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HEALTH CARE NEWS

US Congress extends CHIP, funds opioid crisis response following temporary shutdown

Publish date: February 9, 2018

By 

Gregory Twachtman 

Oncology Practice

 

 

 

 

 

 

 

 

 

Congress, despite a second shutdown in less than a month, was able to pass a number of financial extenders to fund key health care programs.

The bipartisan spending bill (H.R. 1892), passed in the early morning hours on Feb. 9 by a 71-28 vote in the Senate (16 Republicans and 12 Democrats voted against it, and Sen. John McCain [R-Ariz.] was not present) and a 240-186 vote in the House (67 Republicans and 119 Democrats voted against and 5 representatives did not vote). President Trump signed the bill later that morning.

 

The spending bill and continuing resolution to fund the government through March 23 includes $6 billion to fund treatment for opioid addiction and other mental health issues, $2 billion in additional funding for the National Institutes of Health, and 4 additional years of funding for the Children’s Health Insurance Program. The additional CHIP funding extends the program for a total of 10 years.

The funding bill also made a technical correction to the Merit-based Incentive Payment System (MIPS) track of the Medicare Quality Payment Program. It removes Part B drug reimbursement from the MIPS payment adjustment, so any positive or negative change to physician payments based on the MIPS score will only be applied to physician fee schedule payments.

The bill also repeals the Independent Payment Advisory Board, a panel created by the Affordable Care Act that would have the power to slash Medicare spending under certain budget circumstances. That board was never convened.

The funding legislation also accelerates closure of the Medicare Part D “donut hole,” the coverage gap in which beneficiaries must pay 100% of medication costs prior to entering catastrophic coverage.

Just over $7 billion was provided for community health centers and Medicare’s therapy caps were repealed.

While the funding bill was written in the Senate with bipartisan input and received bipartisan support, Sen. Rand Paul (R-Ky.) held up votes over objections to the more than $1 trillion it will add to the nation’s debt, as well as for the fact that there was no opportunity to introduce and vote on amendments, leading to an hours-long government shutdown.

There also were concerns about two issues that could have derailed the vote in the House. Democrats wanted to add language to address immigrants brought to this nation illegally as children, while some Republicans did not want to increase the federal debt. However, there were enough votes to pass the funding legislation.

gtwachtman@frontlinemedcom.com

Study Suggests Older Surgeons Produce Lower Mortality Rates in Emergency Procedures

Drotumdi O

image.jpg
  • UCLA RESEARCH ALERT

  • Credit: Araceli Alarcon/U.S. Air Force

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CITATIONS

The BMJ

CHANNELS

All Journal News, Healthcare, Surgery, Women's Health, Local - California, Local - LA Metro

KEYWORDS

 

FINDINGS

Researchers from UCLA and several other institutions found surgeries performed by older surgeons — age 50 and up — have lower patient mortality rates than those performed by younger surgeons, and that patient mortality rates do not differ significantly based on whether the surgeon is male or female.

Broken down by age group and adjusting for various patient characteristics, mortality rates were 6.6 percent for surgeons aged 40 and younger, 6.5 percent for those 40 to 49 years old, 6.4 percent for surgeons aged 50 to 59 years, and 6.3 percent for surgeons age 60 and older.

The study also showed that when comparing men and women surgeons across those four age groups, female surgeons in their 50s had the lowest patient mortality rate.

BACKGROUND

There has been limited research about how a surgeon’s age, gender and other characteristics are correlated with patient outcomes. The researchers set out to understand whether surgeons’ skills improve with experience, and whether a loss of dexterity or less familiarity with new technologies contributed to poorer surgical outcomes for older doctors. There also has been concern that tighter restrictions on training hours during the residencies of younger surgeons might negatively affect their skills later on.

METHOD

The researchers examined the medical records of 892,187 Medicare patients aged 65 to 99 who had one of 20 common types of emergency surgery between 2011 and 2014. The records incorporated procedures performed by 45,826 surgeons. The study focused on surgeries for which patients are less likely to select their surgeons, and surgeons are less likely to select their patients.  

Among the potential limitations to the study are that the findings may not be applicable to long-term mortality and complication rates, and that the analysis was limited to Medicare patients and may not apply to non-Medicare patients, physicians in other specialties and outpatient care.

IMPACT

The findings suggest a need for more oversight and supervision of surgeons in their early post-residency careers, although the researchers write that further research is warranted.

AUTHORS

The study’s lead author is Dr. Yusuke Tsugawa of UCLA, and the senior author is Dr. Ashish Jha of Harvard T.H. Chan School of Public Health, Brigham and Women’s Hospital and the VA Healthcare System Boston. Other authors are Dr. Anupam Jena of Harvard Medical School, Massachusetts General Hospital and the National Bureau of Economic Research; E. John Orav and Dr. Thomas Tsai of Brigham and Women’s Hospital and Harvard Medical School; and Dr. Daniel Blumenthal and Dr. Winta Mehtsun of Massachusetts General Hospital and Harvard Medical School.

JOURNAL

The study is published in the British Medical Journal.