DCMedical News: Thursday, May 14, 2020
DCMedical News-DCMN
Washington, D.C.
Thursday, May 14, 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).
Coronavirus News: (reference pages below under Reading & References)
Tracking by Johns Hopkins shows on 5-13 at 8:00 p.m. EST worldwide 4,342,565 confirmed cases; 296,690 deaths worldwide; 84,059 U.S. deaths (28%).
Bailout Legislation, $3 Trillion
House Democratic leaders plan a vote tomorrow on a new round (1815 pgs., text here) of coronavirus bailout proposals. This bill has an additional $100 billion for hospitals and medical providers. Questions have been raised (e.g. here, and here) concerning distribution of $175 billion from the CARES and Paycheck Protection bills, much of which apparently went to wealthier hospitals with limited COVID-19 stress, and to investor-owned hospital chains. An additional $75 billion in the bill is proposed for testing, as well as new responsibility for HHS in determination of appropriate testing levels.
Science and Treatment
Testing: Abbott announced (here) “FDA EMERGENCY USE AUTHORIZATION FOR COVID-19 ANTIBODY BLOOD TEST ON ALINITY™ I SYSTEM,” claiming “reliable results with 99.6% specificity and 100% sensitivity for patients tested 14 days after symptoms began.” The company plans to ship 30 million antibody tests globally in May, 60 million in June.
BCG (Bacillus Calmette–Guérin, a TB vaccine) no help, says this study in JAMA, where the data “does not support the idea that BCG vaccination in childhood has a protective effect against COVID-19 in adulthood.” Likewise chloroquine with Z-packs, in the NEJM, here: “Two retrospective studies of COVID-19 patients in New York found no impact of hydroxychloroquine with or without azithromycin on risk of intubation or death.”
Children: In the Lancet (here), a report from Bergamo, Italy, finding “a 30-fold increase in Kawasaki-like disease during the region's novel coronavirus (COVID-19) outbreak.” The finding adds to evidence linking COVID-19 to "pediatric multisystem inflammatory syndrome" being identified frequently in New York, with three deaths to date.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Immigrants Out, Doctor Immigrants In
The Department of Homeland Security has issued a memo (here) allowing immigrant doctors serving in H1-B shortage areas to also provide telehealth services and medical care, but only in the same state as their H1-B commitment. “For those foreign medical graduates currently employed by an IGA [an Interested Government Agency] or through the Conrad State 30 program, USCIS [U.S. Citizenship and Immigration Services] interprets current regulations to allow those physicians to provide telehealth services during the Public Health Emergency.” The AMA had urged (letter here) similar but broader action, noting “The U.S. health care workforce relies upon health professionals and scientists from other countries to provide high-quality and accessible patient care." CQ reports that “More than 10,000 foreign medical residents are currently in the country on special J-1 and H-1B visas, according to the Association of American Medical Colleges.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
International COVID Resource Comparisons Continue
Japanese hospitals, according to this report in the Financial Times, are often small and underequipped, growing out of physician owned hospitals, not unlike new hospitals in the American South and West after World War II. “These smaller hospitals do not have the resources to run an intensive care unit or maintain negative pressure rooms for infectious diseases. What is more, accepting Covid-19 patients puts everything else they do in jeopardy, and so many refuse to treat them.” Japan has approximately five times as many “regular” hospital beds as the U.S. per capita, according to the story, but one quarter the number of intensive care unit beds. The American Hospital Association has reported (here) an estimated $50 billion per month loss for American hospitals, part from the loss of scheduled and elective procedures, part from the skyrocketing cost of scarce supplies. The U.S. Bureau of Labor Statistics reports (here) 245,000 jobs lost in hospitals in nursing homes between March and April, 2020 (3%), a half million more in outpatient settings.
MEDICARE, MEDICAID, AND COMMERCIAL HEALTH INSURANCE
CMS Continues to Waive Requirements and Limitations on Hospitals, Updated
CMS has updated through May 11 (here) its comprehensive guide (40 pages) to waivers for hospital Conditions of Participation, reimbursement and regulation. The HFMA guide to waivers through 4-30 is here.
IPPS Proposed Rule: now has its own “home page,” here.
Block Grant Flexibility Brings the Corruption Closer to Home
A report by the Mississippi State Auditor (here) calls into question “block grant” flexibilities for the states. “In 1996, the TANF [Temporary Assistance for Needy Families] program converted the old federal welfare system, in which cash benefits to poor families were deemed an entitlement, to a system of block grants issued to the states. The new program… gave each state much more leeway on how to spend the money,” according to this report in the New York Times. “Two nonprofit groups [used] the money on lobbyists, football tickets, religious concerts and fitness programs.”
READINGS & REFERENCES
David Cutler and colleagues (here) reflect on the “Business of Medicine in the Era of COVID-19.” They conclude, “The new normal may be not as recognizable as some think . . . It is possible, perhaps likely, that the painful process of reaching a new health care equilibrium will last well into 2021.” Brief but useful bibliography.
IQVIA Reports: the (drug) data company publishes “Shifts in Healthcare Demand, Delivery and Care During theCOVID-19 Era,” here.
NEJM Catalyst publishes younger scholars (here) on “Best Practices for a Covid-19 Preparedness Plan for Health Systems.” Those practices include “(1) mitigating local transmission; (2) conserving, supporting, and protecting staff; (3) eliminating nonurgent strains on the system; and (4) coordinating communication.”
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 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.