DCMedical News: Wednesday, April 29, 2020
DCMedical News-DCMN
Washington, D.C.
Wednesday, April 29, 2020
DCMedical News is published every day both the House and the Senate are in session and on pre-pandemic Regularly Scheduled Session days (see CQ calendar, below).
THE BIG STORY IN HEALTH CARE
Coronavirus
Tracking by Johns Hopkins shows on 4-28 at 9:00 p.m. EST worldwide 3,114,659 confirmed cases; 216,989 deaths; 5,795,728 tests in the U.S. Total deaths in the U.S. (CDC, as of 4-28), 55,258, 25% of the world total.
Coronavirus News:
Curve flattening in leading states, Statista graphic here. Country impact, Statista here.
EmergencyMedicineCases (Canada, here) provides a summary of current clinical treatment, health care worker protection, outcomes. But the Infectious Disease Society of America (here) says “There is currently insufficient evidence to recommend any particular medication for treatment of COVID-19.”
CDC prepares new guidelines (here) for return to work. The Administration hopes that Walmart, Walgreens, CVS and other pharmacies will step into testing; Indiana hires UnitedHealth for that state’s expanded testing efforts.
Financial Calamity Stalks the Hospital Industry, Continued
Federal Financial Support for Health Services:
CARES: Now you see it (air ambulances not eligible for federal financial support, HRSA website for CARES funds on 4-23-2020, here), now you don’t (air ambulances no longer on the prohibited list, HRSA website 4-28-2020 here). Bloomberg Health and Law reports that “The Trump administration reversed its decision to deny air ambulance companies access to coronavirus relief money over the weekend, a move the industry says is needed as it experiences a drop in air medical transports.” The industry, with major companies now largely owned by private equity firms, has been criticized for “surprise” bills (here, here and here) which are extraordinary even by U.S. health cost standards.
Utilization:
A KaufmanHall report (here) says “Across-the-board volume declines were a major contributor to the steep decline in [hospital] margins, as providers postponed elective procedures to free capacity and equipment for COVID-19 patients, and as individuals cancelled appointments for fear of contracting or unwittingly spreading the virus. Operating Room minutes were down nearly 20% compared to the same period last year and were more than 25% below budget. These cancellations drove significant declines in revenues, as hospitals rely on income from scheduled procedures—such as joint replacements and nonemergent heart surgeries—to balance losses from many other acute care services. March revenues fell 13% compared the same period last year, and were significantly below budget expectations, 13% lower than budget for inpatient revenue and 17% lower than budget for outpatient revenue.” The Boston Globe reports (here) on another report “from Harvard University researchers, shows outpatient visits across the country declined 60 percent in mid-March and stayed low through April.” The Healthcare Financial Management Association (here) reports “dire” hospital losses. A columnist for the New York Post (here) says “We’re destroying hospitals in the name of fighting the coronavirus.”
Community Health Systems reports (here) first quarter admissions down 13% (“same store” down 5%), cash flow from operations down 57%, EBITDA down 21%, despite $240 million tax benefit from CARES.
Finance:
The Urban Institute proposes (here) a means through which health services and States would both benefit—increase the “Medicaid match” percentage paid by the federal government for State Medicaid programs.
Health insurers continue to prosper from reduced health services utilization; Anthem reports this morning (here) with consensus estimate of revenue up 17%, earnings per share up 7%, year over year. Humana will also report today with consensus estimates (here) of EPS up 5%, revenue up 15%. Hospitals are looking for help from health insurers, here. Some companies are responding, here.
CARES provider relief program provisions, summarized by HHS, here. The Greater New York Hospital Association on other emergency funds for hospitals, here.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Doctors Looking for Reinstatement of Advance Payment Program, STAT
Cessation of the Advance Payment Program by CMS has brought widespread dismay and protest, sample letter here from AMGA (fka the American Medical Group Association). Says the group’s President, “Integrated health systems also report financial distress related to COVID-19. Our survey found 40% of respondents say revenue has declined by more than half, with nearly all reporting declines of 25% or more. In addition, 55% report having less than six months of cash on hand. Our members also reported that the initial $30 billion released as part of the $100 billion in relief funding provided less than a week’s revenues for health systems. The APP offered a bridge for our members until their operations begin to recover from the cancellation of surgeries and elective procedures that have so significantly reduced their revenues that their survival is far from certain.”
READINGS AND REFERENCES
The first description of novel coronavirus, from the BMJ (known then as the British Medical Journal), in 1965, here.
Siddhartha Mukherjee in The New Yorker on what the coronavirus pandemic reveals about the American medical system, here.
Statista on swords to health care plowshares, here: the cost of a frigate = training 10,662 general practitioners, one F-35 fighter jet = 3,244 ICU beds.
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 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.