received with probability of injection administration and total volume of joint injections.”
“Physician receipt of industry payments was associated with increased likelihood of hyaluronic acid administration and increased volume of injections. These results suggest industry payments are associated with increased use of an invasive, high cost procedure widely considered to have little benefit, which is discouraged by orthopedics and rheumatology guidelines.”
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
May 15, 16, 17, 18
June 6, 7, 8, 11, 12, 13, 14, 20, 21, 22, 23
July 11, 12, 13, 14, 18, 19, 20, 25, 26, 27, 28
Notes to Fred Hyde, MD, JD, MBA, news@dcmedicalnews.org
© 2023 Fred Hyde & Associates, All rights reserved.
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