DCMedical News: Tuesday, July 28, 2020
DCMedical News-DCMN
Washington, D.C.
Tuesday, July 28, 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 7-27 at 8:00 p.m. EST worldwide 16,366,365 confirmed COVID-19 cases; 651,449 deaths worldwide; 147,791 U.S. deaths (22%).
Congress at Work: Senate Republicans released their next COVID-19 bailout package. The deduction for business meals at 100 percent may be back, together with additional appropriations (here), tax law changes (here), liability protections for negligence (here) and more paycheck protection (here). The States at Work: the Council of State Governments releases “COVID-19: Fiscal Impact to States and Strategies for Recovery,” here. The Academy at Work: AcademyHealth begins today, here.
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Military Personnel to California Hospitals
The Los Angeles Times reports (here) that “Active-duty U.S. Air Force doctors, nurses and other medical providers are being sent to work in California hospitals to assist with a steep rise in coronavirus cases that has strained some healthcare systems across the state. The 100 healthcare professionals began work Friday in five hospitals experiencing severe staff shortages after a request for aid by the state. An additional 60 providers will be deployed in the coming week, a military spokesman said.”
Hospital Rankings Faulted, Again
Analysis of hospital rankings in JAMA (here) contends that “Although the reports are intended to help guide consumers in determining where to seek care, these ranking systems often yield conflicting information or, worse, misinformation for patients and their clinicians. As an example, the US News & World Report Best Hospitals rankings correlate poorly with the Leapfrog Hospital Safety Grades (spearman correlation, 0.28) and the Centers for Medicare & Medicaid Services (CMS) Star Ratings (spearman correlation, 0.33).” U.S. News is especially faulted by the three Duke authors for ignoring the relationship between underlying health conditions and hospital rankings: “A pattern emerges: only regions with higher life expectancy have hospitals on the Honor Roll, whereas regions with lower life expectancy (such as the entire Southeast region, including Alabama, Florida, Georgia, North Carolina, South Carolina, and Tennessee) have none. Many hospitals in these states provide excellent care yet are not recognized on this listing.” Worse yet, historically, is “patient satisfaction”: this study, from the Archives of Internal Medicine in 2012, reports that “In a nationally representative sample, higher patient satisfaction was associated with less emergency department use but with greater inpatient use, higher overall health care and prescription drug expenditures, and increased mortality.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Medicaid Financing in the Pandemic, Expense in Uncertainty
MACPAC (the Congressional advisory body, Medicaid and CHIP Access and Payment Commission) releases a paper (here) on financing Medicaid programs during the pandemic. By way of background, the Congressional Budget Office has projected an 11% contraction in GDP during the second quarter, and 26 million fewer employed people. To accommodate resulting (counter-cyclical) growth in the Medicaid program, “Congress provided a temporary enhancement to the Medicaid federal medical assistance percentage (FMAP) and the State Children’s Health Insurance Program (CHIP), enhanced FMAP (E-FMAP) in the Families First Coronavirus Response Act (FFCRA, P.L. 116-127). This 6.2 percentage point FMAP increase is provided to states for the duration of the emergency period.” The report notes, “However, in FY 2020, most states would need more than a 6.2 percentage point increase under any enrollment growth scenario if they are not able to generate enough revenue to finance the state share of program expenditures. It is important to note that there is little data available at this time on actual enrollment and spending increases resulting from the pandemic, so example scenarios are presented to illustrate the effects of federal intervention, but many unknown factors will affect the actual outcomes.”
U.S. Health Insurers in “Rude Health”
Earnings reports lead The Financial Times to this sum, “The country’s biggest listed health insurers — UnitedHealth Group, Cigna, Anthem and Humana — have collectively added about $160.5bn to their market values since the pandemic began in earnest in late March. Expectations of bumper second-quarter earnings have lifted share prices in both UnitedHealth and Humana towards record highs.” The FT report has graphics showing reduction in outpatient services by specialty, and also reduction in insurer medical loss ratios. The Wall Street Journal reports (here) on UnitedHealth earnings.
READINGS & REFERENCES
US Health Care Spending by Payer and Health Condition, 1996-2016
In JAMA, from the Institute of Health Metrics and Evaluation, and others, a twenty year history, here. Highlights (confidence intervals removed from text for readability): “Total health care spending increased from an estimated $1.4 trillion in 1996 (13.3%of gross domestic product, $5259 per person) to an estimated $3.1 trillion in 2016 (17.9% of GDP, $9655 per person) . . . In 2016, an estimated 48.0% of health care spending was paid by private insurance, 42.6% by public insurance, and 9.4% by out-of-pocket payments. In 2016, among the 154 conditions, low back and neck pain had the highest amount of health care spending with an estimated $134.5 billion in spending, of which 57.2% was paid by private insurance, 33.7% by public insurance, and 9.2% by out-of-pocket payments. Other musculoskeletal disorders accounted for the second highest amount of health care spending (estimated at $129.8 billion billion) and most had private insurance (56.4%). Diabetes accounted for the third highest amount of the health care spending estimated at $111.2 billion and most had public insurance (49.8%) . . . After adjusting for changes in inflation, population size, and age groups, public insurance spending was estimated to have increased at an annualized rate of 2.9%; private insurance, 2.6%; and out-of-pocket payments, 1.1%.”
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.
The Guardian and Kaiser Health Network, report on health professionals dead from COVID-19, 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 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.