DCMedical News: Thursday, March 26, 2020
DCMedical News-DCMN
Washington, D.C.
Thursday, March 26, 2020
DCMedical News is published every day both the House and the Senate are in session. Coronavirus resources in light blue.
THE BIG STORY IN HEALTH CARE
Third Bill
The third “coronavirus bill” (here, 883 pgs.; see DCMN March 25 for description and links to the first two) is still pending final passage, although most interests (save some Governors) appear satisfied, including hospitals (here).
Tracking by Johns Hopkins shows on 3-25 at 8:00 p.m. EST worldwide 467,594 confirmed cases, 21,151 deaths, 113,770 patients recovered.
Public Health Resource Pages (alphabetical): AMA resource page for physicians here. CDC information page here. CMS (Centers for Medicare & Medicaid Services) Current Emergencies website, here. JAMA Network’s COVID-19 resource center here. Library of Congress Coronavirus Research Guide, (here) from the Custodia Legis Blog of the Library of Congress (LoC), with links to Congressional Research Service (CRS) reports. 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. World Health Organization COVID-19 page here.
News, medical: Media focus includes cautionary tales about “vulnerable health care workers falling ill,” (here); intensive care bed shortage looming (here) highly variable across the country (map of cases here); “insider” stories, including this cover story from Hospitalist magazine; focus on New York City’s hospitals, struggling to staff up (Wall Street Journal, here, Gothamist here). Grabowski and Joynt Maddox begin thinking (in JAMA Network, here) about the post-acute care needs of COVID-19 patients.
News, general: archive.org creates the National Internet Library of 1.4 million books for homebound students and workers, here. The private sector, UK brand: “[Sir James] Dyson plans to manufacture 15,000 medical ventilators designed from scratch,” according to a report (here) in the Financial Times. “The appliances maker told staff it had received a UK government order for 10,000 of the devices and aims to begin delivering them in weeks, contingent on regulatory approval it expects to obtain on Friday. Billionaire founder Sir James Dyson is to pay for a further 5,000 to be made, of which 4,000 will be donated to other countries.” The newly designed device is “designed to address the specific clinical needs of Covid-19 patients.”
Thought pieces: Anthony Fauci and colleagues discuss “Navigating the Uncharted” in the NEJM, here. On vaccines and clinical care: “A robust research effort is currently under way to develop a vaccine against Covid-19. We anticipate that the first candidates will enter phase 1 trials by early spring. Therapy currently consists of supportive care while a variety of investigational approaches are being explored . . . Critical to moving the field forward, even in the context of an outbreak, is ensuring that investigational products are evaluated in scientifically and ethically sound studies.” STAT publishes (here) an updated guide to coronavirus drugs and vaccines in development. Gideon Lichfield in MIT Technology Review (here) writes that “To stop coronavirus we will need to radically change almost everything we do: how we work, exercise, socialize, shop, manage our health, educate our kids, take care of family members. We all want things to go back to normal quickly. But what most of us have probably not yet realized—yet will soon—is that things won’t go back to normal after a few weeks, or even a few months. Some things never will.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Walmart Moves Into Direct Health Care
Businessweek profiles the Walmart endeavor, with focus (here) on a new store in Georgia. “Visitors to the Calhoun store can also get a $30 medical checkup or a $25 teeth cleaning, or talk about their anxieties with a counselor for $1 a minute. Prices for those services and more are clearly listed on bright digital billboards in a cozy waiting room inside a new Walmart Health center. Walk-ins are welcome, but most appointments are booked online beforehand. No insurance? No problem. Need a lab test on a Sunday? Sure thing. Walmart ‘care hosts’ take customers to one of 12 care rooms in the 6,500-square-foot facility. Afterward, they steer patients to the in-store pharmacy. While they wait, they can visit the produce section and grab some veggies recommended by the doctor. Welcome to health care, Walmart style.” A separate Walmart initiative, reported (here) in HealthcareFinancialManagement, involves “a groundbreaking test of narrow networks for its employee health plan that will examine both enrollee acceptance and physician cooperation. The nation’s largest employer will launch its first selected provider networks in 2021 as part of a groundbreaking initiative that could have ramifications for employer-sponsored health plans that provide coverage for about 155 million Americans. Walmart health plans, which cover more than 1 million lives, will test curated physician networks in three markets in 2021: Northwest Arkansas, the Orlando-Tampa area and the Dallas area. The initiative is a big change from Walmart’s traditionally broad PPO networks, and the company hopes the new approach benefits not only their enrollees but also clinicians in those regions. It’s also a move beyond the company’s earlier contracting with accountable care organizations.”
Whatever Happened to Surprise Billing?
It stalled due to the efforts of private equity investors in physician practices, according to this review in NEJM. “The legislative impasse disappointed observers who hoped that a growing public outcry and rare bipartisan agreement would lead Congress to eradicate these out-of-network bills. An estimated 20% of U.S. emergency-department visits, 9% of inpatient admissions, and more than half of ambulance or air-ambulance transports involve an out-of-network provider . . . The financial impact of such bills extends beyond the patient, increasing health spending by people with private insurance coverage by billions of dollars per year. Surveys show that more than three quarters of Americans want Congress to pass protections against these obligations.”
Coding for Medical Services for Patients with COVID-19
The AMA distributes this guide, with sample scenarios.
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Hospital Bills for Treatment of COVID-19 Patients May Exceed $1.4 Trillion
Fair Health estimates reported in Modern Healthcare (here) are based on influenza and pneumonia codes, expected infection rates and treatment charges. Fair Health says the $1.4 trillion in charges may translate to $558 billion in payments if all services are in-network.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Public Option Explored in States
A report on Colorado efforts (here) in Businessweek says “Colorado's state-sponsored plans would start in 2022 and initially be targeted at the 7% of the population who buy their own coverage directly, instead of getting it from employers or through other government programs. The plans would offer premiums about 11% lower than what's available today, on average, in the state's individual insurance market, and as much as 17% lower in some places.” A chart accompanying the story reports on average hospital costs paid by employer-sponsored health plans in 2017 as a share of what Medicare would pay the same hospitals for the same services. Colorado is sixth highest, with the top payment (400% of Medicare) coming in Indiana, home of the cost containment work of CMS’ Seema Verma, former health director Dr. Jerome Adams, now the U.S. Surgeon General, and Vice President Pence.
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 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.