DCMedical News: Tuesday, April 28, 2020
DCMedical News-DCMN
Washington, D.C.
Tuesday, April 28, 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 House and Senate will both be in session on May 4.
THE BIG STORY IN HEALTH CARE
Coronavirus
Tracking by Johns Hopkins shows on 4-27 at 8:00 p.m. EST worldwide 3,036,770 confirmed cases; 210,804 deaths; 5,593,495 tests in the U.S. Total deaths in the U.S. (CDC, as of 4-26), 53,922, 26% of the world total.
Coronavirus News:
COVID-19 and the Cost of U.S. Health Care
Sherry Glied, Dean of the Wagner School at NYU, writes in JAMA this week (here) that a declining GDP and increasing health costs mean that the percentage of GDP devoted to health care will rise. How much? “In other words, health care spending would increase by 3.7 percentage points, from 17.7% of GDP to 21.4% of GDP, in a single year. This 1-year change would be nearly twice as large as the 10-year forecast provided by the CMS actuaries just before the pandemic happened. Even if the decline in GDP is just 2.4%, reflecting an economy that moves quickly in the fall to make up ground lost in the spring, health care would comprise 20% of GDP next year, well above the amount projected for 2028.”
A separate approach, based on estimated costs and hypothetical incidence of treatment, is (advance) published in the June Health Affairs, here. The CUNY/UCLA group report finds “A single symptomatic COVID-19 infection would cost a median of $3,045 in direct medical costs incurred only during the course of the infection. Eighty percent of the U.S. population getting infected could result in a median of 44.6 million hospitalizations, 10.7 million ICU admissions, 6.5 million ventilators used, and 249.5 million hospital bed days, costing $654.0 billion in direct costs over the course of the pandemic. If 20% were to become infected, there would be a median of 11.2 million hospitalizations, 62.3 million hospital bed days, and 1.6 million ventilators used, costing $163.4 billion.”
Just What is the Number of Deaths Due to COVID-19?
A study in the Financial Times (here) focuses on total mortality and finds that the death toll from the coronavirus could be 60% higher than that being reported. A key difference: total deaths (“all-cause mortality”), versus the smaller figure of deaths in patients in hospitals with COVID-19 diagnosis. “FT has compared deaths from all causes in the weeks of a location’s outbreak in March and April 2020 to the average for the same period between 2015 and 2019. The total of 122,000 amounts to a 50 per cent rise in overall mortality relative to the historical average for the locations studied. In all the countries analysed except Denmark, excess deaths far outnumbered the official coronavirus death tolls. The accuracy of official death statistics from the virus is limited by how effectively a country is testing people to confirm cases.” Statista shows the result graphically, here, with New York City, for example, showing 299% increase in all-cause deaths in March and April 2020 compared to the same periods 2015-2019.
WHO Steps in on Immunity Passport Discussion
The World Health Organization published a paper (here) noting that “Some governments have suggested that the detection of antibodies to the SARS-CoV-2, the virus that causes COVID-19, could serve as the basis for an ‘immunity passport’ or ‘risk-free certificate’ that would enable individuals to travel or to return to work assuming that they are protected against re-infection. There is currently no evidence that people who have recovered from COVID-19 and have antibodies are protected from a second infection.”
Financial Calamity Stalks the Hospital Industry, Continued
Utilization:
The Los Angeles Times asks (here), “Where are the heart attacks?” and strokes, and other patients needing hospitals? The Journal of the American College of Cardiology (here) asks, “Where is the cath lab volume?” The Miami Herald reports (here) that Florida’s Governor joins the state’s doctors in urging patients to return to hospitals. The Commonwealth Foundation (here) found that visits to ambulatory practices declined 60% in mid-March, and remains low through mid-April, greatest in New England and the mid-Atlantic states. Telehealth visit increases partially offset the drop in outpatient visits, account now for nearly 30% of all visits to ambulatory practices. The biggest decline came with surgical and procedural specialties, translating (in the future) into fewer hospital-based imaging, surgery and inpatient admissions. And that is, of course, if you have health insurance; Commonwealth also studies “health coverage insecurity” (here).
Finance:
The Supreme Court announced that the Moda/Lincoln/Maine risk adjustment cases were wrongly decided in favor of the government in lower courts. Now (decision here, briefs by the parties here and here) health insurance companies are projected to be owed $12 billion in “risk corridor” payments under PPACA. CQ reports that “The victory comes too late for many of the small consumer-operated and oriented plans, or CO-OPs, which were intended to give consumers a low-cost, nonprofit option. Many shuttered their doors while they waited for the federal government to provide the promised payments.” The CO-OPs were (in the scramble for 60 votes in the Senate in 2010), a bow in the direction of Senator Kent Conrad, ND. They were to be nonprofit, entirely separated from commercial health insurers and capitalized entirely through debt, an echo of cooperatives in the Depression which remain fondly remembered in the American Midwest.
In its rush to “push out” money from the CARES Act and PPP legislation, HHS sent some to closed hospitals; calculated the amounts sent in proportion to net revenue (not “COVID-related need”); and simultaneously pulled back (from Part B providers) a $100 billion advance payment loan program. “This simple formula used the data on-hand to get the money out the door as quickly as possible.” But also, in March “CMS announced a program of Medicare Advanced/Accelerated Payments that provided expedited funding to Medicare Part A and Part B providers based on their previous year's Medicare billing information.” Now CMS has announced that it is suspending this program immediately.
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
An Old but Important Business: Leave No Objects Behind
The Veterans Health Administration completed a study (here), published in the Journal of Patient Safety, on “surgical count technologies” to detect “retained surgical items” (RSI). They found that “Acquisition of surgical count technology did not significantly improve RSI rates,” citing “human factors, failure to follow policy/procedure, and communication.”
MEDICARE, MEDICAID, AND COMMERCIAL HEALTH INSURANCE
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 29, 30
May 4, 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.