DCMedical News: Tuesday, May 12, 2020
DCMedical News-DCMN
Washington, D.C.
Tuesday, May 12, 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 5-11 at 9:00 p.m. EST worldwide 4,168,427 confirmed cases; 285,690 deaths worldwide; 80,351 U.S. deaths (28%). Johns Hopkins tracking project profiled in Monday’s Wall Street Journal (here).
Coronavirus News:
Projections for U.S. Deaths: The Economist (here) reports that “The South is likely to have America’s highest death rate from COVID-19.” The article focuses on testing protocols locally and projections of high case-fatality rates (CFRs). Age, diabetes, heart disease and smoking push CFRs higher. “If COVID-19 does infect most Americans, the highest death rates will probably not be in coastal cities—whose density is offset by young, healthy, well-off populations and good hospitals—but rather in poor, rural parts of the South and Appalachia with high rates of heart disease and diabetes.”
Immunizations for children are down, according to a new Morbidity and Mortality Weekly Report (here), by 2.5 million doses.
Cancer research is down: STAT reports that the “American Cancer Society [ACS] finds that more than half of [cancer researchers] have had to put their projects on hold due to COVID-19. The ACS got responses from nearly 490 of its almost 750 funded scientists, and 51% of respondents said that the crisis has had ‘a high impact’ on their work, meaning that any research or training activities have been paused until further notice.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
“Ventilator Use Scaled Back”
The Wall Street Journal (front page, here) profiles experiences and studies demonstrating overuse of ventilators in the treatment of COVID-19 patients, and poor outcomes.
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Hospital and LTAC Inpatient Prospective Payment System Proposed Rule for FY 21 Published
The proposed rule (1602 pages, here, CMS fact sheet here), will be published in the Federal Register of May 29. It will provide potential additional increases of $1.9 billion for “value-based” incentive payments, and $534 million less for uncompensated care. Long-Term (Acute) Care Hospitals (LTACs) would receive $36 million less in FY2021; the 360 LTACS have 100,000 Medicare admissions per year, with payment of approximately $40,000 per case. The proposed FY 2021 Medicare rule would also standardize a new CAR-T (cell therapy for, e.g., multiple myeloma) payment. Comments by July 10, continuing coverage of the proposed rule this week in DCMN.
Federal CARES Act Implementation
The Health Resources and Services Administration (HRSA) has created a web site (here) devoted to “Frequently Asked Questions for Coronavirus Aid, Relief, and Economic Security (CARES) Act Provider Relief Fund, Claims Reimbursement to Health Care Providers and Facilities for Testing and Treatment of the Uninsured.”
Federalization of the Supply Chain Continues, with Mixed Results
HHS has announced (here) its allocation plan for the drug remdesivir, donated by Gilead Sciences. The drug received an Emergency Use Authorization from the FDA for use with hospitalized COVID-19 patients. HHS has chosen the state health departments as intermediaries for distribution of the doses to end user hospitals. According to this report in the Boston Globe, “Four local hospitals, including Massachusetts General Hospital (MGH), received the drug this week while nearby health care centers with hundreds of hospitalized patients, such as Beth Israel Deaconess (BI) Medical Center and Boston Medical Center (BMC), didn’t receive any.”
MEDICARE, MEDICAID, AND COMMERCIAL HEALTH INSURANCE
Medicaid Rate Bump for Hospital COVID Preparation, Recovery
Hospitals in New Mexico have received an increase in inpatient hospitalization rates under that State’s Medicaid program, up to a 50% increase for ICU patients, according to the Albuquerque Journal (here). The increase is in addition to the CARES and PPP federal funds, through a waiver requested by the State early in pandemic planning. It is retroactive to April 1 and will continue as long as the federal emergency declaration. The rate increase will apply to all Medicaid patients, not only those with diagnosed COVID-19. Forty percent of New Mexico residents are enrolled in the Medicaid program; 70% of hospital births in New Mexico are paid for through Medicaid, the highest percentage in the nation.
Commercial Insurance Discounts, Credits
UnitedHealth Group has offered discounts and credits toward premiums and suspension of some co-payment and deductible charges for physician office visits. The premium credits (see Wall Street Journal, here) amount to 5% - 20% to employers and individuals; a portion of the payments represent an “advance against rebates that will likely be required under the Affordable Care Act.” The Journal coverage notes “Analysts are expecting huge savings – and rich profits – for insurers in the second quarter due to sharp drop-off in claims for health-care services.” CVS Health has seen a 30% drop in the use of health care services in its Aetna unit in April. Humana announced that it would waive cost-sharing on primary care, behavioral health and telehealth visits by its Medicare members for the rest of the year.”
DRUGS & DEVICES
FDA Approves COVID-19 Antigen Test, $5, 5 Minutes
The Emergency Use Authorization (here) was the first granted by the Food & Drug Administration for a COVID-19 antigen test. A possible “return to work breakthrough,” the test would utilize the Sofia machines already installed in more than 40,000 physician offices for testing strep throat and flu. There is a higher chance of false negatives (15%), with a positive test requiring a follow up polymerase chain reaction (PCR) test, for virus genetic material, taking 24 hours.
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 and real-time dashboard to monitor clinical trials, here. State actions, Kaiser Family Foundation, here. UC Hastings College of Law’s “The Source” COVID-19 page, 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
May 13, 14, 15, 18, 19, 20, 21
June 1, 2, 3, 4, 9, 10, 11, 12, 15, 16, 17, 18, 23, 24, 25, 26
July 21, 22, 23, 24, 27, 28, 29, 30, 31
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.