DCMedical News: Friday, March 27, 2020
DCMedical News-DCMN
Washington, D.C.
Friday, March 27, 2020
DCMedical News is published every day both the House and the Senate are in session.
THE BIG STORY IN HEALTH CARE
Coronavirus
Tracking by Johns Hopkins shows on 3-26 at 8:00 p.m. EST worldwide 529,591 confirmed cases, 23,956 deaths, 122,135 patients recovered. The Hill reports that “The United States surpassed China and Italy Thursday afternoon to become the country with the most confirmed cases of the coronavirus. And a top CDC official warned that New York's coronavirus outbreak is just a preview of what is to come.”
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. The Lancet covid-19 Resource Centre here. State actions, Kaiser Family Foundation, here. The White House open research dataset (CORD-19) here. World Health Organization COVID-19 page here.
Thought pieces: TIME recalls the role of American industry in mobilizing for war (here), but, notes Doris Kearns Goodwin, (here) it doesn’t happen automatically. See also “Readings and References,” below.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Guidelines and Orthodoxy
A review of the levels of evidence supporting American College of Cardiology/American Heart Association and European Society of Cardiology Guidelines from 2008 to 2018 published in JAMA (here) finds that “Among recommendations in major cardiovascular society guidelines, only a small percentage were supported by evidence from multiple RCTs [randomized controlled trials] or a single, large RCT. This pattern does not appear to have meaningfully improved from 2008 to 2018.”
Learning to Treat Virtually
In addition to promoting telehealth (below), the pandemic may hasten other virtual treatments, noted (here) in the Economist’s discussion of the “heart’s digital twin.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Telehealth Expansion
In response to the pandemic the administration has set aside regulatory impediments to distant healing, that is, the use of telehealth tools by medical practitioners to “visit” Medicare patients. The announcement (here) says “Clinicians can bill immediately for dates of service starting March 6, 2020. Telehealth services are paid under the Physician Fee Schedule at the same amount as in-person services [emphasis added].” Medicare coinsurance and deductibles will still apply for these services, but the HHS Office of Inspector General (OIG) is providing flexibility for healthcare providers to reduce or waive cost-sharing for telehealth visits paid by federal healthcare programs. OIG issued a letter (here) saying “physicians and other practitioners . . . will not be subject to administrative sanctions for reducing or waiving any cost-sharing obligations Federal health care program beneficiaries may owe for telehealth services.” (Longstanding federal policy prohibits the waiving of copayments or deductibles, except under limited circumstances.) For Medicaid patients, no new or dedicated funds, but this invitation: “No federal approval is needed for state Medicaid programs to reimburse providers for telehealth services in the same manner or at the same rate that states pay for face-to-face services.” FAQs on the new policy here.
HIPAA Rules Relaxed for Patient and Public Health
In another regulatory pull back, HHS has waived certain portions of the HIPAA Privacy Rule. The announcement (here) says “Health care providers may share patient information with anyone as necessary to prevent or lessen a serious and imminent threat to the health and safety of a person or the public – consistent with applicable law (such as state statutes, regulations, or case law) and the provider’s standards of ethical conduct. See 45 CFR 164.512(j). Thus, providers may disclose a patient’s health information to anyone who is in a position to prevent or lesson the serious and imminent threat, including family, friends, caregivers, and law enforcement without a patient’s permission. HIPAA expressly defers to the professional judgment of health professionals in making determinations about the nature and severity of the threat to health and safety. See 45 CFR 164.512(j).”
An Enormous Cloud, but a Silver Lining
One prominent national leader in hospitals said, in response to the administration-wide move to lower impediments to patient care, “The suspension of low value documentation and reporting requirements has infused some fresh air into our nursing and medical staff – they really like it so they can focus on patient care - I hope some of the emergency measures in place that de-regulate every little bit of operations and practice are made permanent.” Summary of other CMS regulatory activities concerning COVID-19 is here.
READINGS AND REFERENCES
Epidemics and Pandemics in the (not-so-distant) Past
A National Security Council memo on Ebola notes (here) that “The Ebola epidemic in West Africa—one of the swiftest outbreaks of infectious disease since the 1918 Spanish Flu—claimed the lives of 11,000 and sickened more than 28,000. Yet it could have been exponentially worse.” The memo (to Ambassador Susan Rice) noted “It is sobering to note the odds are increasing that the United States will be called upon again in the not too distant future to respond to another health crisis that threatens global security. Population growth, urbanization, deforestation, the expansion of agriculture, the bunching of species together in island ecosystems, global commerce flows, and an unsurpassed level of intercontinental air travel are creating the very conditions for the next dangerous pathogen to emerge.”
A CSIS (Center for Strategic and International Studies) “Commission on Strengthening America’s Health Security” (here, published November 1912) called for “Ending the Cycle of Crisis and Complacency in U.S. Global Health Security.” The CSIS group found that “There is recognition that increasing levels of global disorder and conflict across the world are resulting in destruction of public health infrastructure and capacity, reduced access to critical services for vulnerable populations, and heightened risk of sudden outbreaks. These health threats undermine the economic and political security of nations.”
The CDC publishes (in the Morbidity and Mortality Weekly Report of 3-17, here) an initial investigation of transmission of COVID-19 among crew members during quarantine of the cruise ship off Yokohama in February.
And in a presage to today’s headlines, the “Crimson Contagion” report (here) of a 2019 National Security Council exercise found that “Existing statutory authorities tasking HHS to lead the federal government’s response to an influenza pandemic are insufficient and often in conflict with one another. Currently, there are insufficient funding sources designated for the federal government to use in response to a severe influenza pandemic. It was unclear if and how states could repurpose HHS and the Centers for Disease Control and Prevention (CDC) grants, as well as other federal dollars to support the response to an influenza pandemic.”
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 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.