DCMedical News: Thursday, February 13, 2020
DCMedical News-DCMN
Washington, D.C.
Thursday, February 13, 2020
DCMedical News is published every day both the House and the Senate are in session. Only the Senate is in session the 14th and the 24th. Both Houses are adjourned next week. DCMN will return (both Houses in session) February 25.
THE BIG STORY IN HEALTH CARE
Novel Coronavirus, Now COVID-19
Tracking at https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6 by Johns Hopkins. At 8:00. p.m. EST Wednesday night 60,286 confirmed cases, 5,967 recovered, 1,367 deaths.
Cautionary notes come from the Wall Street Journal (here) which reports “Beware of Wall Street’s Armchair Epidemiologists. Virus experts are far less confident about our ability to control the spread of coronavirus.” Also, a Senate panel was told by former CDC and FDA officials (at https://www.hsgac.senate.gov/are-we-prepared-protecting-the-us-from-global-pandemics) that “The U.S. health-care system lacks the capacity to handle the latest coronavirus if the rapidly spreading outbreak can’t be contained.” The panelists echoed the thrust of last year’s CSIS Commission on Strengthening America’s Health Security (final report here) which found “The United States remains woefully ill-prepared to respond to global health security threats.”
More resources: the New England Journal of Medicine (NEJM) writes that “Our summaries are being posted on the NEJM Journal Watch website (https://www.jwatch.org) and also appear on the New England Journal of Medicine coronavirus site (https://www.nejm.org/coronavirus).” Two dozen new references here: https://www.jwatch.org/na50868/2020/02/12/update-covid-19?query=etoc_jwid&jwd=000020137291&jspc=US
Surprising Consensus on Surprise Medical Bills
Doctor groups (and their private equity backers) and hospitals may be compelled to temper surprise medical bills, if the movement in Congress to compromise on one bill continues. Bloomberg reports that “The relative similarity among proposals being consider in two House committees this week signals that lawmakers are serious about attempting to hammer out a deal this year.” The Ways and Means Committee approved HR 5826 (here), which would not set a benchmark payment rate that insurance plans would pay providers for out-of-network medical services, but would establish a 30-day negotiation period between providers and insurance plans, and allow arbitration if disputes remain.
The Congressional Budget Office has summarized and scored the bill (here). They write, “H.R. 5826 would establish patient protections from surprise medical billing and establish a process to resolve disputes between health care providers and insurers that are unable to reach agreement on payments for out-of-network health care. In determining the most reasonable rates, dispute resolution entities would be instructed to look to the health plan’s median payment rate for in-network rate care. CBO and JCT expect that . . . average payment rates for both in- and out-of-network care would move toward the median in-network rate, which tends to be lower than average rates.”
The rival bill in the House, from the Education and Labor and Energy and Commerce Committee (HR 58000, here), is seen as setting payment limits. Kaiser Health News reports (here) on your doctor, the lobbyist; Modern Healthcare reports, here, on the potential for compromise; Becker’s reports (here) on physician group views, for example, the orthopedics association leader who believes the “median in-network rates should serve as a floor and starting point for negotiation.” The physician groups also believe a longer-term solution would be to compel health insurers to create more robust networks, requiring of course higher fees with which to attract more physician participants to those networks. Bloomberg Health and Law reports (here) on an “explosion of arbitration” for the first full year of a New Jersey process: “The state saw nearly 3,000 arbitration claims in the 2018 . . . and while the decisions were split fairly evenly between insurers and medical providers, the payments that doctors were awarded were partly based on high list prices.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
PCI Volume a Predictor of TAVR Success?
A new study from Mass General researchers in JAMA Cardiology (here) says “No.” The challenge to hospitals adding transcatheter aortic or mitral valve services to their cardiology offerings: “The US Centers for Medicare and Medicaid Services recently released an updated national coverage determination proposal for transcatheter aortic valve replacement (TAVR) that maintains a focus on hospital TAVR volume and percutaneous coronary intervention (PCI) volume, and the national coverage determination for transcatheter mitral valve repair (TMVr) also has PCI volume requirements . . . In this cross-sectional study, there was no association between hospital inpatient PCI volume and median transcatheter aortic [and mitral] valve replacement risk-standardized in-hospital mortality or 30-day readmission rates.”
Suboptimization, the Word of the Week
From an essay (here) in this week’s NEJM on the inexplicable: “Even in medical Meccas, what constitutes good care remains a black box. In part, this opacity is purposeful; the institutional self-interest of most health care providers is not fully aligned with society’s interest in optimizing health outcomes or reducing waste. But . . . the more fundamental problem is suboptimization. Suboptimization occurs when one component of a system optimizes its own performance in a way that does not optimize performance of the system as a whole . . . and “the right hand doesn’t know (or care) what the left hand is doing.”
CMS Doesn’t Want to Know
And, speaking of suboptimization, a report (here) from a University of Vermont Medical Center researcher decries the elimination of autopsy services from the Medicare Conditions of Participation. The background: “On September 30, 2019, the Centers for Medicare and Medicaid Services (CMS) removed CMS regulation 482.22(d), thereby eliminating the requirement that hospitals have an autopsy program to qualify for Medicare reimbursement.” Per the author: “The first step in decreasing medical errors (lethal and nonlethal) is to identify them. The second step is to learn from the mistakes. The third step is to educate so as to prevent future errors. Autopsy, whether complete, limited, or biopsy-based, is the best mechanism to accomplish all these steps.”
DRUGS AND DEVICES
CVS Has a Great Year
CEO Larry Merlo (here, earnings call transcript from Seeking Alpha) reports that “2019 was a transformational year for CVS Health and we have made significant progress in our first full year after acquiring Aetna . . . For the full-year 2019, we delivered adjusted earnings per share of $7.08 with total revenues of nearly $257 billion, up 32% reflecting a full year of Aetna’s operations and positive momentum across our enterprise.”
READINGS AND REFERENCES
Research Methods Homework
JAMA Surgery publishes a series of short essays with examples and references on research methods. Today (here), a “Practical Guide to Decision Analysis.” Excerpt: “Patients (and their clinicians) have to make difficult choices about their treatment. Decision analysis can add a data-driven dimension to these choices . . . a Markov decision model can help integrate . . . states, which represent clinical scenarios (such as recovery from an operation, living with a complication from an operation, awaiting an operation, or death), and state transition probabilities, which represent the estimated chances of moving from one state to another over time.” But “counterfactual scenarios” can be challenging.
U.S. House of Representatives:
Members at https://www.house.gov/representatives
Committees and Members at https://www.house.gov/committees
U. S. Senate:
Committees and Members at https://www.senate.gov/committees
CQ 2020 Calendar of Regularly Scheduled Sessions, here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
February 25, 26, 27, 28
March 2, 3, 4, 5, 9, 10, 11, 12, 23, 24, 25, 26, 27, 30, 31
April 1, 2, 3, 20, 21, 22, 27, 28, 29, 30
May 12, 13, 14, 15, 18, 19, 20, 21
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.