DCMedical News: Wednesday, March 11, 2020
DCMedical News-DCMN
Washington, D.C.
Wednesday, March 11, 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 3-10 at 8:00 p.m. EST worldwide 118,582 confirmed cases, 4,262 deaths, 64,464 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 (14 pgs.) here.
News, medical: The Financial Times with a graphic on hospital beds per thousand population (here), ranging from a high of 13 in Japan to a low of 2.2 in the United Kingdom. Mask and supply chain challenges for hospitals profiled in the New York Times, here. The CDC, faced with a shortage of respirator face masks, says surgical masks are okay for the time being (here); nurses' unions say it will leave their members vulnerable to infection. Also, CMS has sent new guidance to all providers, here. In addition, CMS sent its own guidance concerning protective masks, with a list of other CMS directives, here. Cardiac injury reported (here) in “Clinical and radiographic features of cardiac injury in patients with 2019 novel coronavirus pneumonia.”
News, general: The Dow Jones gained nearly 5%. Senate Democratic leaders call a news conference for 11:30 a.m. today to call on employers to “offer paid sick leave to employees following recommended health procedures in wake of worsening coronavirus outbreak." The New York Times coronavirus update is here; the British Health Minister has tested positive. Homeland Security hearing today at 2:00 p.m. on “"Confronting the Coronavirus: The Federal Response."
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Cancer Passes Heart Disease as Number One Killer in Many Countries
A report in The Lancet (here) on a study spanning 21 countries, five continents and ten years, reveals that “mortality from cancer will probably become the leading [global] cause of death.” Although cardiovascular disease remains the major cause of death globally, in high-income countries and some middle-income countries, “deaths from cancer are now more common than those from cardiovascular disease.” Specifically, “Cardiovascular disease occurred more often in LICs [low income countries] (7.1 cases per 1000 person-years) and in MICs [middle income countries] (6.8 cases per 1000 person-years) than in HICs [high income countries] (4.3 cases per 1000 person-years). However, incident cancers, injuries, COPD, and pneumonia were most common in HICs and least common in LICs. Overall mortality rates in LICs (13.3 deaths per 1000 person-years) were double those in MICs (6.9 deaths per 1000 person-years) and four times higher than in HICs (3.4 deaths per 1000 person-years). This pattern of the highest mortality in LICs and the lowest in HICs was observed for all causes of death except cancer, where mortality was similar across country income levels. Cardiovascular disease was the most common cause of deaths overall (40%) but accounted for only 23% of deaths in HICs (vs 41% in MICs and 43% in LICs), despite more cardiovascular disease risk factors.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
New Pelosi Health Plan to Omit Democratic Presidential Candidates’ Health Plans, with Obama Support
A report in the New York Times (here) says “[House] Speaker Nancy Pelosi is preparing to unveil a sweeping plan to lower the cost of health care, moving to address the top concern of voters while giving moderate Democrats who face tough re-election races a way to distance themselves from the Medicare for All plan embraced by the progressive left and derided by Republicans as socialism. The legislation, timed to coincide with the 10th anniversary of the Affordable Care Act, is part of a major push by Democrats to position themselves as the party of health care before the 2020 elections. Former President Barack Obama will support the effort, appearing with Ms. Pelosi at American University in Washington on March 23, 10 years to the day he signed the Affordable Care Act into law. While the measure has little chance of survival in the Republican-controlled Senate, it is the latest evidence that Democratic leaders, determined to protect their House majority and the moderate lawmakers who helped them to power, are looking for ways to distinguish their rank and file from the party’s presidential nominees. The plan bears no resemblance to Medicare for All, the national health insurance system championed by Senator Bernie Sanders of Vermont, the self-described democratic socialist. And it omits a public option to create a government-run health insurer, an idea embraced by former Vice President Joseph R. Biden Jr., the Democratic front-runner.” The President sent his drug pricing proposal to Congress (press secretary statement, here). CQ Magazine features accomplishments and challenges of the Patient Protection and Affordable Care Act ten years in (here).
Are Medicare Advantage Organizations Cheating on Risk Adjustment Calculations?
A 3-M blog (here) comments on the recent OIG audit of Medicare Advantage Organization (MAO) use or retrospective risk adjustment to achieve higher reimbursement from Medicare. “Retrospective HCC [hierarchical condition categories] auditing should be relatively simple – right? If the diagnosis is documented, add it to the list of any HCC category where it is included. Ah, no, not so simple. CMS requirements include: The(se) diagnoses must be documented annually if the member has a chronic condition, even an amputation; and The diagnosis must be documented properly in progress notes; and The diagnosis must result from a face-to-face visit with a medical doctor or nurse practitioner or physician assistant; and Diagnoses coded last year drive current year payment (prospective model).”
Also, “HCC auditing has become more complex with increased use of EHRs. Some EHRs drag along a problem list from visit to visit, even when conditions are no longer being treated. My favorite is influenza; when this appears in the problem list for months (in my opinion), it means either the list is bogus, or the treatment is. For the diagnosis to ‘count’ for risk adjustment purposes, it needs to be an ongoing problem that requires treatment or impacts the beneficiary’s functioning. An example would be history of amputation. It’s equally disturbing from a clinical standpoint when patients have chronic diseases documented in the problem lists but there is no record of any treatment during a calendar year. This brings up a quality of care issue.”
“The OIG audit’s unsettling results: 99 percent of their chart reviews added diagnoses that were only found on MAOs or vendor chart reviews and not on claims. CMS paid $2.7 billion in risk adjustment dollars that were not linked to a specific service provided to a beneficiary – much less a face-to-face visit. They also found that even though limited to a small number of patients, almost half of MAOs reviewed had received risk-adjusted payments when there was not a single record of a service being provided.”
DRUGS AND DEVICES
Pharmaceutical and Health Product Industry Lobbying and Campaign Contributions, 1999-2018
A study in JAMA Internal Medicine (here) reviews lobbying and campaign contributions from the pharmaceutical and health product industry over a two decade period. The total in this period, $4.9 billion, amounted to $233 million per year of lobbying expenditures at the federal level, more than any other industry. The Pharmaceutical Research and Manufacturers of America (PhRMA) accounted for 9%, $422 million, of the total. The industry also spent $414 million on campaign contributions, $22 million to presidential candidates, $214 million to congressional candidates. Some $877 million was contributed to state candidates and committees, almost half of which went to recipients in California. Large spikes in contributions came during years in which state referenda on reforms and drug pricing regulation were being considered.
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 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.