DCMedical News: Thursday, February 27, 2020
DCMedical News-DCMN
Washington, D.C.
Thursday, February 27, 2020
DCMedical News is published every day both the House and the Senate are in session.
THE BIG STORY IN HEALTH CARE
Coronavirus News
Trump
The President spoke at a press conference on coronavirus preparation Wednesday at 6:30 p.m. EST. He appointed Vice President Pence to coordinate national efforts, supplanting HHS Secretary Alex Azar. In a lead up, Bloomberg Law reported “Top U.S. officials sought to ease public concern over the risks of coronavirus to the American public ahead of President Donald Trump’s address to the nation . . . Trump and his senior advisors see coronavirus as a serious health threat that warrants a full response, yet assess the risk of the virus in the U.S. as more comparable to the flu in terms of fatality rate.” White House preliminary statement here. JAMA infographic (here) shows most recent flu season (29 million U.S. cases, 16,000 deaths) and COVID-19 to date (14 cases, no deaths).
CDC, Two Messages in Conflict
Time Health reports that Tuesday Dr. Nancy Messonnier, Director of the CDC’s National Center for Immunization and Respiratory Diseases, warned that community spread [of the coronavirus] appears imminent, and disruption to U.S. communities could be significant. The CDC official “laid out steps communities and individuals may have to take if person-to-person spread picks up, including school and workplace closures; voluntary home quarantines; postponing or canceling mass gatherings; and implementing surface cleaning measures in schools, homes and public places . . .Hospitals may have to ask patients to delay elective procedures and conduct other appointments using telemedicine . . . even noting their possibility is a marked escalation from some of the CDC’s prior advice on coronavirus containment, which has mostly been limited to frequent hand-washing and covering coughs and sneezes.” Later that afternoon, higher officials walked back those comments. “Officials with the Health and Human Services Department (HHS) and Principal Deputy Director of the CDC Anne Schuchat, said Messonnier’s comments were intended only for the public to be aware of what could happen down the line.”
Tracking by Johns Hopkins shows on 2-26 at 8:30 p.m. EST worldwide 81,409 confirmed cases, 2,772 deaths, 30,534 patients recovered. CDC information page: https://www.cdc.gov/coronavirus/2019-nCoV/hcp/index.html
Drugs and Medical Supplies
Bloomberg Law reported that Peter Marks, head of the FDA’s Center for Biologics Evaluation and Research, said “I think it’s fair to say we are on the cusp of the pandemic.” With regard to medical supplies, Marks cautioned that alternative sources for drugs and medical devices will be very important. He said, “We’re dependent for some of our medical products 90 percent or more on imports.”
Chinese billionaire Jack Ma is funding part of a coronavirus antibody laboratory at Columbia, per Time (here). The import of broader research: COVID-19 is the “third coronavirus epidemic to affect human populations in 20 years, after severe acute respiratory syndromes (SARS) in 2003 and Middle East respiratory syndrome (MERS) in 2012. Coronaviruses make their homes in a variety of animal hosts, from bats to cats, dogs to camels, and it’s just a matter of time before another one makes the jump into people.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
MACPAC Meets Today and Tomorrow
The February 2020 meeting of the Medicaid and CHIP Payment and Access Commission (MACPAC) is set for Thursday, February 27 from 9:00am–4:00pm and Friday, February 28 from 9:00am–11:45am, agenda here. “The February meeting opens with the next installment of MACPAC’s examination of Medicaid’s role in maternal health, when Medicaid officials from New Jersey and North Carolina join the Commission to discuss how their states are addressing maternal morbidity and mortality. The Commission plans to include a chapter on maternal health in its June 2020 report to Congress.”
Medicaid Fiscal Accountability, Proposed Rule
Not on the agenda, but no doubt on the minds of the Commissioners, the Administration proposal on “fiscal accountability.” MACPAC submitted comments, here. The Commission likes the transparency parts of the proposed rule, but “the Commission urges CMS not to implement new limits for supplemental payments and financing arrangements at this time because CMS has not fully assessed the effects of these changes. In particular, the Commission is concerned that the proposed changes could reduce payments to providers in ways that could jeopardize access to care for Medicaid enrollees. Before proposing to substantially change payment and financing policies, CMS should collect and rigorously examine data on the potential effects of such changes on beneficiary access. A careful review of the access implications of new federal policies is especially important given CMS’s previous proposal to rescind the requirement that states evaluate access before reducing or restructuring provider payments.”
Risk Adjustment: The Rope-a-Dope of Medicare Advantage
Medicare Advantage Organizations (MAOs) were paid $210 billion for services to 21 million Medicare beneficiaries in 2018. Part of that payment was calculated through risk adjustment. The HHS Office of the Inspector General reports (here) that “CMS risk-adjusts payments by using beneficiaries’ diagnoses to pay higher capitated payments to MAOs for sicker beneficiaries―which may create financial incentives for MAOs to make beneficiaries appear as sick as possible . . . To be eligible for risk adjustment, a diagnosis must be documented in a medical record as a result of a face-to-face visit.”
They continue, “CMS does not require MAOs to link these chart reviews to a specific service associated with the diagnoses. This may provide MAOs opportunities to circumvent CMS’s face-to-face requirement and inflate risk-adjusted payments inappropriately.” Their findings: “MAOs almost always used chart reviews as a tool to add, rather than to delete, diagnoses—over 99 percent of chart reviews in our review added diagnoses; Diagnoses that MAOs reported only on chart reviews—and not on any service records—resulted in an estimated $6.7 billion in risk-adjusted payments for 2017; CMS based an estimated $2.7 billion in risk-adjusted payments on chart review diagnoses that MAOs did not link to a specific service provided to the beneficiary―much less a face-to-face visit; Although limited to a small number of beneficiaries, almost half of MAOs reviewed had payments from unlinked chart reviews where there was not a single record of a service being provided to the beneficiary in all of 2016.”
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 meta-analysis.” The importance of studies not reported: negative studies are less likely to be submitted or published. Did you know this? “Popular methods of assessing publication bias include funnel plots, Begg rank correlation test, and [the] Egger test.”
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 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.