DCMedical News: Thursday, March 5, 2020
DCMedical News-DCMN
Washington, D.C.
Thursday, March 5, 2020
DCMedical News is published every day both the House and the Senate are in session.
THE BIG STORY IN HEALTH CARE
Coronavirus News
Tracking by Johns Hopkins shows on 3-4 at 4:00 p.m. EST worldwide 95,111 confirmed cases, 3,254 deaths, 51,156 patients recovered.
Public Health Resource Pages: AMA resource page for physicians here. CDC information page here. NIH information page here. National Library of Medicine Coronavirus page here, New England Journal of Medicine update page here.
News and commentary: Congressional leaders have reached agreement (CBO report on Appropriations here) on an $7.7 billion plan to fight coronavirus. The White House (here) extols the virtues of the nation’s coronavirus plan, with comments from The Washington Times, Brietbart, CNBC and Fox News. Testing lags after a troubled beginning. Eleven dead in U.S. from coronavirus disease. The World Health Organization says the “death rate” is 3.4%, although definitions of the denominator vary. USA Today provides a national and international summary roundup (here). HIMSS (see DCMN 3-4) goes on with plan to host President Trump at its convention Monday, although Amazon (and others) have withdrawn.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Workforce Projections
Three papers on reshaping the health care workforce.
More Nurse Practitioners (NPs)? Yes, but many seem to have come from the hospital RN workforce. In Health Affairs (here), this report: In the period 2010–17 the number of NPs in the US more than doubled from approximately 91,000 to 190,000 . . . Employment was concentrated in hospitals, physician offices, and outpatient care centers, and inflation-adjusted earnings grew by 5.5 percent over this period. The pronounced growth in the number of NPs has reduced the size of the registered nurse (RN) workforce by up to 80,000 nationwide.”
Also losing momentum: home care, where Kaiser Health News (KHN) reports (here) that it is suddenly more difficult to find home health care for Medicare patients. KHN writes “Home health agencies across the country are grappling with a significant change as of Jan. 1 in how Medicare pays for services . . .Agencies are responding aggressively, according to multiple interviews. They are cutting physical, occupational and speech therapy for patients. They are firing therapists. And they are suggesting that Medicare no longer covers certain services and terminating services altogether for some longtime, severely ill patients . . . Previously, Medicare’s home health rates reflected the amount of therapy delivered: More visits meant higher payments. Now, therapy isn’t explicitly factored into Medicare’s reimbursement system, known as the Patient-Driven Groupings Model (PDGM).”
The doctor as shift worker: Staff Care publishes a survey (here) showing the growth in and use of locum tenens physicians.
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Walmart vs. Drug Store Clinics
Becker’s profiles the differences (here) between the new (two models open in Georgia) “Walmart Medical” vs. “Drug Store Medical” (e.g., CVS) clinics. “While many CVS clinics are staffed by nurse practitioners, Walmart's two freestanding health centers in Georgia offer patients access to primary care physicians and incorporate many other services, including X-rays, dental, counseling and optometry.”
Patient Data Access Controversies
Senators Bill Cassidy (a gastroenterologist with a specialty in liver disease), Elizabeth Warren and Richard Blumenthal press Google and Ascension (here) on protections for patient data, access and payment in their joint information gathering projects. The Wall Street Journal reports that “A bipartisan trio of U.S. senators pushed again for answers on Google’s controversial ‘Project Nightingale,’ saying the search giant evaded requests for details on its far-reaching data tie-up with health giant Ascension. The senators, in a letter Monday to St. Louis-based Ascension, said they were put off by the lack of substantive disclosure around the effort. Project Nightingale was revealed in November in a series of Wall Street Journal articles that described Google’s then-secret engagement to collect and crunch the personal health information of millions of patients across 21 states.” The Journal notes that Ascension fired the employee who was a source for information in an earlier article. Ascension, the nation’s largest Catholic hospital chain, is no stranger to controversy, having spent millions on an aborted “Cayman Islands Academic Medical Center” and backing a billing start-up (Accretive) later found to have committed abusive and fraudulent hospital billing practices.
Google faces additional challenges in a suit involving patient data sharing with the University of Chicago. STAT+ reports (here) that “In December 2016, Google and the University of Chicago signed a contract outlining a research collaboration in which the tech giant would receive reams of de-identified patient data, some of it unusually detailed. Two and a half years later, that deal would get both organizations sued over allegations that patients could, in fact, be identified. The outcome of the suit could hinge in part on the stipulations in the contract (here).” Two specific types of data that the University of Chicago shared with Google could be tied to specific patients, namely “free text data” (unstructured clinician notes), and “actual dates of service and events.”
Two essays in JAMA (here and here) in February explore the exploitation of patient data by providers and tech companies, largely as questions involving money (payments to individual patient vs. community “benefit”).
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Surprise Billing
JAMA Network publishes a Kaiser Family Foundation infographic chart on surprise medical billing in the U.S., here. JAMA studies out-of-network surprise billings in surgery (here), finding that “In this retrospective analysis of commercially insured patients who had undergone elective surgery at in-network facilities with in-network primary surgeons, a substantial proportion of operations were associated with out-of-network bills.”
READINGS AND REFERENCES
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
March 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.