DCMedical News: Tuesday, September 28, 2021
DCMedical News-DCMN
Washington, D.C.
Tuesday, September 28, 2021
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY
COVID Curves Flatten
The CDC has published (here) an update on COVID-19 data (“Data Tracker Weekly Review”). Among the findings: the seven-day COVID-19 case average fell 15%; the seven-day hospitalization average dropped 14%; 64% of the total U.S. population has received at least one dose of the vaccine, and 55% both doses; the delta variant accounts for more than 98% of all U.S. cases; the seven-day death average rose .7% from the previous week’s average; test volume was down 12%, positivity down 11%.
Life Expectancy Plunges During the Pandemic in the U.S., Not So Much in 28 Other Countries
The Guardian (here) and Kaiser Network News (here) among others report on a study to be published in the International Journal of Epidemiology which found that “The Covid pandemic has caused the biggest decrease in life expectancy in western Europe since the second world war,” and that “the biggest declines in life expectancy were among males in the US, with a decline of 2.2 years relative to 2019 levels, followed by Lithuanian males (1.7 years).”
Pandemic May Promote Greater Public Investment in Health Infrastructure
A report in The Financial Times (here) notes that “Even countries that have had a far greater tradition of private financing of healthcare over the years — such as the US, Ireland, Cyprus and South Africa — are now seeking to increase and improve publicly funded provision.” Fierce Healthcare collects information (here) on the loss of hospital employees objecting to mandatory vaccination: so far, not so many.
DOCTORS, NURSES AND OTHER HEALTH CARE PROFESSIONALS
A Sacred Trust, Revisited
Members of the American Dental Association—who contribute more to political campaigns each year than the political action committee of the AMA—are mobilizing to fight Congressional proposals to provide dental benefits under Medicare. Their campaign, described in The Wall Street Journal (here), may provide “opposition that could prove pivotal as Democrats look to make cuts in their $3.5 trillion domestic policy agenda. Giving dental, vision and hearing benefits to the 60 million older and disabled Americans covered by Medicare will provide needed care to people who otherwise might not afford it, supporters say. The ADA contends that Medicare won’t reimburse enough to cover their costs and is pushing an alternative plan that would limit benefits to the poorest Medicare recipients.” There are five Members of Congress who are dentists and seventeen physicians (list here).
The WSJ notes, “Even without adding dental, vision and hearing, the Medicare program faces insolvency in the coming years,” and, indeed, the August 31 report of Trustees for the Medicare program (here, HFMA analysis of Trustee report here) projects the year of “asset depletion” as 2026, noting that “Current-law projections indicate that Medicare still faces a substantial financial shortfall that will need to be addressed with further legislation. Such legislation should be enacted sooner rather than later to minimize the impact on beneficiaries, providers, and taxpayers.”
HOSPITALS AND OTHER HEALTH CARE FACILITIES
Low Value at the Local Level—In Fact, at Your Health System
A study in JAMA Internal Medicine (here) notes that “Low-value health care remains prevalent in the US despite decades of work to measure and reduce such care. Efforts have been only modestly effective in part because the measurement of low-value care has largely been restricted to the national or regional level, limiting actionability.” Now a Dartmouth and Harvard group has studied 41 examples of low value care at 556 health systems. The health system characteristics associated with higher use of low-value care were those with a “smaller proportion of primary care physicians . . . no major teaching hospital . . . larger proportion of non-White patients . . . headquartered in the South or West . . . and [those] serving areas with more health care spending.”
The authors note, “Health systems could use system-level data on low-value care to develop incentive schemes to reduce unnecessary care, educate their workforce, or link hiring and retention decisions to use of low-value services. Health plans might include specific targets for the reduction of low-value care in contract negotiations or create networks of ‘high-value’ clinicians. System-level reporting may also help to inform patients about specific low-value services and where they may be at greater risk of receiving them. Future measurement might emphasize other important facets of low-value care, such as cost, potential for direct harm, and potential for care cascades. Even with its imperfections, the transparent and actionable measurement of low-value care is a critical step toward improving the quality and affordability of US health care.”
Epic-Sepsis
STAT+ goes further into the story (here) of the failure of Epic systems to diagnose sepsis accurately, noting “real world” information omitted, and other information included but not disclosed to users, in the sepsis algorithms. “The company tested the algorithm on data from three health systems, but left the pivotal work of scrutinizing its impact in live clinical settings to its users, who have no obligation to test the model, register its use, or report findings.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Hospital Use for Stroke and AMI Medicare Patients Declined in Pandemic, Remained Down
A Research Letter in JAMA Cardiology (here) found that “The sharp, absolute decline early in the COVID-19 pandemic was much larger for Medicare beneficiaries than younger, commercially insured adults, as reported elsewhere. This decline was especially large among beneficiaries with multiple chronic conditions, a group at high risk of disability or death after an AMI or stroke. Furthermore, at the end of 2020, hospital use for AMI and stroke among Medicare beneficiaries remained substantially lower than in previous years, despite a recovery in total Medicare spending over the same period.”
DRUGS & DEVICES
Humana Sues Biogen, as Well as Teva and Regeneron, Alleging “Charities” Acted to Market Expensive Drugs
FiercePharma (here) reports that “Humana says Biogen sought to boost sales for multiple sclerosis drugs Tysabri, Avonex and Tecfidera by ‘seeding’ patients with free sample drugs then ‘sweeping’ them onto Medicare and other government insurance programs through its charity giving. To do so, Humana says Biogen illegally paid patients’ copays ‘under the guise of unrestricted charitable giving.’ . . . Because Biogen's multiple sclerosis drugs cost between $50,000 and $80,000 per year, copays can be thousands of dollars per patient, Humana says. Those copays are a ‘tiny fraction of the total cost, meaning drug companies can ‘earn a major return’ from paying those copays.”
CMS Schedule for New Medical Services and New Technologies Medicare Hospital “Add-On” Payments for FY 2023
The complete announcement is here. The deadline for application is October 8. A “Town Hall” Q&A will be held mid-December, for public input.
Additional background: “Sections 1886(d)(5)(K) and (L) of the [Medicare] Act establish a process of identifying and ensuring adequate payment for new medical services and technologies (sometimes collectively referred to in this section as “new technologies”) under the IPPS [Inpatient Prospective Payment System, annual payment rules update] . . . The regulations at 42 CFR 412.87 implement these provisions and § 412.87(b) specifies three criteria for a new medical service or technology to receive the additional payment: (1) the medical service or technology must be new; (2) the medical service or technology must be costly such that the DRG rate otherwise applicable to discharges involving the medical service or technology is determined to be inadequate; and (3) the service or technology must demonstrate a substantial clinical improvement over existing services or technologies.”
Select Coronavirus Public Health Resources and References may be found here.
2021 CQ Congressional Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
September 29, 30
October 1, 19, 20, 21, 22, 25, 26, 27, 28
November 1, 2, 3, 4, 5, 15, 16, 17, 18, 30
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.