DCMedical News: Tuesday, March 10, 2020
DCMedical News-DCMN
Washington, D.C.
Tuesday, March 10, 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 3-9 at 5:00 p.m. EST worldwide 113,584 confirmed cases, 3,996 deaths, 62,496 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, medical: The Annals of Internal Medicine (here) reports on research that “Provides additional evidence for a median incubation period for COVID-19 of approximately 5 days, similar to SARS. Our results support current proposals for the length of quarantine or active monitoring of persons potentially exposed to SARS-CoV-2, although longer monitoring periods might be justified in extreme cases.” Monitoring of those exposed for travel related contacts, per the CDC’s Morbidity and Mortality Weekly Report of March 6 (summarized here), shows a secondary attack rate of .45%. A Lancet report on the clinical course (here) says “Median duration of viral shedding was 20 days in survivors, but SARS-CoV-2 was detectable until death in non-survivors. The longest observed duration of viral shedding in survivors was 37 days.”
News, general:
The Dow Jones lost 2013 points, a record number (although not a record percentage point drop, 7.7%), on Monday. The Hill reports that “President Trump on Monday took his biggest step to address the economic fallout of the coronavirus, saying he will ask Congress to approve a payroll tax cut and relief for hourly workers. Trump called for the tax cut during an appearance at the White House briefing room, where Vice President Pence tried to reassure the public that the risk for the average person remains low. Fears that coronavirus represents a major threat to both public health and the economy grew dramatically Monday amid school closures, lawmakers quarantining themselves and a growing number of U.S. cases.” Democrats may focus on sick leave, with a hearing planned Wednesday before the House Education and Labor Committee.
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
TAVR vs. Surgical Aortic Valve Replacement: Death and Stroke Rates the Same at Five Years, but More Trouble for TAVR in the Interim
In a study (here) of the incidence of death and disabling stroke at five years after transcatheter aortic-valve replacement (TAVR) compared with surgical aortic-valve replacement, for patients at intermediate surgical risk, there was no difference. The study prompted an editorial (here) that asked the question “TAVR at 5 Years – Rematch or Swan Song for Surgery?” The editorial, however, noted that between operative procedure and five years, the study (funded by Edwards Life Sciences, a valve maker) found a significant difference in regurgitation (both mild and moderate) at two years (many more with the TAVR recipients), three times as many valve-related hospitalizations as those in the surgery group, and, perhaps most important, that surgery offers an “all-in-one treatment” (coronary artery bypass graft concomitant with valve replacement) “that could provide long-term benefit for patients with complex conditions.”
Interoperability Final Rule Published
A CMS fact sheet (here) notes that “The Interoperability and Patient Access final rule (CMS-9115-F) delivers on the Administration’s promise to put patients first, giving them access to their health information when they need it most and in a way they can best use it.” The API (application program interface) is required of virtually all health plans, and provides “a secure, standards based (HL7 FHIR Release 4.0.1) API that allows patients to easily access their claims and encounter information, including cost, as well as a defined sub-set of their clinical information through third-party applications of their choice. Claims data, used in conjunction with clinical data, can offer a broader and more holistic understanding of an individual’s interactions with the healthcare system, leading to better decision-making and better health outcomes.” The final rule prepared for the Federal Register is here.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
MedPAC Materials from March 5 – 6 Meeting:
Here are meeting materials from MedPAC’s most recent meeting, including presentations on Addressing Medicare Shared Savings Program Vulnerabilities (here); Impact of Changes in the 21st Century Cures Act to Risk Adjustment for MA Enrollees (here); Realigning Incentives in Medicare Part D (here); Redesigning the Medicare Advantage Quality Bonus Program (here); The Role of Specialists in Alternative Payment Models and Accountable Care Organizations (here); Improving Medicare’s End-Stage Renal Disease Prospective Payment System (here); and Separately Payable Drugs in the Hospital Outpatient Prospective Payment System (here). Also, MedPAC comments on the proposed changes in methodology for measuring Medicare Advantage (MA) capitation rates and Part C and Part D payment policies with risk adjustment (here).
DRUGS AND DEVICES
Medscape Report Concerning Cardiovascular “Events” in Cancer Trials
Medscape publishes a report (here) on failure of clinical trials supporting FDA approval of cancer therapies to have captured major adverse cardiovascular events, and, when they did, reporting rates much lower than those in non-cancer trials. The study reports on FDA approval of 123 anti-cancer drugs from 1998 to 2018, with 1,148 incidents of major adverse cardiovascular events. The study’s senior author noted that “I think often when an event may be brought to someone’s attention, there is a tendency to just write it off as kind of a generic expected event due to age, or just something that’s not really pertinent to the study. So they don’t really focus on it as much.”
“Coverage with Evidence Development Schemes for Medical Devices” Reviews
A study in Health Policy and Technology (here) reviewed the use by payers of “coverage with evidence development” schemes to reduce decision uncertainty. Questions examined include whether or not a “CED” scheme was required, understanding uncertainties and risks, and defining an adequate duration for a CED scheme and for market entry of new technologies.
READINGS AND REFERENCES
Potential Consequences of Changing Disease Classification
In a “Viewpoint” from JAMA (here), disease classification may be altered based on the work of professional societies and guideline committees; on changes in the sensitivity of tests affecting judgements concerning disease prevalence; in a shift in the “implicit threshold” clinicians may use to diagnose a disease, all leading to distortions of perceptions of trends in the incidence and prevalence of disease and also resulting in “artifactual improvements in outcomes.”
A Review of Six Sigma Utilization in Health Services
A comprehensive review in Health Policy (here) on quality and process improvement.
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 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.