DCMedical News: Tuesday, March 8, 2022
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY Tuesday, March 8, 2022
Congress, the Omnibus FY 2022 Budget, and Stopgap Funding Which Expires Friday
CQ reports that "Top appropriations and congressional leaders are aiming to wrap up omnibus negotiations within 24 hours so they can file the massive spending package in the House on Tuesday, vote on it in that chamber Wednesday and get it through the Senate before Friday at midnight when stopgap funding expires."
InsideHealthPolicy reports there are "big asks" by health interests for programs to be included in the budget package, but no answers. "As lawmakers work to pull together an omnibus spending bill before government funding runs out Friday night, health care lobbyists are beginning to view the prospects as increasingly slim that major Medicare riders will be attached, with the White House now seeking the addition of Ukraine funding and $22.5 billion in new COVID-19 relief."
"Health care stakeholders have spent weeks pressing lawmakers to further delay the return of Medicare sequestration, to avert pay cuts for therapy assistants and those tied to Medicare clinical labor policies, and to extend Medicare telehealth flexibility beyond the pandemic . . . It is also viewed as a stretch that Congress will give the White House the full $22.5 billion it wants for new COVID-19 relief now that funding for Ukraine is also part of the mix. As a result, the portion of the COVID-19 relief to help cover testing and treatment costs for the uninsured is also viewed by some as on shaky ground."
Six Million (Probably More) Dead From COVID-19
"The number of known Covid-19 deaths around the world surpassed six million, according to data from the Center for Systems Science and Engineering at Johns Hopkins University," reported in The New York Times (here). “Six million is really unfathomable,” said Beth Blauer, the data leader for the Coronavirus Resource Center at Johns Hopkins. “These are real lives.”
"Public health experts agree that six million is a vast undercount and that the true devastation will never be precisely known . . . Surges are still intensifying in Hong Kong, South Korea and New Zealand, but new death counts are dropping in many places as Omicron recedes. The world is averaging more than 7,000 new confirmed deaths a day, down from almost 11,000 a day in early February and the known pandemic peak of more than 14,000 a day in January 2021."
"The United States, with ample vaccine supply, has suffered the highest known total — more than 950,000 deaths — and failed to inoculate as much of its population as other wealthy nations . . . an average of about 1,500 Americans are still dying each day, around a year after vaccines became readily available."
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Most Cancer Centers Ignore One or More Screening Guidelines for Prostate Cancer
A research letter in JAMA Internal Medicine (here) examined prostate cancer screening recommendations of US cancer centers, to determine whether their practices differ from national clinical practice guidelines. The guidelines are those jointly developed by the U.S. Preventive Services Task Force, the American Cancer Society and the American Urological Association. NCI-designated cancer centers performed worse than non-designated centers.
The guidelines "Recommend that men at average risk engage in shared decision-making with their physicians regarding the decision to start prostate cancer screening with prostate-specific antigen (PSA) testing at age 50 or 55 years, and most recommend discontinuing screening at age 70 years or in men with fewer than 10 years of life expectancy. These recommendations reflect evidence that PSA screening has both benefits and harms. Screening may reduce the incidence of metastatic disease, and possibly prostate cancer–specific mortality, but there is no clear evidence that screening decreases all-cause mortality. Potential harms include false-positive results, psychological effects, biopsy complications, and treatment sequelae for over diagnosed or indolent tumors."
"Contrary to national guidelines, 156 centers (26%) recommended that all men universally initiate screening . . . Of the centers providing recommendations, 476 (78%) did not specify an upper age limit at which to stop screening. The NCI-designated centers were less likely than non–NCI-designated centers to recommend shared decision-making and more likely to recommend universal screening without discussion . . . Potential harms of screening were acknowledged by 229 centers (38%), of which 116 (19%) detailed specific risks."
The End of Non-Compete Agreements? DoJ Weighs In
The Justice Department has opened the door to criminally prosecute companies that have noncompete agreements it deems too restrictive and in violation of antitrust laws, says JDSupra (here).
Anesthesiologists sued Pickert Medical Group, alleging the organization's noncompete provisions violated Nevada state law, which limits noncompete covenants. The anesthesiologists were prohibited from serving facilities within 25 miles of facilities at which the anesthesiologists had previously worked.
The Justice Department argued the noncompete could be seen as an attempt by Pickert to restrict any competitors within the areas covered by the noncompete agreements, constituting "horizontal restraint between competitors." Comment authors in JDSupra from Hogan Lovells wrote that "DOJ’s position opens the door to the possibility of criminal prosecution for employee non-compete agreements. Such a development would signal a significant shift in the enforcement of antitrust violations in labor markets, an area that DOJ has indicated is a top agency priority."
"DOJ has in recent years expanded its scrutiny of agreements that restrict the solicitation, wages, or movement of employees. This expansion has included an increase in criminal investigations and prosecutions of no-poach agreements, wage-fixing, and other “naked conspiracies in labor markets” that DOJ argues should be treated as per se violations of the antitrust laws. Federal courts in Texas and Colorado have recently lent support to this argument by holding that wage-fixing and no-poach agreements are among the types of agreements that are per se unlawful and can be prosecuted criminally."
Who Tests and Who Treats in Test-to-Treat?
The American Medical Association ("doctors should do this") and the American Pharmacists Association ("more pharmacies should be involved") both have expressed opposition to the administration's "test to treat" program as proposed (here). "The American Pharmacists Association said the program should be expanded to include more pharmacies . . . the group also said it will continue to work with the federal government to eliminate barriers that prevent pharmacists from prescribing antivirals or receiving appropriate reimbursement . . . The American Medical Association . . . said the current plan is 'extremely risky' as pharmacy-based clinics usually treat simple illnesses."
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Rural Hospitals in Peril
"Over 500 rural hospitals – more than one-fourth of the rural hospitals in the country – are at immediate risk of closure because of continuing financial losses and lack of financial reserves to sustain operations." So reports the Center for Healthcare Quality and Payment Reform, here. Another group of more than 300 hospitals are at risk in the future, on grounds that their reserves are low and/or their functioning depends on subsidies from local taxes, state subsidies or other non-operating sources.
"In total, nearly 900 rural hospitals – over 40% of all rural hospitals in the country – are either at immediate risk or high risk of closure. More than 20% of rural hospitals are at risk of closing in almost every state in the country, and in 15 states, the majority of the rural hospitals are at risk of closing. Millions of people who live in the areas served by the at-risk hospitals could be directly affected if the hospitals were to close." A complete (89 page) list of the imperiled hospitals is here.
READING & REFERENCES
Select Coronavirus Public Health Resources and References may be found here.
2022 CQ Congressional Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
March 9, 10, 15, 16, 17, 18, 28, 29, 30, 31
April 1, 4, 5, 6, 7, 26, 27, 28, 29
May 10, 11, 12, 13, 16, 17, 18, 19
Notes to Fred Hyde, MD, JD, MBA, news@dcmedicalnews.org