DCMedical News: Thursday, March 31, 2022
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY Thursday, March 31, 2022
COVID.gov
The "test to treat" website opened (here), promising a "One-Stop Shop Website for Vaccines, Tests, Treatments, Masks, and the Latest COVID-19 Information," with a "New Test-to-Treat Locator Tool to Help People Access the Over 2,000 Locations that Offer COVID-19 Tests and Antiviral Pills at One Convenient Location."
Said the White House, "The Administration has worked over the past 14 months to set up over 90,000 vaccination sites, make more than 400 million high-quality masks available for free, send free tests to peoples’ homes, and stand up new test-to-treat sites where people can get tested and receive life-saving antivirals all in one place. Now, with a click of a button, people will be able to find where to access all of these tools, as well as receive the latest CDC data on the level of COVID-19 in their community."
Meanwhile, the Administration continued to implore Congress to provide new COVID funding, here.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Too Many Places to Die, and Not Enough Deaths
A much-anticipated State audit of hospices in California found that "A rapid boom in the number of hospices and other factors strongly point to a large-scale organized effort to defraud federal end-of-life care programs in Los Angeles County, putting vulnerable dying patients at risk of harm . . . auditors blamed lax oversight for the problems, noting that the California Department of Public Health became aware of possible fraud by some for-profit hospices seeking licenses yet still approved them."
Audit here, "fact sheet" on the audit here, Los Angeles Times coverage of the audit here, Times original investigation report here.
"The audit found a sharp increase in the number of hospices in L.A. County since 2010 without a proportional need for end-of-life care. Hospice patients received services for long periods of time and were often still alive when they were discharged — both telltale signs of potential fraud."
"Auditors also found excessive geographic clustering of hospices, including a single building in Van Nuys that had more than 150 licensed hospice and home health agencies— a number that exceeds the physical capacity of the structure."
HOSPITALS AND OTHER HEALTH CARE FACILITIES
The Green O.R.
A report (here) in JAMA Surgery highlights the importance of the operating room on the environment. "Health care alone accounts for nearly 10% of this [national] energy expenditure. Within hospitals, operating rooms (ORs) produce a disproportionate amount of greenhouse gases and disposable waste and consume an inordinate amount of energy. Recent studies attribute more than 30% of hospital medical waste to ORs and estimate their energy intensity, defined by amount of energy used per occupied space, to be 3 to 6 times that of a hospital in its entirety."
The report examines what might be done with energy consumption, anesthetic gas, and waste management.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
153 Million People Covered by Government Health Insurance Programs
An update on Medicare and Medicaid enrollment (here) finds that "As of December 2021, 64.2M people are enrolled in Medicare. This is an increase of over 87K since the last report. 36.2M are enrolled in Original Medicare. 28.0M are enrolled in Medicare Advantage or other health plans . . . 49.1M are enrolled in Medicare Part D. This includes enrollment in stand-alone prescription drug plans as well as Medicare Advantage plans that offer prescription drug coverage . . . Over 11.8 million individuals are dually eligible for Medicare and Medicaid, and are counted in the enrollment figures for both programs."
"As of November, 2021, 85,809,179 of people are enrolled in Medicaid and CHIP. This is an increase of 980,636 since the last report. 78,910,300 are enrolled in Medicaid. 6,898,879 are enrolled in CHIP."
The "marketplace" subsidized plans of the Patient Protection and Affordable Care Act have 14.5 million enrolled. More detail on all coverages here.
Pathways to Universal Coverage
Beyond the 153 million, the House Committee on Oversight and Reform held hearings Tuesday on "Examining Pathways to Universal Coverage." The Commonwealth Fund's Sara Collins testified (here) on the "Status of U.S. Health Insurance Coverage and Policy Levers to Expand Coverage and Lower Consumer Costs," with 17 charts (here).
DRUGS & DEVICES
National Academy Tackles the Medical Supply Chain
An editorial in JAMA Health Forum (here) introduces a new report of the National Academies of Science, Engineering and Medicine (NASEM) (here) on the medical supply chain, entitled "Building Resilience into the Nation's Medical Product Supply Chains." "The NASEM report is the product of a year-long study by an ad hoc committee established as a measure that Congress included as part of the 2020 Coronavirus Aid, Relief, and Economic Security (CARES) Act. The committee was charged with examining the causes of shortages of medical supplies and proposing ways to enhance resilience during public health emergencies and other disruptive circumstances."
The report notes that "There are reasons why supply chains have become increasingly globalized, including achieving lower prices, higher quality, and a wider variety of choices." The report says "Onshoring could increase costs and reduce affordability of medical products . . . US companies that stepped up to produce N95 masks early in the COVID-19 pandemic struggled to survive financially after health systems resumed purchasing from non-US suppliers to reduce costs when access to those suppliers improved."
"The [NASEM study] committee urged the US Food and Drug Administration (FDA) to make information about sourcing, quality, volume, and capacity publicly available for all medical products approved or cleared for sale in the US. This would require drug manufacturers and device makers to publicly disclose their manufacturing locations and other data and manufacturers of the active ingredients in drugs to disclose the sources of raw materials."
Disclosure In This Study Shows U.S. Generic Drugs Heavily Dependent on Indian Components
Bloomberg Health & Law reports (here) that U.S. Pharmacopeia (USP) "a 200-year-old nonprofit, little known outside the drug industry, took it upon itself to meticulously map the supply chain of medications Americans take. It was an ambitious undertaking that not even the Food and Drug Administration had tried before . . . Active ingredient production, the USP found, is far more concentrated in India than was previously understood given the FDA’s limited data, which had made China look like a more dominant player in the pharmaceutical supply chain than it really is."
Two conclusions: "Of the 100 drugs Americans use most, 83 have no production source in the U.S. for their active ingredients," and "About 75% of 52 drugs used to treat Covid . . . including analgesics as well as pulmonary and cardiology drugs, don’t have a U.S. source for active ingredients."
READING & REFERENCES
Select Coronavirus Public Health Resources and References may be found here.
2022 CQ Congressional Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
April 1, 4, 5, 6, 7, 26, 27, 28, 29
May 10, 11, 12, 13, 16, 17, 18, 19
June 7, 8, 9, 10, 13, 14, 15, 16, 21, 22, 23, 24
Notes to Fred Hyde, MD, JD, MBA, news@dcmedicalnews.org