Volume 19
There is so much to cover this week, including: a court case that could set a precedent for banning medications; new mergers and acquisitions; new oversight by Congress about the questions doctors are asked for medical licenses (and about clinician shortages in general); and questions about whether federal policymakers will change the hospital outpatient billing structure.
This week’s newsletter also discusses hospital opposition to a Federal Trade Commission proposal on non-compete clauses, how Medicaid expansion impacts medical debt, how losing Medicaid benefits will erode access to care, and how we cannot rely on patient forms to accurately assess social determinants of health.
#1 Hospital Outpatient Billing May Hit Some Bumps
Federal lawmakers are keeping an eye on the prices hospitals charge for outpatient treatments that can be done in less expensive environments, like a doctor's office. Why? AXIOS notes that if a site-neutral payment structure is put in place, Medicare could save up to $100 billion over the course of a decade and people with private health insurance could see some savings as well. But hospitals are strongly opposed to these changes. That’s because Medicare permits hospital-owned clinics to be classified as an outpatient department, allowing them to receive a higher payment for certain services than if they were owned by private practitioners or separate entities.
So What’s The Big Deal? Analysts say there is not much proof current rules have caused health services to improve. Additionally, as a result of the rule, physician practices were purchased by medical centers and labeled as part of an outpatient facility in order to benefit. Changing the law now, however, may strain the finances of already-struggling hospitals. While the law may make sense, its timing may reap significant consequences and lawmakers are likely aware of that.
#2 Hospital Medical Staff Offices and State Licensing Boards: Take Note
U.S. Senators Ron Wyden, Cory Booker, and Jeff Merkley have asked the Department of Justice to broaden its inquiry into violations of the American Disabilities Act to include state medical license boards. The lawmakers raised worries that the questions asked by these boards during the medical licensing and application process breach the ADA and discourages doctors from getting the mental health care they require. The questions at issue include, “Have you at any time during the last 10 years, been hospitalized or received any other type of institutional care for physical or mental problems?”
So What’s The Big Deal? These questions do create stigma and the perception that if a physician answers one of these questions in the affirmative, it may prevent them from obtaining or keeping a job. And questions like these are especially problematic because clinicians are suffering. Physicians have twice the number of suicides than the general population. These questions also reinforce the myth that physicians are superhuman. Clinicians must be able to have the “normal’ medical or psychiatric problems that other people can have and feel supported to get treatment. Delaying treatments whether medical or psychiatric can have life-altering, disastrous consequences.
So What Do You Do? Hospitals, change your credentialing application questions to:
Do you have any reason to believe that you would pose a risk to the safety or well-being of your patients or clients?
Are you able to perform the essential functions of a practitioner in your area of practice with or without reasonable accommodation?
#3 Hospitals Aren't Happy with the Non-Compete Push
The American Hospital Association has called on the Federal Trade Commission to scrap its broad initiative to outlaw noncompete agreements in labor contracts and to make existing ones unenforceable. The Federal Trade Commission's proposal could significantly alter the current practice of restrictive covenants that have been used by hospitals to hang on to physicians.
So What’s The Big Deal? With hospitals facing serious staffing shortages, it is not surprising that hospitals would disapprove of this rule. The AHA argued, “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.” If the rule is finalized, physicians and other healthcare workers could have greater power in negotiations and mobility.
#4 Medical Debt and a Failure to Expand Medicaid Drives Disparities
According to a recent analysis by The Washington Post, the southern region of the United States has the lowest credit scores in the country. But why? Medical debt. In addition to high medical debt, the South has higher levels of poverty, lowest median income level, and lowest percentage of people who have finished college. These states also bucked Medicaid expansion which would have cut medical debt by almost half in the past 10 years.
So What’s The Big Deal? Healthcare insurance access and, more specifically, Medicaid expansion makes a significant impact on reducing medical debt and improving health outcomes. And when there are high levels of medical debt, other economic pressures follow. Economics, politics, education, housing, and environment are significant drivers of health and health outcomes. Period. Fortunately, some states (like North Carolina) are expanding Medicaid, which is likely to bring a large influx of federal dollars and greater economic prosperity to the state.
#5 States Can Unenroll Medicaid Beneficiaries in April
According to a survey done by the Urban Institute and Robert Wood Johnson Foundation, in December, 60% of those receiving Medicaid benefits were unaware of the possible risk of losing their eligibility due to redeterminations. States can start making those redeterminations on April 1, which could lead to Medicaid enrollees being dis-enrolled.
So What’s The Big Deal? It is estimated that as many as 18 million individuals could be deprived of Medicaid benefits when the period of mandatory enrollment, which was established during the public health crisis, terminates. As previously mentioned, Medicaid is a vital tool for reducing disparities to healthcare access, for improving outcomes, and mitigating medical debt. An increase in the uninsured rate could mean far reaching consequences beyond insurance coverage.
#6 United Healthcare Expands Their Home Health Footprint
The merger of UnitedHealth Group and home health care provider LHC Group has been finalized. The $5.4 billion transaction, which was unveiled in March of 2022, was finalized according to the filing with the Securities and Exchange Commission.
So What’s The Big Deal? As United Healthcare through Optum obtains control of more and more parts of the patient medical care cycle, they have more power to influence the expense of healthcare and their profits. Furthermore, home health has become a major industry as the population ages. At the peak of the coronavirus outbreak, having hospitals at home for acute care was a huge help for health systems who had the capability and the means to use public health emergency exemptions. LHC has their sights set on services for those who have chronic diseases or have been injured.
#7 It's Done. Amazon Completes Purchase of OneMedical
On Wednesday, Amazon finalized its purchase of One Medical, a primary care provider, for an amount of $3.9 billion, signifying a major step forward in terms of its healthcare services with the expansion of physical medical clinics. The Federal Trade Commission let the sale go through without a lawsuit. Nevertheless, antitrust regulators are continuing to look into the merger.
So What’s The Big Deal? As readers know, massive consolidation is occurring in the healthcare sector with large entities attempting to control multiple components of the patient journey. Unlike CVS, Walgreens, and UHC, Amazon utilizes its online platform as the main driver of healthcare delivery, making a play for a technologically savvy demographic. With the purchase of OneMedical, Amazon now has acute and chronic healthcare management options when brick-and-mortar services are needed. This deal will give Amazon:OneMedical customers access to more than 200 offices across the country and Amazon’s current suite of healthcare offerings.
#8 Primary Care Clinics Aren't Accurately Identifying SDOH
A recent study in JAMA brought to light that electronic medical records are not always accurate when it comes to recognizing social determinants of health (SDOH). When looking at screenings for food insecurity, housing instability, and financial hardship in adult primary care, accuracy varied widely. Indeed, while 826 patients' self-reports showed electronic health records were effective in detecting those who were struggling with food insecurity, the reports were less successful in recognizing those with housing or financial problems. Missing these data points means people could benefit most from extra support will go unnoticed.
So What’s The Big Deal? The results of the study do not come as a surprise. Identifying barriers to access or other SDOH disparities requires focused and at times, nuanced questions. A fully automated or self-reporting process will likely miss significant opportunities for improvement. Healthcare companies must resource patient navigators, social workers, and other resources to identify drivers of health.
#9 Is the Senate HELP Committee Coming to the Rescue for the Clinician Workforce?
The Senate HELP Committee initiated a major push to fix a healthcare worker dilemma that has been a problem for a long time. The panel held a hearing in February to explore potential policy solutions such as increasing the Graduate Medical Education program and developing teaching health centers. Committee Chair Bernie Sanders (I-VT) announced an additional 120,000 physicians and 450,000 nurses will be needed within the next decade and two years, respectively. The nurse scarcity has been especially severe, and hospitals have resorted to costly temporary labor to make up for the lack of personnel.
So What’s The Big Deal? Clinician shortages almost 100 million people are living in an area where they cannot get timely medical assistance when necessary. Additionally, nearly 70 million people do not have access to dental care and nearly 158 million Americans, almost half the population, live in an area with inadequate mental health service during a time when mental health problems are a leading concern. The problem is likely to get worse without a comprehensive solution that includes addressing burnout, working conditions, lowering barriers to schooling, and identifying appropriate financial incentives for hospitals and employers.
#10 The FDA Plans to Regulate AI
In September, the Food and Drug Administration declared its aim to manage many AI-backed clinical decision support (CDS) equipment as appliances. CDS programs might present a list of treatments for a certain ailment or even alert doctors if a patient is in peril of suffering a stroke or sepsis. As more of these tools have been incorporated into electronic health records and other automated hospital systems, their utilization has risen exponentially.
So What’s The Big Deal? While stricter examination of AI technology may be needed, it may have a cooling effect on investment in that sector. Clinical decision support software using AI algorithms are meant to assist medical professionals in providing the most effective care for their patients. Investors will need to watch this space closely as regulatory hurdles could provide significant delays to technological implementation.
BONUS: Could States and Courts Determine What Drugs Are Available for Patients?
A federal court judge, appointed by former President Donald Trump and known for a very strict interpretation of the law, is hearing a case concerning the FDA's endorsement of mifepristone - a drug used for a medical abortion. While pro-life groups have argued that the drug should be removed from the market, others are concerned about the “slippery slope” effect. If the judge rules in favor of the pro-life organizations that initiated the lawsuit, it may set a far-reaching legal precedent.
So What’s The Big Deal? Three Things:
A verdict that restricts access to medical abortion, even momentarily, will create disruptions in abortion services all over the country.
Courts and state legislatures are increasingly writing nonsensical, anti-science laws based upon political expediency. Physicians are becoming targets and patients, especially women, are having greater difficulty accessing medical care.
If the plaintiffs win this case, we will see a court official who is not an expert in the field of science or medicine overriding the opinion of a team of specialists regarding the safety and effectiveness of a medication. The implications could be broad with courts deciding to “ban” vaccines and other life saving medications.
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