DCMedical News: Wednesday, April 1, 2020
DCMedical News-DCMN
Washington, D.C.
Wednesday, April 1, 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 3-31 at 8:00 p.m. EST worldwide 856,955 confirmed cases, 187,919 in the U.S.; 42,107 deaths; 178,034 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 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.
News, Medical:
The Financial Times reports on shortages of drugs associated with ventilator use (here): “There was a 51 per cent increase in demand for sedatives and anaesthetics in March, compared to the same period in January, before the coronavirus pandemic hit the US. Now, only 63 per cent of these orders have been fulfilled. For analgesics . . . painkiller, demand rose by 67 per cent. Orders for neuromuscular blockers, which relax muscles, rose 39 per cent.” Just in time, the NEJM published a study this week (here) which found that “nonsedation during invasive mechanical ventilation [it] can lead to more ‘active’ or alert patients, possibly contributing to the higher rate of self-extubations.”
News, Medical Regulation:
CMS alerts describing extraordinary hospital regulatory changes (March 13, here; 180+ telehealth services, here; additional pay issues March 30, here) include eliminating the 25 bed cap for Critical Access Hospitals and modifying or eliminating professional supervision requirements. The Public Health Service issued 43 pages of guidance (here) on if, when and how one ventilator can be used for the care of two patients simultaneously.
Late Tuesday CMS unveiled proposed COVID services regulations (229 pgs., here) for publication in the April 6 Federal Register to provide regulatory flexibility for Part B providers, so that “Physicians and other practitioners, home health and hospice providers, inpatient rehabilitation facilities, rural health clinics (RHCs), and federally qualified health centers (FQHCs) are allowed broad flexibilities to furnish services using remote communications technology . . . also altering the applicable payment policies to provide specimen collection fees for independent laboratories collecting specimens from beneficiaries who are homebound or inpatients (not in a hospital) for COVID-19 testing. . . [and] also expanding, on an interim basis, the list of destinations for which Medicare covers ambulance transports under Medicare Part B.”
News, General:
The CDC is considering asking/requiring the general public to wear masks outdoors, story in the Washington Post, here. Bettering Wuhan’s hospital building record by one day: the Financial Times reports (here) that 3500 beds in “NHS Nightingale, the UK’s largest hospital, is due to open this week in London’s Docklands just nine days after military logistics teams were first scrambled to build a new facility for coronavirus patients.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Out-of-Network But Not Out-of-Hospital
Cooper and colleagues report (Health Affairs, here) that at in-network hospitals, 12% of anesthesiology, 12% of pathology, 5.6% of radiology, and 11% of assistant surgeons were all billed out-of-network, allowing “these specialists to negotiate artificially high in-network rates.” The out-of-network billing was “more prevalent at hospitals in concentrated hospital and insurance markets and at for-profit hospitals.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Comprehensive Care for Joint Replacement, Three-Year Extension, Comments by April 20
The four-year anniversary of the “Mandatory Bundled Payment Initiative” is today. The current experiment is scheduled to end December 31 this year. The Comprehensive Care for Joint Replacement Model is the subject of a proposed rule (here) which would change the definition of the “episode of care” to now include outpatient hip and knee replacements. Among other changes, CMS is addressing the “inpatient-only list” that now allows for total knee and hip replacements to be treated in the outpatient setting. The proposal seeks to extend the model for three years, through the end of 2023. The comments period is open until April 20th.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
MedPAC Sends Recommendations to Congress, Baffled by 340B Program
The Medicare Payment Advisory Commission (MedPAC) has sent its annual package of payment recommendations to Congress and to the Department of Health and Human Services (full report here, executive summary here, press release here). In a report on the 340B drug discount program the panel noted that it could not determine what hospitals actually pay for drugs under the program, nor could it determine what mark-up or final reimbursements were. Other proposals from MedPAC to Congress were to increase payments to acute care hospitals by as much as 3.3% in 2021, but to maintain the current pay freeze for physicians.
Department of Justice Trips Up Anthem on MA “Risk” Score Fraud
The U.S. Department of Justice has sued Anthem for ‘puffing up’ the illness of Medicare Advantage (MA) beneficiaries, fraudulently collecting millions of dollars. Anthem allegedly added diagnostic codes (co-morbidities) to already-submitted bills, as part of the controversial “risk adjustment” program allowed to Medicare Advantage plans. The Department took issue with Anthem not also subtracting, that is, not removing inaccurate diagnostic codes that would have reduced revenue.
The government outlines in detail Anthem’s actual practices. “To persuade providers to supply records for review, Anthem told providers that Anthem’s chart review process was an ‘oversight activity’ that ‘will help ensure that the ICD9 codes have been reported accurately’ and in accord with ‘proper coding guidelines.’ That was not true.” Anthem did not have to deceive all providers, however, since some providers were sharing the proceeds. In so-called “capitated reimbursement” relationships, “Anthem shared a percentage of its Medicare Part C risk adjustment payments with the contracted providers.” The 52-page Complaint (here) includes communications from Anthem’s three dozen subsidiaries to physicians, which Anthem claimed were confidential since they contained “protected health information subject to HIPAA,” also not true.
READINGS AND REFERENCES
FAIR Health on the Cost of COVID Healthcare
FAIR Health was a creation of then-NY Attorney General (now NY Governor) Andrew Cuomo, with funds coming from the settlement of NY’s case against commercial insurers for their deception in underpayment of physician bills. The FAIR Health report on COVID health expenses (here) projects $558 billion in payments for inpatient services for COVID patients, an average of $38,221 per commercially insured patient.
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
April 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.