DCMedical News: Monday, March 30, 2020
DCMedical News-DCMN
Washington, D.C.
Monday, March 30, 2020
DCMedical News is published every day both the House and the Senate are in session. The Senate is in recess until April 20, the House until an indefinite date.
THE BIG STORY IN HEALTH CARE
Coronavirus
Tracking by Johns Hopkins shows on 3-29 at 8:00 p.m. EST worldwide 720,117 confirmed cases, 140,886 in the U.S.; 33,925 deaths; 149,082 patients recovered. NIAID Director Dr. Anthony Fauci says U.S. coronavirus deaths could reach 100,000 to 200,000. The President signed the “CARES” Act ($2.5 billion for damages, bill here, Senate Committee staff summaries here and here), extended “social distancing” guidelines to April 30, predicted recovery in June.
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 In 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.
Medical and General: The Food and Drug Administration has approved the use of plasma from recovered patients to treat some COVID-19 patients. A report in JAMA (here) says “In this preliminary uncontrolled case series of 5 critically ill patients with COVID-19 and ARDS, administration of convalescent plasma containing neutralizing antibody was followed by improvement in their clinical status,” discussion in the New York Times (here). Epidemic Calculator (select transmission and clinical dynamics, see results) here. The Peterson-KFF “Health System Tracker” asks, “How prepared is the US to respond to COVID-19 relative to other countries?” here.
The Next Big Shortage: Money
Hospitals report current or about-to-be-current financial distress from the impact of treating COVID-19 patients. Other patients stay away, and the expense of the COVID-19 patients will be high but payment uncertain. Massachusetts safety net hospitals (here) say four systems may close, due to dependence on government pay (Medicare, Medicaid), the absence of cash reserves, and loss of revenue from declining numbers of elective procedures and outpatient visits. CMS announces accelerated and advance payments for the duration (news release, here, fact sheet here), promises to pay within seven days of receiving the request. Sunday’s Boston Globe (here) reports pay cuts for doctors and nurses, in the midst of the pandemic (“Doctors Day” is today, March 30.)
Then: Staff
Boston hospitals report record number of employees testing positive for coronavirus (CNN, here). In Washington, the Governor (here) has changed medical assistant licensing requirements temporarily, to allow medical assistants to work without a supervising health care practitioner being physically present, extending the one year limit within which a medical assistant can work under an interim credential, and to continue to work while a pending application is in effect.
Then: Space for Patients
Home hospitalization? NBC news reports here. Ambulatory surgery centers (ASCs) and hotel rooms as alternative patient care sites? Array (here) studies ASCs. “Breaking down potential ASC Surge Capacity within each Hospital Referral Region (HRR) and state, the model projects that employing ASCs will increase the national potential ICU bed supply by 21 percent and med-surg bed supply by eight percent,” but not enough. The Array firm also maps hotel rooms, which offer “robust technology platforms, proximity to densely populated areas and a planning and space model that make them ideal for either isolating mildly ill people who have been diagnosed with COVID-19, or housing those who have been exposed and should be quarantined.” In the UK, “NHS Nightingale Hospitals,” large scale critical care field hospitals, are being set up, here. And “Where is all the PPE [personal protective equipment]?” asks the AAMC, here.
Scott Gottlieb, Mark McClellan and the American Enterprise Institute release a “Road Map to Reopening,” here.
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Hammer Drops on Hospital Cardiac Care
Medicare’s new policy of paying for percutaneous coronary intervention (PCI, angioplasty) in ambulatory surgery centers will save the government approximately 40% of the cost of those services, compared to hospital outpatient care. The half dozen PCI codes for which payment may now be made may be complemented for 14 additional “high risk” coronary procedures in ASCs, pending finalization of the follow up rule. Modern Healthcare reports (here) that some commercial insurers are already following Medicare, covering both diagnostic and interventional catheterization in ASCs for non-Medicare patients, unless prohibited by state statute. Becker’s ASC Review reports (here) barriers to the migration of cardiology cases from the hospital to the ambulatory surgery center. “Hospitals may advise employed cardiologists against working in competing ASCs. ASCs will need to find and retain experienced catheterization lab staff who are prepared to handle emergencies. Cardiology cases are typically performed in bigger rooms, with longer patient stays. California, Ohio and other states don't support the provision of cardiac procedures in ASCs.” On the other hand, notes Becker’s, “The American College of Cardiology and the Society for Cardiovascular Angiography and Interventions both support the provision of PCIs in the ASC setting.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Beneficiaries of ACO Risk Contracting
Modern Healthcare reveals one beneficiary of CMS moves to compel Accountable Care Organizations to accept financial (as well as business) risk: consultants. See the story, “ACO consultants getting more attractive as downside risk approaches” (here).
READINGS AND REFERENCES
More PPACA at Ten Years: Coverage Up, Costs Up, Measurements of Health Impact Mixed
More commentary on the Patient Protection and Affordable Care Act at 10 years, from the Commonwealth Fund in the New England Journal of Medicine (on payment and delivery system reforms, here; and on coverage and access provisions here). In sum: Medicaid expansion associated with reductions in mortality from cardiovascular causes, end-stage renal disease, all causes, with less progress in birth outcomes. The role of PPACA marketplaces in replacing lost coverage during the COVID-19 epidemic, from the Kaiser Family Foundation, here.
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 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.