DCMedical News: Tuesday, February 25, 2020
DCMedical News-DCMN
Washington, D.C.
Tuesday, February 25, 2020
DCMedical News is published every day both the House and the Senate are in session.
THE BIG STORY IN HEALTH CARE
COVAD-19 a/k/a 2019-NCoV a/k/a Coronavirus News
The Washington Post reports that the incubation period may be much longer than expected, possibly double the previous estimate of two weeks (here).
Tracking at https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6 by Johns Hopkins. At 7:30 p.m. Monday there were 79,570 confirmed cases, 2,629 deaths and 25,227 patients recovered. CDC information page: https://www.cdc.gov/coronavirus/2019-nCoV/hcp/index.html.
The Dow Jones Industrial Average fell more than 1,000 points Monday. Up more than 5%, Gilead; Bloomberg reports that Gilead’s remdesivir has been rushed into clinical trial in China, and is called the most promising alternative for coronavirus treatment by the World Health Organization.
HHS Secretary Azar appears this morning before the Senate Appropriations Subcommittee on Labor-HHS-Education, newly armed with an Administration request for $2.5 billion in new coronavirus-fighting funds.
Both Houses of Congress are back in session today.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
We’re Doing This for You, Doctor
Data sharing rules expected in final form by the end of February will help the doctor with his/her administrative burdens. Bloomberg reports that a new HHS/CMS report (here) says that doctors shouldn’t spend hours after their last patient of the day filling out paperwork when health IT can make the process so much smoother. EPIC and its client health systems have opposed the (related) interoperability rules, a major sales point of EHRs being the capacity to keep patient and physician information away from competitors.
Going After Private Equity Investment in Medical Practices
The House Ways and Means Committee has reported HR 5825 which, according to a Congressional Budget Office summary (here), “would generally require private equity firms that have a controlling interest in certain medical service providers to file annual information returns with the Internal Revenue Service. Those returns would include information on certain income, assets, and debt, and the information would be made available to the public. The bill also creates a new penalty for failure to comply as a result of willful negligence with the new reporting requirements.”
The bill “defines a new category of persons subject to special provisions for information returns and outlines the required items for that information return . . . the reporting requirements apply to entities who hold at least a 50-percent interest in a specified medical care provider, and are engaged in or receive services from a service provider in the business of raising or returning capital, investing in or disposing of assets, and in which some of the interest must be with respect to a medical service provider. Specified medical care providers are defined as those that are enrolled and eligible to participate in and receive payment under Medicare or a state’s Medicaid program.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Fire Sale Continues at Community Health Systems
CHS (stock ticker CYH) continues to unload unprofitable hospitals with resulting modest improvement for corporate results.
CEO Wayne Smith (earnings call from Seeking Alpha here) is upbeat, as are slides (here) and a news release (here) presented to analysts. The 10-K report (here) tells this story for 2019: admissions (due to the sale of hospitals) down 9%, net loss of $(373) million for 2019 compared with net loss of $(328) million for 2018, net cash provided by operating activities $194 million, compared with net cash used in operating activities of $165 million for the same period in 2018, which prior year period included $266 million paid for the Health Management Associates, Inc. (HMA) legal settlement during the quarter. On a same-store basis, admissions increased 0.1 percent and adjusted admissions increased 1.8 percent, compared with the same period in 2018.
A report (here) from Modern Healthcare notes that those purchasing cast off CHS hospitals have fared even worse than CHS did in running them. Of the 50 hospitals sold to pay debt 40 are operating at a loss, have filed for bankruptcy or are closed. A key event for CHS was acquisition in 2012 of scandal ridden HMA: both corporations were controlled by the same private equity firm. CHS began selling off hospitals in 2014.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Medicare Advantage or Medicare “Takes Advantage”
A feature in the Business section of The New York Times Sunday (here) put the spotlight on a little known feature of Medicare Advantage programs. Like the Hotel California, you can get in easily, but you can’t get out. That is, once enrolled in Medicare Advantage, re-enrollment in “traditional Medicare,” for example, when a patient is diagnosed with a serious illness whose therapy will not be paid for by the MA program, is nearly impossible. Four states (California, Massachusetts, Maine and New York) provide partial guarantees for re-enrollment in Part B outpatient services.
Problems With Paying Bills Remain, Plateau
The National Center for Health Statistics reports (here) that “The percentage of all persons who were in families having problems paying medical bills in the [previous] 12 months decreased 4.5 percentage points from 19.7% in 2011 to 15.2% in 2015 and then decreased 1.0 percentage point from 2015 through 2018 (14.2%). The percentage of all persons who were in families having problems paying medical bills did not change significantly between 2017 (14.6%) and 2018 (14.2%).”
READINGS AND REFERENCES
Hope, Hype, Promise, Peril
This is the subtitle, in fact, of “Artificial Intelligence in Health Care,” (here), a new (269 page) publication of the National Academy of Medicine.
Research Methods Homework
JAMA Surgery publishes a series of short essays with examples and references on research methods. Today (here) policy analysis. Key steps, “Identifying Policy-Relevant Outcomes; Strategy: Focus on a causal pathway; Characterizing the Policy-Exposed Populations; Exploring Both Intended and Unintended Consequences; Strategy: Evaluate for heterogeneity of policy effects; Managing Threats to Causal Inference; and Strategy: Use difference-in-difference study design, interrupted time series analyses, or other statistical methods to reduce bias due to secular trends or confounders.”
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 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.