DCMedical News: Friday, May 15, 2020
DCMedical News-DCMN
Washington, D.C.
Friday, May 15, 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 5-14 at 8:00 p.m. EST worldwide 4,434,590 confirmed cases; 301,917 deaths worldwide; 85,807 U.S. deaths (28%).
Bailout Legislation, $3 Trillion, House Votes Today
House Democratic leaders plan a vote on a new round (1815 pgs., text here) of coronavirus bailout proposals. CQ reports that “The House Rules Committee voted along party lines Thursday night to send to the floor a rule for consideration of the $3 trillion coronavirus bill and a resolution to change House rules to allow for proxy voting and remote committee proceedings. The rule, approved 8-4, would provide for consideration of a bill that would provide almost $916 billion in direct aid to state and local governments and additional funds for aid to hospitals and for national testing. The measure would also provide assistance for the U.S. Postal Service and to prepare for the November elections.”
This bill has an additional $100 billion for hospitals and medical providers. The Kaiser Family Foundation found (here) that much of the CARES Act money has gone to higher profit hospitals. The first $50 billion was sent to hospitals with highest net revenue, more likely to be non-teaching and for-profit. “The hospitals in the top 10% … received $44,321 per hospital bed, more than double the $20,710 per hospital bed for those in the bottom 10% of private insurance revenue.” The distribution accentuated the advantage of monopolist (“must have” in a commercial health insurance network) hospitals: “These hospitals’ large share of private reimbursement may be due either to having more patients with private insurance or charging relatively high rates to private insurers or a combination of those two factors. All things being equal, hospitals with more market power can command higher reimbursement rates from private insurers and therefore received a larger share of the grant funds under the formula HHS used.”
CDC Re-Opening, Toned Down
Detailed re-opening guidelines were issued by the CDC (here).
Science and Treatment
Testing: a report in the Annals of Internal Medicine (here) on a test often used to “rule out” infection among high risk patients cautions that “Care must be taken in interpreting RT-PC [reverse transcriptase polymerase chain reaction] tests for SARS-CoV-2 infection—particularly early in the course of infection—when using these results as a basis for removing precautions intended to prevent onward transmission.” The results: “Over the 4 days of infection before the typical time of symptom onset (day 5), the probability of a false-negative result in an infected person decreases from 100% on day 1 to 67% on day 4. On the day of symptom onset, the median false-negative rate was 38%.”
Combination (Drug) Therapy Seems to Help: A study in The Lancet (here) reports that “In a randomized trial, people who received interferon-beta, ribavirin, and lopinavir/ritonavir had more-rapid clearance of virus and quicker clinical improvement than a control group who received just lopinavir/ritonavir.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
AMA Guides Members in Corona-Time
The American Medical Association regularly updates guides (sample, here) for physicians concerning coronavirus issues, most recently in serology and anti-body testing (“The AMA cautions physicians and the general public about use of these tests to determine individual immunity and warns that public health decisions, such as discontinuation of physical distancing, should not be made on the basis of results”), complete guide here.
Doctors Sue to Reopen
Three health care practices and a patient in Michigan sued in federal court (complaint here) to reopen. The doctors assert that estimates which lead to closing down of non-essential businesses were in error, and that “Fortunately, however, the projections upon which the government leaders made their decisions back in March 2020 were grossly inaccurate.” One plaintiff group, GI specialists Grand Health, claimed “patients are obtaining surgery only after their gallbladder is gangrenous or their appendix is ruptured, instead of obtaining care when their condition was in a much less severe state” and that “Grand Health furloughed most of its employees and has pushed back almost all of its patients’ procedures and post-operative support meetings. If the shutdown continues, Grand Health will almost certainly go out of business, and
its medical staff will be out of work.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
HCCI Studies Variation in the Cost of Childbirth: It’s the Prices!
The Health Care Cost Institute studied (here) variation in the cost of more than 350,00 births in 35 states 2016-2017 and found “Widespread variation in the cost of childbirth in the U.S. ranging from $8,361 in Arkansas to $19,771 in New York”; that “Individuals' out-of-pocket costs for childbirth also varied dramatically across states. Average out-of-pocket spending ranged from $1,077 in Washington, D.C. to $2,473 in South Carolina”; that “spending on vaginal birth [that is, excluding C-section] ranges from $7,507 in Arkansas to $17,556 in New York”; and that “In almost every state, the average price level accounted for the majority of the difference in spending per childbirth.”
MEDICARE, MEDICAID, AND COMMERCIAL HEALTH INSURANCE
The FY 2021 proposed payment rule known as the Inpatient Prospective Payment System has its own “home page,” here.
READINGS & REFERENCES
From blood clots to ‘Covid toe’: the medical mysteries of coronavirus. The wide variety of Covid-19 symptoms seen by doctors is confounding the scientific community, in the Financial Times, here.
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 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.