The International Physician in the U.S. (One in Five), Profiled by the AAMC
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
The Association of American Medical Colleges profiles (here) the story of the international physician, from medical education in his or her native country, to residency in an American hospital, and the prospect of a career in U.S. medicine.
“Consider some statistics: In 2021, approximately 1 in 5 active U.S. physicians were born and attended medical school outside the United States or Canada. Known as non-U.S. international medical graduates (non-U.S. IMGs) to distinguish them from Americans who attend medical school abroad, they totaled more than 203,500 physicians in 2021. Since 2004, their numbers have increased by more than 30%.”
PCI as Safe in Hospitals with No On-Site Surgical Backup as it is in Hospitals with Such Backup
Cardiovascular Business reports that “Percutaneous coronary intervention (PCI) is just as safe to perform at facilities without on-site surgical backup as it is at facilities with on-site surgical backup, according to a new expert consensus statement (here) from the Society for Cardiovascular Angiography and Interventions (SCAI).”
“The SCAI previously evaluated this topic in 2007 and 2014. When the group issued its 2014 statement, it was purposefully conservative with its recommendations due to the relatively limited amount of available data on PCI at facilities with no SOS. This new statement, however, is crystal clear: PCI at facilities with no SOS provided safe procedures and can provide substantial value.”
Since 2014 same-day discharge after elective PCI has increased to 28.6% of all PCIs and 39.7% of radial PCIs in the United States. The chair of the statement’s writing group noted that “There have been operators performing PCI in office-based laboratories (OBLs) and ambulatory surgery centers (ASCs) with positive outcomes. Thanks to improvement in PCI safety and several global studies in recent years, we now know that PCI at ASCs may improve access, patient satisfaction and reduce costs.”
Cardiovascular Business reported that “The document, published in full in the Journal of the Society for Cardiovascular Angiography and Interventions and JACC: Cardiovascular Interventions, has been endorsed by the American College of Cardiology, American Heart Association, British Cardiovascular Intervention Society, Canadian Association of Interventional Cardiologists and Outpatient Endovascular and Interventional Society.”
Cardiology and Private Equity: Growing Together
Roger Strode of the law firm Foley & Lardner writes (here) about cardiology as the “new darling” of private equity.
He notes, “Cardiology practices still drive high margin procedures and are well-suited to leverage revenue generators such as nuclear medicine, ultrasound, and office-based labs (OBLs) and ambulatory surgery centers (ASCs), especially as the Centers for Medicare & Medicaid Services (CMS) releases more procedures that can be performed in an ambulatory setting.”
“Coupled with the above is the fact that there is a looming shortage of cardiologists in the United States. According to Merritt Hawkins, 26.5% of cardiologists are older than 61 years of age, and the number of cardiologists coming out of training does not compare to the number of cardiologists planning to retire in the next five to 10 years . . . and 80% of cardiology groups employ between one and five physicians. . . According to a survey conducted by Merritt Hawkins, cardiovascular surgeons and invasive cardiologists drive, on average, $3.5 to $3.7 million per physician, respectively, in hospital revenues. Moreover, there has been a significant move of cardiology procedures from inpatient to outpatient settings, including office based laboratories and ambulatory surgery centers, which is being further energized by CMS’ addition of cardiac procedures (23 [in] 2019 and 2020) to Medicare’s ASC approved list.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
AHA Urges FTC to Keep Non-Compete Agreements for Physicians and High Paid Executives
The American Hospital Association (here) has urged the Federal Trade Commission to abandon efforts to curb or eliminate non-compete agreements, arguing that rural areas, among others, would be deprived of the fruits of increased competition among physicians and “senior executives.”
Says the AHA, “The proposed rule would profoundly transform the health care labor market – particularly for physicians and senior hospital executives. It would instantly invalidate millions of dollars of existing contracts, while exacerbating problems of health care labor scarcity, especially for medically underserved areas like rural communities.”
In addition, the AHA notes favorably the comments of an economist that “What we find is that in physician groups that use non-compete agreements, doctors are much more likely to make referrals of their patients to other doctors within the same practice, because they don't have to be as concerned about their fellow colleagues getting to know their patients and then opening a business next-door and poaching the patients.” The question of whether non-compete agreements increase consumer cost, however, brought a different conclusion to the AHA, here citing the same economist to the effect that there “is evidence that non-compete clauses increase consumer prices and concentration in the health care sector. Whatever evidence exists, however, should be taken with a grain of salt.”
The Only Medical Specialty Identified by Employer
A study in the Journal of Hospital Medicine (here) chronicles the growth of hospitalists in the U.S. “We saw more than a 50% growth rate of practicing adult hospitalists between 2012 and 2019. In 2019, we identified 44,037 adult hospitalists . . . hospitalists are in the top five largest physician specialties in the United States.” The researchers found a dearth of identifying information for hospitalists and instead used the prevalence of HCPCS billing codes to do so.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
MedPAC to Meet Thursday and Friday
The Congressional chartered advisory group on Medicare, the Medicare Payment and Access Commission, is meeting this Thursday virtually (here), to discuss reforming Medicare's wage index systems; the high prices of drugs covered under Medicare Part B; evaluation of a prototype design for a post-acute care prospective payment system; and, on Friday, to review presentations on “Favorable selection and future directions for Medicare Advantage payment policy” and “Aligning fee-for-service payment rates across ambulatory settings.”
DRUGS & DEVICES
Employer Sponsored Insurance Pays More, Sometimes Much More, for Physician-Administered Drugs
Research (here) in the JAMA Health Forum found that “In this cross-sectional study, we found that ESI [Employer-Sponsored Insurance] plans paid more than Medicare for most top spend and top use physician-administered drugs, including those with biosimilars available. While high-volume drugs had relatively low unit prices, ESI markups over Medicare prices were especially high for these drugs.” Some examples: “The ESI plans paid more than 30 times as much as Medicare per unit of midazolam and more than 20 times as much for ondansetron in 2020. Five other top use drugs had ESI prices more than 200% higher than Medicare prices.”
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
March 1, 7, 8, 9, 22, 23, 24, 27, 28, 29, 30
April 17, 18, 19, 20, 25, 26, 27, 28
May 9, 10, 11, 12, 15, 16, 17, 18
Notes to Fred Hyde, MD, JD, MBA, news@dcmedicalnews.org
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