DCMedical News: Tuesday, March 24, 2020
DCMedical News-DCMN
Washington, D.C.
Tuesday, March 24, 2020
DCMedical News is published every day both the House and the Senate are in session. Both Houses return to session today.
THE BIG STORY IN HEALTH CARE
Tracking by Johns Hopkins shows on 3-23 at 8:00 p.m. EST worldwide 378,287 confirmed cases, 16,497 deaths, 100,958 patients recovered.
Public Health Resource Pages (alphabetical): AMA resource page for physicians here. CDC information page here. JAMA Network’s COVID-19 resource center here. NIH information page here. National Library of Medicine Coronavirus page here, New England Journal of Medicine update here, New England Journal of Medicine Journal Watch here. Washington State (epicenter) coronavirus page here. The Lancet covid-19 Resource Centre here. The White House open research dataset (COVID-19 Open Research Dataset, CORD-19) here.
New: The Coronavirus Resource Guide (here) from the Custodia Legis Blog of the Library of Congress (LoC). The LoC guide is “Intended as a guide to laws, regulations and executive actions in the United States, at both the federal and the state level, and in various countries with respect to the new coronavirus and its spread. We are also including links to Congressional Research Service (CRS) reports.” Also, the Medical Group Management Association (MGMA) COVID-19 Resource Center here, especially for medical practitioners. Harvard Global Health Institute, joint study with ProPublica on medical care resources, here.
News, medical: CMS (Centers for Medicare & Medicaid Services) Current Emergencies website, here. New York State’s Department of Health has a coronavirus website compendium here. Survival of SARS-CoV-2 (which causes COVID-19) on surfaces: a study reported in the New England Journal of Medicine (here) finds that “After aerosolization, viable SARS-CoV-2 virus was detectable throughout the 3-hour experiment . . . SARS-CoV-2 was detectable after 72 hours after application to plastic and after 48 hours on stainless steel, although titers dropped. Survival was shorter on cardboard (no viable SARS-CoV-2 after 24 hours) and copper surfaces (no viable SARS-CoV-2 after 4 hours).” The virus survives in people, on the other hand, for up to 37 days, according to this study of the clinical course of patients in China in The Lancet: the “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.” And the role of that unrecognized infection, per a study in Science, here: “Due to their greater numbers, undocumented infections were the infection source for 79% of documented cases. These findings explain the rapid geographic spread of SARS-CoV2 and indicate containment of this virus will be particularly challenging.”
News, general: Axios coronavirus dashboard here. FEMA Coronavirus Rumor Control page here.
Back to normal? On Monday the President said “Our public health experts, who are terrific, are studying the variation and the disease across the country, and we will be using data to recommend new protocols to allow local economies to cautiously resume their activity at the appropriate time."
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
How Radiologists are Paid, a History
This four part series in the Journal of the American College of Radiology (here) begins with “The Fight for Independent Billing.” Independent billing status began with Rep. Wilbur Mills and the passage of Medicare. “Arkansas radiologists sought out Representative Mills and persuaded him to accept that radiologists should be treated the same as other physician specialists in the pending Medicare program. It was Representative Mills’ effort that defined medical service and specified that radiologists should be paid professionally separately from technical fees for hospital cost.” The history proceeds to “The impact of advanced imaging technologies on radiologists’ incomes in the 1980s to the ‘bubble years’ of the 1990s and to the end of the bubble in the first decade of the 21 century.” Hastening the end of the bubble was “The Death of Distance,” a byproduct of technologic advance, where “The combination of digitized images, the DICOM [Digital Imaging and Communications in Medicine] standard and affordable PACS [Picture Archiving and Communication Systems] sharply increased Radiologist productivity but they also allowed an imaging study to be read anywhere, an innovation with mixed effects.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Public and Private Resources
STAT reports (here) on a Coronavirus model which shows individual hospitals what to expect in the coming weeks. The hospital-medical-nursing lobbies are pressing their messages (here) in the face of difficulties in the Senate with the “stimulus/subsidy” bill. House Speaker Pelosi released her own 269-page $2.5 trillion bill (here), a prod to the Senate.
The National Guard is building four “pop-up” hospitals inside New York City’s Javits Convention Center and taking over 10,000 hotel rooms for patient care, according to this report in the Wall Street Journal. In the UK virtually all private sector hospitals have been “nationalized” by contract, according to this report in the Financial Times. The entire capacity of the private hospital sector in England will be used to treat coronavirus patients, and take on work the NHS is too overwhelmed to carry out, under a deal announced by the government on Saturday. The agreement will provide nearly 20,000 extra staff to help manage the surge in cases, NHS England said.
MEDICARE, MEDICAID, COMMERCIAL HEALTH INSURANCE
CMS Breaking Speed Records
CMS announced Monday night (here) that it had approved an additional 11 state Medicaid waiver requests under Section 1135 of the Social Security Act, bringing the total number of approved Section 1135 waivers for states to 13. The waivers were approved within days of states submitting them. CMS had previously approved the measures for Florida and Washington. The additional states approved are Alabama, Arizona, California, Illinois, Louisiana, Mississippi, New Hampshire, New Jersey, New Mexico, North Carolina and Virginia.
As with the recent CMS announcement suspending deadlines for “quality” reports, the waivers amount to CMS lowering the quantity of red tape required of providers to participate in the Medicaid program. Included are “Temporarily suspend prior authorization requirements; Extend existing authorizations for services through the end of the public health emergency; Modify certain timeline requirements for state fair hearings and appeals; Relax provider enrollment requirements to allow states to more quickly enroll out-of-state or other new providers to expand access to care, and Relax public notice and submission deadlines for certain COVID-19 focused Medicaid state plan amendments, enabling states to make changes faster and ensure they can be retroactive to the beginning of the emergency.” The red tape can be expected to return to existing levels “upon termination of the public health emergency, including any extensions.”
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 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.