Good morning,

It is Friday, 20 January 2023 and this is the Friday Pulse Check from FLATLINING.net and Fulcrum Strategies.

Starting today, all of our clients will receive this newsletter, the Friday Pulse Check, a run-down of the week’s healthcare news that may affect you. Additionally, this newsletter sends our podcast to your inbox every Wednesday morning.

At Fulcrum, we continually work to add value to our relationship with our clients. We want them to be informed and benefit from our decades of experience in the business of healthcare.

In the news:

US hits debt ceiling; Treasury sec takes extraordinary measures

As was widely reported this week, the United States hit the debt ceiling set by Congress and pundits and politicians on both sides started pointing fingers at whose fault it is. Regardless, hitting the debt ceiling affects how the government will pay for entitlement programs like Social Security and Medicare as well as military and federal employee salaries. Ron and I plan to talk in more detail about this next week in the FLATLINING Podcast and invite you to subscribe now so you don’t miss an episode. In the meantime, CNBC has a good summary of how different government programs might be affected because of the debt limit. Read more in CNBC.

Republicans avoid Medicare and Social Security when discussing spending cuts

Raising the debt ceiling or cutting the federal deficit requires a deal between Democrats and Republicans. During the midterms, some Democrats warned that Republican control of either house would mean proposed cuts to entitlement programs like Medicare and Social Security since they make up nearly two-thirds of federal expenditures. Republicans in the House, however, have been avoiding that topic and even pushing back on the idea that those are on the table for cuts. Representative Chip Roy (R-TX 21) said “we're not going to touch” Social Security and Medicare. So what might be on the chopping block then? Read more in the Washington Examiner.

Until debt tear us apart printed red brick wall at daytime — Photo by Alice Pasqual on Unsplash

SC hospital denied Medicare reimbursement for all of 1997

A Fourth Circuit Court of Appeals judge ruled in favor of the Department of Health and Human Services (HHS) which denied Medicare reimbursement for the entirety of 1997 to Lancaster Hospital Corporation. HHS said they failed to provide information in a way that could be verified and audited. The judge agreed and said it was the responsibility of the hospital to know and understand the regulations surrounding Medicare reimbursement and that private corporations must “must turn square corners when they deal with the government”, especially when dealing with the government’s money. HHS laws and regulations allow for payment denial for inadequate data. Read more in Bloomberg 🔒 and Becker’s Hospital Review.

Other items of interest:

Plan and timeline released on Medicare drug price negotiations - USA Today
MA ballot initiative to mandate nurse-to-patient ratios - Boston.com
Virginia VA hospital drops name of Confederate surgeon - Richmond Times-Dispatch 🔒
How much does an ambulance cost? - Health Affairs 🔒 and Becker’s Hospital Review
Rep. Brett Guthrie (R-KY 2) introduces bill to end COVID-19 emergency - House.gov

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What Congress did about 2023 Medicare

On the FLATLINING Podcast this week, Ron and I discussed the 2023 Medicare fee schedule. At the very end of the year, Congress adjusted the cut to the fee schedule in the omnibus spending bill. When it was all said and done, the cut looks more like 2.1% (instead of the whopping 8.5% they started with). Additionally, Congress suspended PAYGO for 2023 and 2024.

PAYGO, short for “pay as you go,” is a policy that says you must offset tax cuts by also having spending cuts; it also is true for the reverse: you must offset spending increases by tax increases. PAYGO amounted to a good portion of the Medicare reimbursement cut.

Ron said in the podcast that the PAYGO suspension for 2024 is likely so Congress won’t have to deal with it in an election year; now the House won’t have to answer questions for significant pay cuts for doctors when they’re running for re-election.

As Ron and I also discussed, the ground-hog day-like process of waiting until the last minute to not cut Medicare reimbursement is extremely frustrating. It leaves physicians in a bind because they have to seriously consider taking an 8% pay cut on half of their business (even more if they have current-year Medicare contracts with other payors) until Congress fixes it in the final days of the year.

Ron and I both hope that we’re getting close to a point where physician voters will say to Congress “enough is enough.”

Also in the podcast, UnitedHealth Group's () pharmacy benefits manager (PBM), Optum, earned more profit than their insurance company last year. How is it that PBMs make so much money and what is it that they actually do for healthcare? (Hint: Not a lot.)

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Subscribe to the FLATLINING Podcast on Apple Podcasts, Spotify, the iHeartRadio app, Amazon Music, Google Podcasts, Stitcher, Pandora, TuneIn, and Audible.

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Next week on the FLATLINING Podcast

Ron and I will discuss if and how US hitting the debt ceiling will affect Medicare reimbursement. Treasury Secretary Janet Yellen seems to be prioritizing Social Security and maybe flipping a coin on everything else. If they stop paying Medicare claims, what happens?

Ukraine

Russia is reportedly recruiting doctors and nurses to work in occupied eastern Ukraine. The Russian government is asking health officials from different regions to supply ten doctors and nurses to send to the areas of Ukraine that Russia claimed to have annexed last year. It comes after Russian authorities launched a campaign for “reconstruction” of eastern Ukraine. Read more in the Moscow Times via MSN.

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Final Thought

A new Gallup poll shows that Americans have low opinions on the US healthcare system. Only 48% of respondents rated US healthcare quality as “excellent” or “good,” however 72% said their own experience was “excellent” or “good.” That being said, the age group that uses healthcare the most, fifty-five and up, high much higher opinions of US healthcare compared to lower age groups. These numbers have remained steady over the last several decades. Read more in Gallup.

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Have a good weekend,

Matthew

Clock ticks on US default; what about…