DCMedical News: Wednesday, June 17, 2020
DCMedical News-DCMN
Washington, D.C.
Wednesday, June 17, 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
Tracking by Johns Hopkins shows on 6-16 at 8:00 p.m. EST worldwide 8,144,842 confirmed cases; 440,342 deaths worldwide; 116,854 U.S. deaths (26%). The website https://rt.live/ tracks the highest and lowest COVID-19 reproduction rates, measuring the average number of people who become sick from an infectious person. A value less than one shows the spread of the disease to be slowing, greater than one increasing. States with fastest spread of COVID-19 are Arizona 1.18; Alaska 1.14; Montana 1.12; Arkansas 1.09; Mississippi 1.09; Oklahoma 1.06; South Carolina 1.06; and Washington 1.05. States with the slowest spread of COVID-19 were New Jersey 0.79; New York 0.80; Delaware 0.82; Connecticut 0.83; Michigan 0.83; Minnesota 0.84; Hawaii 0.85; and Illinois 0.86.
COVID-19 and Society
The Intersection of Work, Medicaid and COVID-19: The Kaiser Family Foundation reports on work (here), the Pew Charitable Trust on surging Medicaid enrollment (here).
Fraud Pandemic: Bloomberg Health Law and Business News reports (here) that “Companies that settled cases involving overbilling or fraud -- among them Tenet Healthcare Corp., Universal Health Services Inc. and Beaumont Health -- received more than $36 billion in interest-free loans from a U.S. Health and Human Services Department program to help providers handle cash-flow shortages caused by the pandemic.” This is more than a third of the $100 billion distributed through the loan program. “In addition, companies accused of wrongdoing got more than $20 billion in grants issued by HHS to stave off coronavirus-related losses.”
Good Jobs First, which conducted the survey with Bloomberg, says “The number of providers that have settled fraud claims with Medicare is so large, and comprises such a big segment of the health-care system, that barring them from receiving Covid aid would have been impractical . . . There literally wouldn’t be enough providers to care for people because so many hospitals and clinics and doctors have engaged in these activities.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
AHRQ Reports on “Potentially Preventable” Hospital Stays
The Agency for Healthcare Research and Quality reports (here) on hospitalizations in 2017 which it says were avoidable. “In 2017, 3.5 million potentially preventable adult inpatient stays accounted for $33.7 billion in aggregate hospital costs. These stays represented 12.9 percent of all non-obstetric stays and 8.9 percent of costs for all non-obstetric stays. The most common and most expensive reason for potentially preventable stays was heart failure for adults (1,112,600 stays and $11.2 billion in aggregate hospital costs) and asthma for children (53,900 stays and $278.1 million in aggregate costs). In 2017, the rate of potentially preventable adult stays increased with age and decreased with community-level income. Potentially preventable stays with a primary expected payer of Medicare accounted for 65.4 percent of potentially preventable adult stays and 65.9 percent of hospital costs associated with these stays.”
Private Equity and ‘Right to Try’
A San Diego private equity firm and a Tijuana “cancer center” are raising money for five “Right to Try” cancer centers. Modern Healthcare reports that “Vivaris Capital is raising money to launch a chain of outpatient cancer clinics in the U.S. called United Cancer Centers . . . The system will be run by the owners of an alternative medicine hospital in Mexico.” The “Right to Try” initiative authorized in 2018 allows use of drugs not yet approved by the FDA.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Highmark, HealthNow to Combine
Highmark, which acquired (“affiliated with”) Blue Cross plans in Delaware in 2010 and West Virginia in 1999, now with 5.6 million members, will acquire HealthNow of New York. The $21 billion (revenue) combination will be the second largest not-for-profit “Blue” plan in the nation, after the Health Care Service Corporation (a mutual). Highmark brings experience in resuscitating the Allegheny Health Network in Pennsylvania following long-running battles with UPMC and a rocky financial beginning (see, for example, here and here).
MedPAC June 2020 Report to Congress
The Medicare Payment Advisory Commission has released its June report to Congress (here, news release here), including discussion of unanticipated failure in value-based payment, accountable care organizations, quality bonus programs, risk adjustment and incentives in Part D, hospital outpatient and end stage renal disease drug payments.
MACPAC Reports to Congress, Too
The Medicaid and CHIP Access and Payment Commission also released its report (here). Issues emphasized include “(1) improving integration of care for low-income people over age 65 and people with disabilities who are dually eligible for Medicaid and Medicare; (2) ensuring that Medicaid is the payer of last resort when its beneficiaries also have coverage from another insurance program; and (3) addressing concerns about high rates of maternal morbidity and mortality.”
READINGS & REFERENCES
Germany’s All-Payer Health System
An essay in honor of Uwe Reinhardt by his widow and Princeton colleague Tsung-Mei Cheng in the Milbank Quarterly, here. She writes, “Amenable mortality in Germany declined by 37% in the period 2000–2014 . . . This is in sharp contrast to the stubbornly high rate in the United States during the same period.” Some elements of the German system: more doctors (twice as many annual visits as in the U.S.), more nurses, more beds, longer hospital stays, less imaging technology.
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 for professionals here, Morbidity and Mortality Weekly Reports on Coronavirus, 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 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.