Docs to See Medicare Pay Cut Nearly 3% Next Year

Axios / By Maya Goldman
 
It's official: Doctors face another year of pay cuts from Medicare in 2025 under a rule finalized by the Biden administration on Friday, unless Congress steps in again to avert the decrease. 

• Medicare administrators also said payments for hospital outpatient services will increase slightly next year.

 
The big picture: Physicians will see a 2.9% decrease in their average Medicare payment rates next year, tracking with what the administration first proposed in July.

• Medicare law prevents the program from making annual inflation adjustments to doctor payments like it does for hospitals, nursing homes and other health providers.
• Meanwhile, physician operating costs will increase an estimated 3.5% in 2025, the rule said. 

 
State of play: Lawmakers last week released a bill that would avert the cut and give doctors a partial inflationary boost of 1.8%. 

• Congress will likely pass legislation in a post-election session with a temporary "doc fix" to keep at least some portion of the cuts from taking effect, Axios Victoria Knight reported first on Pro.

 
What they're saying: "For physician practices operating on small margins already, this means it is harder to acquire new equipment, harder to retain staff, harder to take on new Medicare patients, and harder to keep the doors open, particularly in rural and underserved areas," American Medical Association president Bruce Scott said in a statement. 
 
Zoom out: Hospital outpatient departments will see a 2.9% increase in Medicare reimbursement next year, amounting to an extra $2.2 billion for the industry, regulators also announced.

• Home health providers' Medicare payment will increase by 0.5% ($85 million) compared with this year. 
• Home health lobbyists said the final policy makes it difficult for agencies to keep up with rising costs, and urged Congress to fix their Medicare payment system as well. 

 
Additionally, the Biden administration finalized new maternal health safety standards for hospitals that offer obstetrical services, though the requirement will be phased in over a longer period of time than originally proposed. 

• The American Hospital Association said it appreciated the extended implementation timeline but believes the maternal health policy is still too punitive.

HCBS Waiting Lists Remain ‘An Incomplete Picture Of Need’

Home Health Care News / By Joyce Famakinwa
 
The number of states with waiting lists for people in need of home- and community-based services (HCBS) hasn’t seen much variation between 2016 and 2024, according to a new data analysis from the KFF.
In fact, there have been about 700,000 people on waiting lists, or interest lists, in most years since 2016. 
 
Total enrollment in waiting lists went up by 2.6% between 2023 and 2024. Currently, there are more than 710,000 people on waiting lists. 
 
When looking at individual states, 14 saw a decrease in the number of people on waiting lists, and 19 saw an increase.
 
KFF’s analysis noted that some of these changes can be explained by some states not screening for Medicaid eligibility before putting people on these lists. 
 
“Changes in this policy may result in changes in waiting list volumes,” KFF wrote. “For example, between 2018 and 2020, the total number of people on waiting lists decreased by 155,000 or 19%. However, nearly half of that change came from Ohio’s implementation of a waiting list assessment of waiver eligibility, which reduced the size of the state’s waiting list by nearly 70,000 people.”
 
Since 2016, more than half of people on waiting lists were based in states that don’t screen for eligibility. 
 
“One reason waiting lists provide an incomplete picture of need is that not all people on waiting lists will be eligible for services,” KFF wrote. “Interviews about HCBS waiting lists found that when waiver services are provided on a first-come, first-served basis, people enrolled in waiting lists are in anticipation of future need.” 
 
KFF’s analysis also offered insight into the people on these waiting lists. 
 
People living with intellectual or developmental disabilities made up 89% of waiting lists in states that didn’t screen for eligibility, and 49% in states that don’t screen prior to putting someone on the list.
 
Additionally, seniors and adults with physical disabilities made up 24% of waiting lists. 
In terms of average wait time, people on the wait lists typically accessed services after about 40 months. This is a decrease from 45 months in 2021, but an increase from 36 months in 2023.
 
As federal funding for HCBS from the American Rescue Plan Act (ARPA) begins to dry up, it might become more challenging to address waiting lists, according to KFF…

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The Flu Vaccine Might be Less Effective this Year

Medscape / By Ralph Ellis

The CDC says the influenza vaccine being used this flu season might be less effective than the one used last flu season, based on reports of how well the vaccine is working in five South American countries.

The seasonal flu vaccine cut the risk of hospitalization for high-risk groups by 35% in Argentina, Brazil, Chile, Paraguay, and Uruguay, the CDC said. Last flu season, the vaccine had a 51.9% effectiveness in those countries.

Vaccine effectiveness "might be similar in the Northern Hemisphere" if similar flu viruses circulate, according to the federal health agency.

How well the vaccine works in South America, where the flu season runs from April to September, provides an idea of how well the vaccine will work in North America, where the flu season usually runs from October to April.

During the past flu season in North America, the CDC estimated the vaccines were 41%-44% effective in preventing flu-related hospitalization in adults and 52%-61% effective for children.

This year's flu vaccines for the United States, all trivalent (protecting against three viruses), will target the three strains expected to circulate — H1N1, H3N2, and influenza B (Victoria). Health officials say that everyone 6 months and older should get a flu vaccination.

An estimated 75 million people in the US got the flu between October 2023 and April 2024, according to the CDC, resulting in 900,000 hospitalizations and between 17,000 and 100,000 deaths.

The data about the South American nations came from a research network coordinated by the Pan American Health Organization.

SOURCES:

CDC: "Interim Effectiveness Estimates of 2024 Southern Hemisphere Influenza Vaccines in Preventing Influenza-Associated Hospitalization — REVELAC-i Network, Five South American Countries, March-July 2024."

CDC: "Interim Estimates of 2023-24 Seasonal Influenza Vaccine Effectiveness — United States."

Severe Acute Respiratory Infections Network (SARInet) plus: "Acerca de SARInet plus."

Silent Epidemic: Loneliness a Serious Threat to Both Brain and Body

Medscape / By Sue Hughes  

In a world that is more connected than ever, a silent epidemic is taking its toll. Overall, 1 in 3 US adults report chronic loneliness — a condition so detrimental that it rivals smoking and obesity with respect to its negative effect on health and well-being. From anxiety and depression to life-threatening conditions like cardiovascular disease, stroke, and Alzheimer’s and Parkinson’s diseases, loneliness is more than an emotion — it’s a serious threat to both the brain and body.

In 2023, a US Surgeon General advisory raised the alarm about the national problem of loneliness and isolation, describing it as an epidemic.

“Given the significant health consequences of loneliness and isolation, we must prioritize building social connection in the same way we have prioritized other critical public health issues such as tobacco, obesity, and substance use disorders. Together, we can build a country that’s healthier, more resilient, less lonely, and more connected,” the report concluded.

But how, exactly, does chronic loneliness affect the physiology and function of the brain? What does the latest research reveal about the link between loneliness and neurologic and psychiatric illness, and what can clinicians do to address the issue?

Medscape Medical News spoke to multiple experts in the field to explore these issues.

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A Major Risk Factor

Anna Finley, PhD, assistant professor of psychology at North Dakota State University, Fargo, North Dakota, explained that loneliness and social isolation are different entities. Social isolation is an objective measure of the number of people someone interacts with on a regular basis, whereas loneliness is a subjective feeling that occurs when close connections are lacking.

“These two things are not actually as related as you think they would be. People can feel lonely in a crowd or feel well connected with only a few friendships. It’s more about the quality of the connection and the quality of your perception of it. So someone could be in some very supportive relationships but still feel that there’s something missing,” she told Medscape Medical News.

So what do we know about how loneliness affects health? Evidence supporting the hypothesis that loneliness is an emerging risk factor for many diseases is steadily building.

Recently, the American Heart Association published a statement summarizing the evidence for a direct association between social isolation and loneliness and coronary heart disease and stroke mortality…

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