DCMedical News: Tuesday, July 21, 2020
DCMedical News-DCMN
Washington, D.C.
Tuesday, July 21, 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 7-20 at 8:00 p.m. EST worldwide 14,632,087 confirmed COVID-19 cases; 608,637 deaths worldwide; 140,879 U.S. deaths (23%).
Treatment and Vaccines: “Remdesivir is most effective in hospitalized patients with moderate disease, while dexamethasone works best in more advanced disease,” while “Hydroxychloroquine failed to improve outcomes in early or mild COVID-19,” per a summary from the American College of Physicians Internist (ACP-I) weekly, here. On vaccines, the ACP-I reports “A successful phase 1 trial of a SARS-CoV-2 vaccine was reported in the New England Journal of Medicine on July 14. It gave 45 healthy adults, 18 to 55 years of age, two vaccinations, 28 days apart, with mRNA-1273 at doses of 25 μg, 100 μg, or 250 μg. After the second vaccination, immune response was detected in all evaluated participants.”
And in a cautionary note, “The current state of COVID-19 research in the U.S. was highlighted by a research letter in JAMA Network Open on July 13. It found 674 current registered randomized trials, only 71.1% of which had valid control groups, and 23.5% of which were testing chloroquines. “Although these overlapping trials may afford opportunities for replication and validation, the high degree of multiplicity also enhances the likelihood of finding a positive result through chance alone, potentially resulting in widespread use of an ineffective and possibly hazardous intervention.”
The British Medical Journal reports (here) that mortality is down by one-third in intensive care units since the beginning of the pandemic.
Coronavirus Numbers: The Administration sends new instructions (here) to hospitals, report COVID-19 cases to HHS’ private contractor, not to the CDC. ProPublica finds problems already with some numbers (here), reporting that “A Spike in People Dying at Home Suggests Coronavirus Deaths in Houston May Be Higher Than Reported.” Excess deaths as reported in JAMA IM (here), “The number of excess all-cause deaths was 28%higher than the official tally of COVID-19–reported deaths during that period [March to May 2020].”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Radiology Practice Volumes Down 80%
Radiology Business reports (here) that “The COVID-19 pandemic has hit private radiology practices harder than most, a trend that has tugged down doc pay and may accelerate consolidation in the specialty. Some such practices have seen patient volume declines as high as 80%.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Hospital Industry Loses Site-of-Service Differential Ruling, at Least for 2019
The U.S. Court of Appeals for the District of Columbia Circuit unanimously ruled [here] in favor of the Administration’s reduction of Medicare payment rates for ”off-campus” hospital outpatient departments. The rates would be reduced to those paid to independent physicians, generally estimated to be a 60% reduction in the rates charged by hospitals for services in physician offices acquired by those hospitals. CQ reports that “A second lawsuit from the hospital industry, led by the American Hospital Association, is still pending over cuts made to 2020 rates.” Some if not most of the acquisition of physician practices by hospitals has been fueled by the expectation that the hospitals could overpay for those practices, then recover the overpayment by raising rates in the former physician offices.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Short Term Limited Duration Health Insurance Plans—You Can’t Have More Than One . . .
The Minneapolis StarTribune reports that “The patient enrolled in two consecutive short-term health insurance policies issued by the same company. When he bought the second, he got treatment for a heart condition. Golden Rule, the UnitedHealthcare subsidiary that sold the patient both policies, refused to pay. The company said the claims submitted were for a condition diagnosed during the first plan. So it was a pre-existing condition, not covered in the second. The situation brings up a big shortcoming in relying on the short-term plans being pushed by the Trump administration as a cheaper alternative to Affordable Care Act (ACA) benefits, according to a new 197-page report [here] from the Health Subcommittee of the House Energy and Commerce Committee.” Friday the D.C. Court of Appeals affirmed (decision here) broad discretion for the Administration to allow STLDI plans to be offered, indicating that Congress had delegated authority concerning the plans, and thereby lost some control.
10 Million to Lose Employer-Based Health Insurance
The Urban Institute and the Robert Wood Johnson Foundation report (here) that “More than 10 million people are estimated to lose employer-sponsored health insurance as a result of pandemic-related job loss in their household between April and December 2020.” The report continues, “Projections show 3.3 million of those people will regain employer-sponsored insurance by being added to a family member’s policy, 2.8 million people will enroll in Medicaid, and 600,000 people will enroll in the individual market, mainly via the Affordable Care Act’s marketplace. Still, 3.5 million people will become uninsured.”
DRUGS & DEVICES
Drug Channels Issues Annual Report
The publication (here) reports that “Pharmacy industry prescription dispensing revenues reached a record $446 billion in 2019. Revenues were highly concentrated due to the rapid growth of large specialty pharmacies.”
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 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.
Reproduction rate (rt), website https://rt.live/ tracks the highest and lowest COVID-19 reproduction.
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
July 22, 23, 24, 27, 28, 29, 30, 31
August, none
September 8, 9, 10, 11, 14, 15, 16, 17, 22, 23, 24, 25, 30
October 1, 2
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.