Public Health Emergency Ends May 11
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
HHS Secretary has announced (news here, fact sheet here) that the “Public Health Emergency” measures associated with the COVID-19 pandemic will end May 11 (here). “On Feb. 9, the agency's secretary, Xavier Becerra, sent a letter to U.S. governors informing them that effective Feb 11, he is renewing the PHE for 90 days and that it is anticipated to be the last time.”
High stakes and consequences for children and families were highlighted (here) in the Kaiser Family Foundation’s update on Medicaid growth during the pandemic, as well as the Public Health Emergency provisions which deferred periodic re-enrollment and eligibility determinations.
“Adult enrollment in Medicaid/CHIP has increased rapidly during the pandemic, growing by 39.4% from February 2020 through October 2022 enrollment reports. This growth amounts to an additional 13.5 million adults in the 49 states and DC that report adult/child monthly enrollment (Arizona does not report children or adults separately). As mentioned above, five states began newly enrolling expansion adults since January 2020 (Idaho, Missouri, Nebraska, Oklahoma, and Utah), contributing to increased adult enrollment. Child enrollment grew as well, but at a slower pace: 17.6% or 6.2 million enrollees in the same period. Still, every state reporting these data saw an increase in child Medicaid/CHIP enrollment from February 2020.”
Enrollment unwinding reports are discussed here. The AHA’s appeal to the Secretary concerning a gentler “glide path” is here.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Cost of Cancer Surgery Down: More Outpatient, Less Costly Inpatient
Surgical procedures for cancer are growing in number, with a higher percentage of cases done in outpatient areas, but also declining cost for inpatient hospital procedures. These findings (here) come from research published in JAMA Surgery.
“While outpatient surgery expenditures remained relatively stable . . . mean (SD) adjusted episode spending on inpatient surgeries decreased from $31,964 in 2011 to $27,418 in 2019, corresponding to a –2.27 annual percentage change . . . Over this period, the proportion of outpatient operations increased from 30.3% to 46.7%.”
“This cross-sectional study revealed that 30-day episode spending for cancer-directed surgery decreased significantly among Medicare fee-for-service beneficiaries. This overall decrease was largely attributable to lower spending associated with inpatient procedures and a concomitant increase in the proportion of surgeries performed in the less expensive outpatient setting. These results have important implications for policy and clinical practice, particularly because the absolute number of patients with cancer aged 65 years or older is projected to nearly double from 52 million in 2018 to 95 million by 2060.”
“The increasing use of minimally invasive approaches may have catalyzed the shift to outpatient surgery, while broad-based improvements in perioperative care (i.e., care standardization, implementation of enhanced recovery protocols, and multidisciplinary teams) may have led to reductions in surgical morbidity and mortality, contributing to the declines in 30-day episode spending for cancer-directed surgery.”
Surgery More Expensive In “Health Systems”: Study of Surgery Payments to 3,195 Hospitals
A Research Letter in JAMA Network Open (here) found that the cost of surgery in health system member hospitals exceeded the cost of the same surgery in independent hospitals. “For 15 of the 16 procedures, the median negotiated price was significantly higher at facilities within networks compared with independent hospitals. Median price for shoulder arthroscopy was 1.68 times higher at facilities within networks compared with independent hospitals.”
The authors note, “Our economic evaluation of negotiated prices for surgical procedures at facilities participating in hospital networks vs independent hospitals had 2 principal findings. First, surgical procedures at network facilities had higher negotiated prices. Second, we noted wide variability across facilities within and outside hospital networks. Both findings build on prior work that identified commercially negotiated price variation for other health care services and extend these findings further by accounting for hospital network participation for surgical procedures.”
Washington Post Reports on Step Therapy, “Failing First”
The paper notes (here) that “Lawmakers in 36 states have passed laws that attempt to solve the biggest problems with step therapy — offering more clarity on the rules and a process for patients and their doctors to seek exceptions. While the new laws may help some patients, they don’t fully eliminate ‘fail first’ requirements.”
“Proposed federal legislation called the Safe Step Act, which has bipartisan support in the Senate and the House, would go further, creating more transparency about step therapy rules and covering more patients, notably those who have employer-based health insurance plans regulated by the Labor Department, including self-insured employer plans.”
DRUGS & DEVICES
Rebate Rules in the “Inflation Reduction Act” Outlined by CMS
The Centers for Medicare and Medicaid Services is asking for input (here, detail here) on the Medicare Prescription Drug Inflation Rebate Program. CMS described “A new section 1847A(i) to the Social Security Act establishes a requirement for manufacturers to pay Medicare Part B rebates for single source drugs and biological products with prices that increase faster than the rate of inflation for a calendar quarter to the Federal Supplementary Medical Insurance Trust Fund, and provides for lower Part B beneficiary cost sharing on these drugs and biologicals.”
CQ noted, “The Inflation Rebate Program formally began on October 1, 2022. CMS aims to issue the first round of invoices to drug companies that raise prices faster than inflation in 2025. Beginning April 1, people with Medicare and Medicare Advantage may see lower out-of-pocket costs for certain Part B drugs with higher price increases than inflation. The agency will release information to the public about which drug companies raise prices faster than inflation. Part B drugs include single source or biologics, including some biosimilars.”
From the Federal Register notice, “CMS will be releasing additional Inflation Reduction Act-related guidance; all can be viewed on the dedicated Inflation Reduction Act section of the CMS website at https://www.cms.gov/inflationreduction-act-and-medicare/. Comments must be received by March 11, 2023.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
MACPAC to Meet Thursday
The Medicaid and CHIP Payment and Access Commission will meet virtually Thursday (here), to discuss “policy options for countercyclical disproportionate share hospital allotments; pre-release Medicaid services for adults leaving incarceration; an update on unwinding the continuous coverage requirements in Medicaid during the public health emergency . . . study findings from managed care external quality review; and possible comments on a proposed rule on disclosures of nursing facility ownership.”
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
February 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
© 2023 Fred Hyde & Associates, All rights reserved.
Editor: Jane Guillette; Systems and Distribution: Colby Miers, Los Angeles