DCMedical News: Wednesday, September 9, 2020
DCMedical News-DCMN
Washington, D.C.
Wednesday, September 9, 2020
DCMedical News is published every day both the House and the Senate are scheduled to be in session this year. Subscription information and archives here.
THE BIG STORY IN HEALTH CARE
The (Presidential and Other) Campaigns
The Candidates: Kaiser’s Larry Levitt compares candidate positions and statements in a JAMA Forum piece (here), including comments on the candidates’ positions on COVID-19, the Patient Protection and Affordable Care Act, Medicaid, prescription drug prices, abortion, and immigration and health care. Forbes columnist Bruce Japsen opines (here) that “Trump Still Has No Health Plan As Campaign Enters Home Stretch.”
Staff: The Washington Post reports (here) on health staff working for Democratic Presidential candidates. MedPage Today reports (here) on recent changes in health lobbying, connections to the Administration. Business Insider profiles Biden adviser Dr. Lisa Fitzpatrick, here, as well as a more extensive list of health advisers (here) with prominent names from the Obama and Clinton past (Berwick, Bianchi, Emanuel, Jennings, Jee, Murthy and others).
Coronavirus
Tracking by Johns Hopkins (here) shows on 9-8 at 8:00 p.m. EST worldwide 27,453,109 confirmed COVID-19 cases; 894,796 deaths worldwide; 189,557 U.S. deaths (21%).
Congress: The Hill reports (here) that “Senate Majority Leader Mitch McConnell (R-Ky.) is working to wrangle his caucus behind a pared-down coronavirus relief bill, with top GOP senators predicting they’ll be able to win over at least 51 Republican votes this week.” But “Democratic leaders and Trump administration officials remain hundreds of billions of dollars apart on a new coronavirus package.” The McConnell package includes “a $300 per week federal unemployment benefit, another round of Paycheck Protection Program (PPP) funding, $105 billion for schools and an additional $16 billion for coronavirus testing.” The proposal, scheduled for a Senate vote tomorrow, has no new funds for health providers.
Science: AstraZeneca’s vaccine trial is halted due to unanticipated illness in a participant, while the National Academies publishes (here) a “Discussion Draft of the Preliminary Framework for Equitable Allocation of COVID-19 Vaccine.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Bonuses Under MIPS Associated with Health System Affiliation: Higher Quality, or Better Reporting?
A report in JAMA (here) on the Merit-based Incentive Payment System for outpatient care concludes that “Clinician affiliation with a health system was associated with significantly better 2019 MIPS performance scores. Whether this represents differences in quality of care or other factors requires additional research.”
A skeptical editorial (here) in the same issue says “A large amount of skepticism remains about whether this pay-for-performance approach correlates with better patient outcomes. The proportion of physicians employed by hospitals or health systems has been rapidly increasing from about 28% of primary care physicians in 2010 to almost 50% in 2018. There are consequences from this consolidation, such as increasing prices in commercial markets without meaningful improvements in care quality and patient outcomes. In addition, choice in referrals to inpatient settings, specialty physicians and centers, or ancillary services may be limited. Alternately, larger health systems have economies of scale to make investments in technology that may help with reporting of quality measures in pay-for-performance programs . . Because the quality measures were chosen by practices and were process based, the investigators could not disentangle whether their results represent better quality of patient care or reflect resources available to support selection and reporting of quality measures.”
The editorial continues, “The second major finding raised by these reports is the uncomfortable recognition that the MIPS and other alternative payment models consistently appear to penalize physicians who care for low-income and vulnerable populations.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Jobs Return in Hospitals, But Not So Many
The August report of the Bureau of Labor Statistics (here) shows 1.4 million jobs added (including temporary 2020 census jobs), unemployment at 8.4%. Only half of the jobs were recovered which were lost to the coronavirus pandemic (10.6 million of 22.2 million jobs lost). According to the report, “Health care employment increased by 75,000 over the month, with gains in offices of physicians (+27,000), offices of dentists (+22,000), hospitals (+14,000), and home health care services (+12,000). Elsewhere in health care, job losses continued in nursing and residential care facilities (-14,000).
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
DRUGS & DEVICES
Sunshine:
STAT+ reports (here) that “Amid ongoing concern that drug and device makers may influence medical practice and research . . . teaching hospitals received a total of $832 million in payments for various activities and arrangements other than research in 2018. Of 1,281 teaching hospitals, 91% received money from industry . . . nearly 47,000 payments were made . . . [and] one-fifth of the hospitals received more than 90% of the $832 million.”
FROM THE ARCHIVES
Readers who are subscribers can access DCMN from January 1, 2018 to the present, here.
One year ago: In DCMN September 10, 2019 (here) stories about Democratic efforts at drug price control, maternal morbidity and mortality, MedPAC alarm over coming shortfalls in the Medicare trust funds with Part B and Part D premiums consuming one quarter of the average Social Security benefit, and general revenue transfers (subject to Congressional action) now (then) exceeding payroll taxes and premiums as the major source of Medicare current funding.
READINGS & REFERENCES
Select Coronavirus Public Health Resources and References (alphabetical):
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.
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.
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.
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
September 10, 11, 14, 15, 16, 17, 22, 23, 24, 25, 30
October 1, 2
November 16, 17, 18, 19, 20
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.