DCMedical News: Wednesday, May 13, 2020
DCMedical News-DCMN
Washington, D.C.
Wednesday, May 13, 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 News: (reference pages below under Reading & References)
Tracking by Johns Hopkins shows on 5-12 at 8:00 p.m. EST worldwide 4,255,194 confirmed cases; 291,366 deaths worldwide; 82,246 U.S. deaths (28%).
Bailout Legislation, $3 Trillion
House Democratic leaders unveiled a new round (1815 pgs., text here) of coronavirus bailout proposals. CQ reports “The package would provide funding for state and local governments to cover steep budget shortfalls stemming from pandemic-related economic shutdowns; another round of direct payments to households; enhanced unemployment benefits; nutrition aid for the poor; additional funds for popular small-business loan programs; and more.” The “more” includes a variety of reimbursement-related Medicare proposals, such as placing a “floor” under calculations of wage indices in urban states and making Critical Access Hospitals eligible for the Paycheck Protection Program. These latter provisions are similar in nature (not new money, but lowering some barriers) to that in the CARES Act which suspended the 2% Medicare “sequestration” for the period May 1 through December 31, 2020, to be tacked on the end of sequestration, however, extending the 2% loss period from 2029 to 2030.
Super-Spreading; Case Fatality Rates
CDC’s Morbidity and Mortality Weekly Report has this recap of a March 20 “super-spreading” event in Skagit, Washington:
A two-and-a-half-hour choir practice of 61 persons was followed by 52 cases of COVID-19, three hospitalizations and two deaths. Case fatality rates remain uncertain (report in JAMA, here): “A yet unanswered question that adds to uncertainty around the outbreak involves the case-fatality rate (CFR), defined as the percentage of deaths among all cases. Presently, global mortality is reported at 4.7% but this varies widely by location from a high of 10.8% in Italy to a low of 0.7% in Germany. Several factors influence the CFR including a reliable estimate of the total number of cases.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Cardiovascular Death and Morbidity May Accompany COVID-19, or Follow It
MedPage Today reports (here) on emerging evidence of CV death and morbidity, including the possibility of a post-COVID-19 cardiac syndrome, as well as pulmonary embolism and DVT.
Cardiovascular Mortality Growing Faster in Rural Areas
A study in JAMA (here) notes that, overall, U.S. age-adjusted mortality rates (AAMR) declined from 350.8 in 1999 to 219.4 in 2017. “Rural areas had consistently higher AAMRs than nonrural areas in all subgroups. In all regions, black people had higher AAMRs than other races and males had higher AAMRs than females. In addition, non-Hispanic people had higher AAMRs than Hispanic people” and “The AAMRs declined more slowly in rural areas, resulting in a widening disparity between regions. The absolute difference in the AAMRs between large metropolitan areas and rural areas in 1999 was 24.0 deaths per 100,000 population, which increased in 2017 to 42.8 deaths per 100,000 population.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
LightStrike UV, Not for Internal Use, $140,000 per unit
The Financial Times (here) reports that “A machine that uses ultraviolet light to disinfect hospitals has been shown to deactivate the novel coronavirus in just two minutes . . . The technology has been proven to work against multidrug-resistant bacteria and the Ebola virus . . . The LightStrike robot was also shown to be 99.99 per cent effective in eliminating the coronavirus from N95 masks, which would reduce the risks associated with reusing vital protective equipment amid an acute global shortage. The machines have been introduced in about 500 healthcare facilities worldwide.”
MEDICARE, MEDICAID, AND COMMERCIAL HEALTH INSURANCE
CMS Continues to Waive Requirements and Limitations on Hospitals
CMS has updated (here) its comprehensive guide to waivers for hospital Conditions of Participation, reimbursement and regulation, including the ability to (see portions in red) “Expand hospitals’ ability to offer long-term care services (“swing beds”); Waive distance requirements, market share, and bed requirements for Sole Community Hospitals; Waive certain eligibility requirements for Medicare-Dependent, Small Rural Hospitals (MDHs); and Update specific life safety code requirements for hospitals, hospice, and long-term care facilities.” HFMA guide to waivers through 4-30 here.
Hospital and LTAC Inpatient Prospective Payment System Proposed Rule for FY 21, Continued
The proposed rule (1602 pages, here, CMS fact sheet here), will be published in the Federal Register of May 29. See DCMN 5-12. Comments on the proposed rule are due (see rule for instructions) July 10. The proposed FY 2021 Medicare rule would standardize a new CAR-T payment. STAT reports (here) that the CAR-T payment, currently based on bone marrow transplant costs, would rise to as much as $450,000 per case. “The new policy would reimburse hospitals that provide the therapies based on the average price of administering the two therapies currently on the market, Gilead’s non-Hodgkin lymphoma treatment, Yescarta, and Novartis’ leukemia treatment, Kymriah.”
DRUGS & DEVICES
Drug Political Contributions Chronicled, 1999-2018
An original investigation in JAMA Internal Medicine (here) by an LSE economist found that “From 1999 to 2018, the pharmaceutical and health product industry recorded $4.7 billion—an average of $233 million per year—in lobbying expenditures at the federal level, more than any other industry . . . Of the 20 senators and 20 representatives who received the most contributions, 39 belonged to committees with jurisdiction over health-related legislative matters, 24 of them in senior positions. The industry contributed $877 million to state candidates and committees, of which $399 million (45.5%) went to recipients in California and $287 million (32.7%) went to recipients in 9 other states.”
READINGS & 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 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.