DCMedical News: Monday, April 27, 2020
DCMedical News-DCMN
Washington, D.C.
Monday, April 27, 2020
DCMedical News is published every day both the House and the Senate are in session. DCMN publication will follow the pre-pandemic Calendar of Regularly Scheduled Sessions (below).
THE BIG STORY IN HEALTH CARE
Coronavirus
Tracking by Johns Hopkins shows on 4-26 at 8:00 p.m. EST worldwide 2,964,543 confirmed cases; 206,055 deaths; 5,441,079 tests in the U.S. Total deaths in the U.S. (CDC, as of 4-25), 52,459.
Coronavirus News:
Is Testing Helpful in Limiting Coronavirus Transmission?
A report from researchers at the Imperial College of London (here) says “Widespread PCR [point-of-care] testing in the general population is unlikely to limit transmission more than contact tracing and quarantine based on symptoms alone, but could allow earlier release of contacts from quarantine. Immunity passports based on tests for antibody or infection could support return to work but face significant technical, legal and ethical challenges. Testing is essential for pandemic surveillance but its direct contribution to the prevention of transmission is likely to be limited to patients, HCWs [health care workers] and other high-risk groups.”
Financial Calamity Stalks the Hospital Industry
HHS has announced (here) its protocol for distribution of additional hospital bail-out funds. The agency (frequently) summarizes (example here) regulatory relief and waivers attempting to expand services by lowering its own bureaucratic barriers. But government cash is not moving in as quickly as hospitals are losing money; see reports from NPR here, USA Today here, Wall Street Journal, here. HCA announced declines in volume and profit and a dividend suspension (here). Private equity firm Cerberus—in a repeat of its 2008 performance in obtaining government funding for the bailout of Chrysler—told one community (here) it would close their hospital if it did not receive state money.
Adding to anecdotal evidence, CIGNA has reported (here) evidence of dramatic decline in hospital inpatient claims and in preauthorization for future admissions for hospital inpatient care. The report indicates that, in addition to “elective” procedures there are significant drops in hospitalization for cardiovascular, gastrointestinal, neurologic and other conditions (see also Krumholz, “Where Have All the Heart Attacks Gone?” NYT 4-6-2020, DCMN 4-22).
Some hospitals have had the resources to be generous to front-line workers (Northwell example, here), while staff in others have resorted to GoFundMe pages for PPE (story here, GFM page here).
Perspective
Coronavirus is now the leading cause of death in Los Angeles County, according to this report from the Los Angeles Times.
Radiology Volume
AuntMinnie.com (radiology blog, here) reports that “Radiology procedure volume in the U.S. is down 50%-55% due to the effects of the COVID-19 outbreak. But the good news is that the decline appears to have stabilized, according to new statistics from market research firm Quinsite.” The report continues, “Hardest hit has been mammography, with a decline of 77.8% compared with the start of the pandemic. Next is MRI, with volumes down 46%, ultrasound down 43.3%, and x-ray down 41.8%.” Telemammography may not be ready for prime time, as AuntMinnie reports here, but is well-suited for “screening and noncomplex diagnostic indications.”
The (Federal, Economic) Cost of all This
CBO has issued revised economic projections for the year (summary here). “In the second quarter of 2020, the economy will experience a sharp contraction . . . Inflation-adjusted gross domestic product (real GDP) is expected to decline by about 12 percent during the second quarter, equivalent to a decline at an annual rate of 40 percent for that quarter. The unemployment rate is expected to average close to 14 percent during the second quarter. . . The federal budget deficit is projected to be $3.7 trillion. Federal debt held by the public is projected to be 101 percent of GDP by the end of the fiscal year.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Information Blocking and Patient Access to EMR/EHR Records
EPIC has backed off its strident opposition (e.g., here) to new rules allowing patients access to their own electronic medical record information. The Office of the Inspector General of HHS announced a proposed new rule (here, news release here) opposing “information blocking,” and imposing Civil Monetary Penalties for prohibited blocking activity. The announcement said “The proposed information blocking enforcement regulations are intended to help improve coordination within the health care system and patients' access to their health care data by addressing the negative effects of information blocking. OIG is seeking comment on when information blocking enforcement should begin.” In addition, “In the proposed rule, OIG provides examples for how it would determine single or multiple violations of the information blocking provision for individuals and entities subject to OIG's CMPs, such as health information technology developers. Additionally, OIG explains that information blocking determinations require determining if actors had the right level of intent.” [Italics added.]
Surprise Bills Can be Experienced in Ambulatory Surgery Centers, as Well as in Hospitals
Unpleasant and expensive “surprise” bills may hit patients treated in ambulatory surgery centers, as well as in hospital emergency and operating rooms, according to this report in Health Affairs. “We analyzed 4.2 million ASC-based episodes of care in 2014–17, involving 3.3 million patients enrolled in UnitedHealth Group, Humana, and Aetna commercial plans. One in ten ASC episodes involved out-of-network ancillary providers at in-network ASC facilities . . . The average balance per episode increased by 81 percent, from $819 in 2014 to $1,483 in 2017. Anesthesiologists (44 percent), certified registered nurse anesthetists (25 percent), and independent laboratories (10 percent) generated most potential surprise bills.”
READINGS AND REFERENCES
Coronavirus Public Health Resources and 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 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.