DCMedical News: Wednesday, April 22, 2020
DCMedical News-DCMN
Washington, D.C.
Wednesday, April 22, 2020
DCMedical News is published every day both the House and the Senate are in session. DCMN publication will follow the CQ 2020 Calendar of Regularly Scheduled Sessions (below).
THE BIG STORY IN HEALTH CARE
Coronavirus
Tracking by Johns Hopkins shows on 4-21 at 8:00 p.m. EST worldwide 2,561,044 confirmed cases; 176,984 deaths; 4,155,178 tests in the U.S.
Public Health Resource Pages on Coronavirus (this section moved below, under “Readings and References”)
Coronavirus News:
The Senate passed a fourth coronavirus bailout bill, text here, $383 billion for small businesses, $100 billion for hospitals and funding for expanded coronavirus and antibody testing capacity. A vote in the House is expected Thursday; the President has expressed his support.
Of the $100 billion total, a $75 billion public health and social services emergency fund is described beginning pg. 7 of the bill, “to prevent, prepare for, and respond to coronavirus, domestically or internationally, for necessary expenses to reimburse, through grants or other mechanisms, eligible health care providers for health care related expenses or lost revenues that are attributable to coronavirus.”
An additional $25 billion is provided through language beginning on pg. 10, “to prevent, prepare for, and respond to coronavirus, domestically or internationally, for necessary expenses to research, develop, validate, manufacture, purchase, administer, and expand capacity for COVID–19 tests . . . including tests for both active infection and prior exposure, including molecular, antigen, and serological tests, the manufacturing, procurement and distribution of tests, testing equipment and testing supplies,” with $11 billion in set asides for the states, and $1 billion for research under the Biomedical Research and Development Authority, whose director, according to STAT, has been moved to another post.
The National Institutes of Health issued guidelines for coronavirus treatment (text here, news release here)
The panel “does not recommend any drug for pre- or post-exposure prophylaxis outside of clinical trials. It does not make a recommendation for specific antiviral or immunomodulatory treatments, as no drug has been proven to be safe and effective. The panel does provide rationale for use of certain therapies under investigation, as well as a summary of studies on these treatments. It comes out against use of hydroxychloroquine plus azithromycin outside of clinical trials because of the toxicity risk, as well as against lopinavir/ritonavir or other HIV protease inhibitors because of negative clinical trial results and unfavorable pharmacodynamics. The panel also recommends against interferons and Janus kinase inhibitors. The group recommends against use of systemic corticosteroids for mechanically ventilated adults with COVID-19 who don't have acute respiratory distress syndrome (ARDS). It prefers low-dose corticosteroids over no corticosteroids in patients with refractory shock.”
DOCTORS, NURSES AND OTHER HEALTH CARE PROFESSIONALS
Universal Basic Income for Doctors
More than 150 physician organizations (here) wrote to HHS Secretary Azar: “Specifically, we urge HHS to provide one month of revenue to each physician (MD or DO), nurse practitioner, and physician assistant enrolled in Medicare or Medicaid to account for financial losses and non-reimbursable expenses. HHS should use an individual’s average monthly payment amount from October-December 2019, which has been provided to the Medicare Administrative Contractors (MACs), as the basis for determining pre-pandemic monthly revenue. For most specialties, Medicare patients account for 35% of all patients, so to extrapolate to all patients, HHS should use three times the October-December 2019 average as the basis for issuing a payment. Certain specialties have fewer Medicare patients and should be adjusted upward accordingly: psychiatry (20%), allergy/immunology (15%), obstetrics/gynecology (15%), and pediatrics (5%).” Within days, $30 billion went to physicians (here).
Outpatient Care in Coronavirus Time
Five academic physicians describe “Rapidly Converting to ‘Virtual Practices’: Outpatient Care in the Era of Covid-19,” in NEJM Catalyst, here. The alternative is massive job loss in the outpatient sector, here. In a New York Times column (here), discussion of safety net clinics concludes “Just When They’re Needed Most, Clinics for the Poor Face Drastic Cutbacks.” The FDA has approved LabCorp’s home coronavirus test (here), called Pixel, a nasal swab requiring a doctor’s order, mailed in, for $119, but may not be as accurate as the “long swab” (up through the nasal passage to the back of the throat).
“How Private-Equity Firms Squeeze Hospital Patients for Profits” in The New Yorker, here.
The report says, “The patchwork structure of the health-care industry creates an opportunity for private-equity firms to make money, often at patients’ expense.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Where are the Heart Attacks?
Yale’s Harlan Krumholz asks, “Where Have All the Heart Attacks Gone? Except for treating Covid-19, many hospitals seem to be eerily quiet,” here.
MEDICARE, MEDICAID, AND COMMERCIAL HEALTH INSURANCE
Insurance Coverage Does Not Translate into Primary Care Coverage
An infographic from HHS (here) says “Increased access to health insurance has not led to an increase in persons with a regular primary care provider, particularly among younger patients.”
READINGS AND REFERENCES
Coronavirus References:
AMA resource page for physicians here. AMA guide to medical education and COVID-19, here. American Public Health Association information here. Association of American Medical Colleges Clinical Guidance Repository, here. CDC information page here. CMS (Centers for Medicare & Medicaid Services) Current Emergencies website, here. Council of State Governments, 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.
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 27, 28, 29, 30
May 12, 13, 14, 15, 18, 19, 20, 21
June 1, 2, 3, 4, 9, 10, 11, 12, 15, 16, 17, 18, 23, 24, 25, 26
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.