DCMedical News: Monday, December 6, 2021
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY Monday, December 6, 2021
Covid Treatments are Coming
David Leonhardt explains why they are a “big deal,” here, in The New York Times. “A new generation of Covid-19 treatments will soon be available, and they matter more than many people realize. They have the potential to substantially reduce hospitalization and death. And they are likely to be effective against the Omicron variant, many scientists believe, even if Omicron makes the Covid vaccines weaker at preventing infections . . . In the simplest terms, they can help turn Covid into a more ordinary respiratory disease, similar to the common cold or flu, rather than one that’s killing about 1,000 Americans a day and dominating daily life for millions.”
“Two treatments are on the way — one from Pfizer and one from Merck — and they will have both medical and psychological benefits. Not only can they reduce serious Covid illness, but they can also reduce Covid fears and help society move back to normalcy, lessening the pandemic’s huge social and economic side effects.”
Bi-Partisan Plan to Avert Medicare Cuts
CQ (here) reports that a coalition of lobby groups did not secure provisions blocking Medicare cuts in the short-term spending bill passed in both houses of Congress December 2. House Appropriations Chair Rosa DeLauro, D-Conn., said lawmakers are working on bipartisan language the chamber will seek to pass this month. “The wave of cuts is set to take effect in January, largely stemming from previous coding adjustments and a series of concessions Congress granted in light of the pandemic.”
“A wide range of lobbying groups [e.g. here] representing providers, medical device companies and others have fought in recent months to avert the reductions, recruiting a lengthy list of congressional allies that petitioned leaders to address them this year.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
The National Stockpile
A review in The BMJ (here) examines the “national stockpiles” of health supplies of western countries, in the face of and recovering from the demands of the COVID-19 pandemic.
For the U.S.: “The US strategic national stockpile wasn’t short of funding, maintained with an annual budget of $600m. But once stocks were accessed in early 2020, they were found to consist of ‘millions of doses of smallpox vaccine alongside thousands of caches of nerve gas antidote’ to protect against an expected bioterrorist attack, says Andrew Lakoff, professor of sociology at the University of Southern California and author of Unprepared (2017), which explores how the US responds to public health emergencies.”
“The available PPE had been distributed to US states at the time of the 2009 H1N1 epidemic and had never been replenished. A contract to replace thousands of ventilators used at the time of the H1N1 outbreak remained unfulfilled when the company with the contract was taken over. The US was ready, but not for the pandemic . . . The American stockpiles . . . were ‘assembled in preparation for a particular imagined future and well prepared for a range of possible threats—but not covid.” A year and a half after covid-19 first struck, the US Strategic National Stockpile was short ‘by hundreds of millions of surgical masks, gloves, and gowns, with an inventory that’s less than 7% of federal targets,’ Politico reported in June 2021.
HOSPITALS AND OTHER HEALTH CARE FACILITIES
The Price of COVID Pfizer Vaccination: Pick One, $15, or the Other, $381
Hospital Pricing Specialists’ Rick Louie highlights the extreme variation in U.S. hospital pricing, publishing (here) a list of prices for vaccination with the Pfizer vaccine from 5,428 providers, ranging from $381 at Glendale’s (CA) Memorial Hospital and Health Center to $15 at Girard Medical Center (Girard, KS), with 7 of the highest 10 prices charged by California hospitals.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Medicare Annual Enrollment Period (AEP) Ends Tomorrow, December 7
A survey from “HealthInsurance.com” (here) finds that “63% [of Medicare beneficiaries contacted] review their Medicare coverage on an annual basis . . . our survey found that 33% are considering switching from Original Medicare to Medicare Advantage; 33% are considering changing from one Medicare Advantage plan to another; and 20% are considering changing their prescription plan. . . Cost is playing a big role in the decision-making process for many Medicare beneficiaries. Of those on Medicare, 89% think prescription drug prices are too high, 64% are worried about out-of-pocket medical costs, and 39% admit to not filling a prescription because it was too expensive.”
MedPAC to Meet December 9 and 10
The Medicare Payment Advisory Commission will hold meetings this Thursday and Friday, but, despite the virtual platform, the meeting notice (here) announces limited public attendance. Thursday 11:30 a.m. to 1:00 p.m. the group will discuss “Assessing payment adequacy and updating payments: Hospital inpatient and outpatient services; and Mandated report on Bipartisan Budget Act of 2018 changes to the low-volume hospital payment adjustment,” register here. The Thursday afternoon sessions will continue reports on payment adequacy and an update on payments, for physicians and other health professionals (1:45 to 3:15 p.m.); ambulatory surgery centers (3:15 to 4:00 p.m.); outpatient dialysis services (4:00 to 5:00 p.m.); and hospice services (5:00 to 5:45 p.m.), register here.
Friday’s MedPAC sessions (morning, register here; afternoon, register here) will continue the reporting on payment adequacy and update, with skilled nursing facilities (10:00 to 11:00 a.m.); home health services, and a mandated report on Bipartisan Budget Act of 2018 changes to the home health payment system (11:00 a.m. to 12:15 p.m.); inpatient rehabilitation facilities (1:00 to 1:45 p.m.); and long term (acute) care hospitals (1:45 to 2:30 p.m.).
Telehealth Utilization Dramatically Increased in PHE
HHS’ Assistant Secretary for Planning and Evaluation disclosed (report here, news release here) that Medicare visits with providers held via telehealth increased 63 fold from 2019 to 2020 as a result of telehealth regulation changes, and patient caution, during the COVID-19 pandemic’s “public health emergency” (PHE) period. In the PHE, Medicare paid for telehealth visits as if they were in-person visits, as did many commercial health insurers, and overrode limitations on practice across state lines. These new “flexibilities” were accompanied last month with the addition of mental health treatment via telehealth, authorized in the 2020 hospital outpatient rule published in final form in the November 16th Federal Register.
A summary of the outpatient rule developed by the Hospital Financial Management Association (here) of the changes for mental health says “Due to the circumstances of the COVID-19 pandemic, particularly the need to maintain physical distance to avoid exposure to the virus, CMS waived provisions of the hospital conditions of participation and the provider-based rules that permitted hospital staff to provide outpatient hospital services through an interactive telecommunications system for patients located in the home . . . CMS has not required any claims-based modifier identifying specifically when a service is furnished by clinical staff of the hospital to a beneficiary in their home through communications technology. Therefore, CMS is not able to gauge the magnitude of how often mental health services are being provided remotely by hospital staff to patients located in the home [italics added].
“Public comments supported continuing OPPS payment for mental health services furnished to beneficiaries in their homes by clinical staff of the hospital through the use of communication technology as a permanent policy post-PHE.”
READINGS & REFERENCES
Select Coronavirus Public Health Resources and References may be found here.
2021 CQ Congressional Calendar here.
2022 CQ House of Representatives Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
December 7, 8, 9, 10
January 10, 11, 12, 13, 18, 19, 20, 21
February 1, 2, 3, 4, 7, 8, 9, 28
Notes to Fred Hyde, MD, JD, MBA, news@dcmedicalnews.org