NEJM Goes All In on AI: Report, Series, New Journal Dedicated to Artificial Intelligence
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
The New England Journal of Medicine is moving quickly in extending its coverage of the impact of artificial intelligence (AI) in medicine, publishing a special report, a review, and announcing the creation of a spin-off journal dedicated to AI. NEJM notes (here) “The uses of artificial intelligence (AI) in medicine have been growing in many areas, including in the analysis of medical images, the detection of drug interactions, the identification of high-risk patients, and the coding of medical notes. Several such uses of AI are the topics of the AI in Medicine review article series that debuts in this issue of the Journal. Here we describe another type of AI, the medical AI chatbot.”
The article, authored by Microsoft researchers, concludes by noting “We speculate that GPT-4 will soon be followed by even more powerful and capable AI systems — a series of increasingly powerful and generally intelligent machines. These machines are tools, and like all tools, they can be used for good but have the potential to cause harm.”
DOCTORS, NURSES, AND OTHER HEALTH PROFESSIONALS
Non-Compete Clauses Under Attack by FTC, Supported by AHA
Kaiser Health News reports in Forbes that “Banning Noncompete Contracts for Medical Staff Riles Hospitals.” In January, the Federal Trade Commission proposed prohibiting noncompete clauses in employment contracts. “The freedom to change jobs is core to economic liberty and to a competitive, thriving economy,” said Lina Khan, the FTC chairperson. “The proposed rule would prohibit employment contract provisions that block employees or contractors from working for a competing employer when they move on, or from starting a competing business. Such contracts typically bar people from working within a certain geographic area for a period after the job ends.”
The report concludes, “It’s about money for them [hospitals], too. They say eliminating non competes would drive up the cost of hospital care because hospitals would have to pay physicians more to keep them.”
Avoiding the Wrong Doctors
A study in the Journal of Empirical Legal Studies (here) finds that “Online ratings have limited utility in helping patients avoid physicians with troubled medical malpractice and disciplinary records, and steering patients away from hospitals at which more physicians have paid medical malpractice claims and disciplinary sanctions. The study was cited in The Wall Street Journal (here) with this example: “An Indiana doctor has top marks on several physician-review sites, with one patient writing that the doctor was the best she had seen in years. The site, however, is missing some key information—including his conviction for insurance fraud, medical-malpractice claims and licensing-board sanction.”
A study in JAMA Health Forum (here) found that the past matters: “In this study of paid medical malpractice claims for all US physicians, a single prior paid claim was associated with substantial, long-lived higher future claim risk, independent of whether a physician was practicing in a high- or low-risk specialty, or whether a state publicly disclosed paid claims.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
The House Subcommittee on Health (of Energy and Commerce) heard from Turquoise Health’s CEO and other witnesses in a hearing Tuesday on transparency and competitiveness in health care. A briefing paper for the hearing (here) notes that “From 2013 to 2018, spending by commercial health insurers grew by an average of 3.2 percent per year, driven primarily by growth in the price paid by commercial health insurers for health care services to hospitals and providers. Such prices rose by an average of 2.7 percent per year, one percentage point higher than the GDP price index growth over the same period. Similarly, Medicare costs per beneficiary are growing faster than the economy and, according to the Medicare Trustees, will continue to grow 1.2 percentage points faster than GDP per capita over the next 25 years.”
The hearing noted that most attention to date has been paid to the hospital price transparency rule, in effect since January 2021, with arguably increasing compliance. “Beginning on January 1, 2023, the Transparency in Coverage rule also required most health insurance plans to provide personalized pricing information for 500 items and services through a consumer tool that can be accessed online, by phone, or in paper form. In 2024, insurance companies will be required to have an internet-based price comparison tool that allows patients to receive an estimate of cost-sharing for a specific item or service from specific provider or providers.”
Both CBO and a peer-reviewed study concluded that price transparency could reduce cost increases by as much as 1% a year. “The analysis found that those with lower incomes had the most significant reduction in relative costs among income cohorts,” and suggested that similar transparency requirements for pharmaceutical manufacturers and PBMs could save more.
The hearing also heard from witnesses on consolidation in health services and price increases due to diminished price competition, in hospitals, physician practices and PBMs. “According to CBO, hospital markets . . . highly or very highly concentrated increased from 63 percent to 70 percent. In physician markets analyzed by CBO, from 2010 to 2016, the average Herfindahl-Hirschman Index (a measure of market concentration) across 370 metropolitan statistical areas (MSAs) rose by nearly 29 percent for primary care physicians and 5 percent for specialists. The share of MSAs considered highly or very highly concentrated nearly doubled, rising from 20 percent in 2010 to 39 percent in 2016. Amongst PBMs, roughly 80 percent of all prescription claims were processed by three companies.” Chair Rep. Cathy Rodgers statement on consolidation is here.
Physician Owned Hospital [POH] Debate Returns
An editorial in The Wall Street Journal reflects resurrection of the debate over whether physicians should be allowed to own hospitals. In February (here) authors of the opinion wrote “A tiny paragraph in the enormous Affordable Care Act prohibits physicians from building or owning hospitals. Any existing physician-owned hospital built before 2010 is prohibited from growing beyond the size it was when the bill passed. This law limits competition, defies common sense and is likely contributing to higher prices for Medicare and reduced access to treatment for millions of Americans.”
Becker’s reports (here) that “Major hospital groups are ramping up resistance to physician-owned hospitals, which were checked by the Affordable Care Act but have recently become subject of renewed attention . . . Enacted in 2010, the law placed a number of restrictions on POHs, including a prohibition on expanding the capacity of existing Medicare-certified POHs unless they meet certain exceptions and a moratorium on the establishment of new Medicare-certified POHs.”
“In December 2022, POHs regained some industry attention when CMS granted a high Medicaid facility expansion request from Edinburg, Texas-based Doctors Hospital at Renaissance to establish a new physician-owned hospital 55 miles away in Brownsville. The Federation of American Hospitals, which represents investor-owned hospitals, heavily criticized the development as unlawful and argued that the 55-mile distance between DHR's main campus and new location makes it "a thinly veiled attempt to set up a new POH in a new service area." “Shortly after that development, in February, more than a dozen Republican lawmakers reintroduced legislation that would repeal the ACA's ban on POHs. The bill, dubbed the Patient Access to Higher Quality Health Care Act, received support from the American Medical Association and Physician-Led Healthcare for America.”
The AHA and the for-profit association FAH issued a report (here) which contends that “Compared to non-POHs, POHs generally treat a population that is younger, less complex or comorbid, and less likely to be dually eligible or non-white, and that POHs have higher margins and lower unreimbursed and uncompensated care costs as a percent of net patient revenue compared to non-POHs.”
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Notes to Fred Hyde, MD, JD, MBA, news@dcmedicalnews.org
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