DCMedical News: Thursday, June 4, 2020
DCMedical News-DCMN
Washington, D.C.
Thursday, June 4, 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 6-3 at 8:00 p.m. EST worldwide 6,392,319 confirmed cases; 383,298 deaths worldwide; 107,093 U.S. deaths (28%). Cases by country (Statista), here, countries worst hit recently here.
Bailout Turmoil for Hospitals and Other Providers
As the (June 3) deadline passed for attestation concerning use of CARES health field bailout funds, rules were changed concerning the funds (Modern Healthcare report here) and a bipartisan group of House and Senate leaders scolded HHS Secretary Azar (letter here, Healthcare Dive report here, Politico report here) for the pace and methods involved in distributing the funds. Congress authorized $100 billion for health care providers in the Coronavirus Aid, Relief and Economic Security (CARES) Act. Congress provided an additional $75 billion in the Paycheck Protection Program and Health Care Enhancement Act. The Congressional leaders wrote “After allocating $30 billion in funds based on 2019 Medicare reimbursements, and supplementing this with $20 billion to reflect 2018 total reimbursements . . . providers that depend on Medicaid for a large source of their payments have not yet received a meaningful allocation. . . Many of these providers are safety net providers that operate on thin profit margins, if at all . . . HHS has, thus far, relied on methodologies that favor providers that receive a larger share of their payments from Medicare or private insurance.” Many observers believe the initial distributions were shaped by (a) necessity and convenience and/or (b) a desire to preserve the greatest number of jobs (among the bigger systems, with more employees, notwithstanding 250 such systems undertaking employee furloughs).
Treatment:
The Hill reported that “The muddled evidence on hydroxychloroquine was in full view on Wednesday . . . Enrollment in the hydroxychloroquine arm of the WHO’s Solidarity Trial was temporarily paused last week after an article in The Lancet journal warned about the safety of the drug.” The Guardian (here) found that the U.S. data firm Surgisphere, behind The Lancet and an NEJM article, has “A handful of employees [who] appear to include a science fiction writer and an adult-content model,” and “has provided data for multiple studies on Covid-19 co-authored by its chief executive, but has so far failed to adequately explain its data or methodology.” Hospitals which would have had to participate in the studies, based on data submitted, had never heard of the company.
Home is Where the Hospital (Out) Patient is Treated
Emanuel and others (here) report in JAMA Network that “Hospital outpatient departments can now relocate health care services to off-campus sites or even into Medicare beneficiaries’ homes. For the duration of the public health emergency, these relocated services will be reimbursed at the higher outpatient prospective payment system rates rather than the typical physician fee schedule rates for new off-campus sites, an increase of approximately 40% for similar outpatient services.” In an expansion of Part B, at least for as long as the Coronavirus emergency continues, “The waiver permits beneficiaries to receive any infused or injected drug at home covered under the Part B benefit. The waiver also includes other outpatient services, such as physical therapy or wound care.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Doctors Flip the Company, Catch It
Cerberus has been bought out of the Steward hospitals by the physician shareholders of the company, led by the charismatic cardiovascular surgeon who started the company, Dr. Ralph de la Torre, with Medical Properties Trust of Alabama (which owns most of the physical plant of the hospitals) retaining a 10% share, Becker’s report here. In the ordinary course of events, private equity companies, such as Cerberus, load up an acquired enterprise with debt (“financial engineering”), distribute the proceeds to investors, increase charges to accommodate the debt, and look to “flip” the acquired company into the hands of the next owner (see e.g. here, here and here).
Equal Opportunity for Conflicted Interest
A new study (here) “adds to a growing body of evidence showing gender inequities in payments that surgeons in various specialties receive from industry in the form of royalties, licensing and consulting fees. The latest research, conducted by investigators at Hospital for Special Surgery (HSS) and other medical institutions, finds such disparities pervasive in the
field of orthopedic surgery.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Calamity for Individuals, Banality for Hospitals
Texas hospitals sue their patients at an increasing rate, in a non-Medicaid expansion state. This conclusion is reached by Makary and colleagues from Johns Hopkins and other leading medical centers. Their report (here, Becker’s report here) notes that “These garnishment practices, in addition to the lawsuits, dismantle patients’ lives while negligibly impacting overall hospital finances . . . Thus, recouped medical debt, in relation to total gross hospital revenue, was insignificant. These practices took advantage of patients when they were most vulnerable.” Becker’s reported that “In the report, researchers found the average revenue of 15 of the hospitals that sued patients was $972 million, with the hospitals suing for an average of 0.15 percent of their total revenue, or $17.8 million.”
MEDICARE, MEDICAID, AND COMMERCIAL HEALTH INSURANCE
Proposed FY 2021 IPPS Rule
The FY 2021 proposed payment rule known as the Inpatient Prospective Payment System has its own “home page,” here.
READINGS & REFERENCES
Coronavirus Public Health Resources and References (alphabetical):
Association of American Medical Colleges Clinical Guidance Repository, here.
AMA resource page for physicians here. AMA guide to medical education and COVID-19, here.
American Public Health Association information 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.
The New York Times Coronavirus coverage, here.
State actions, Kaiser Family Foundation, here.
UC Hastings College of Law’s “The Source” (on health care prices and competition) 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
June 9, 10, 11, 12, 15, 16, 17, 18, 23, 24, 25, 26
July 21, 22, 23, 24, 27, 28, 29, 30, 31
August, none
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.