DCMedical News: Thursday, September 17, 2020
DCMedical News-DCMN
Washington, D.C.
Thursday, September 17, 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
Coronavirus
Tracking: By Johns Hopkins (here) shows on 9-16 at 8:00 p.m. EST worldwide 29,730,140 confirmed COVID-19 cases; 938,820 deaths worldwide; 196,661 U.S. deaths (21%). Statista published a graph (here) discussing the first six months of the pandemic, noting “Daily new cases [are] hovering around 250,000 for more than a month now.” Vox has a piece (here) on the second wave (graph here) and the current drop off of cases in the U.S.
Vaccine: HHS distributes a plan (summary here, 57-page “playbook” here), “Operation Warp Speed Strategy for Distributing a COVID-19 Vaccine.” Bloomberg reports (here) that “Siemens Healthineers AG has joined U.S. and European health officials to create an international standard for coronavirus antibody tests, a key step toward knowing who needs a future vaccine or booster shot.” Vaccine rush by government, caution by pharma, noted (here) in NEJM, “Up Is Down — Pharmaceutical Industry Caution vs. Federal Acceleration of Covid-19 Vaccine Approval.”
Testing: Hopkins heavyweight Gerard Anderson and colleagues report (here) on the charges levied in 46 states and the District of Columbia for COVID-19 diagnostic tests, in the Journal of General Internal Medicine. They found: COVID-19 diagnostic test charges ranged from 1 cent to $14,750; that the average COVID-19 diagnostic testing charge ranged from $64.98 in Utah to $505.65 in the District of Columbia (Medicare rate $51.31); that for COVID-19 antibody testing average charges ranged from $45.85 in New York to $195.41 in New Mexico (Medicare rate $42.13); and that “No statistically significant association was found between testing charges and state-level testing ratings, infection rates or mortality rates." AHIP, the commercial health insurance lobby, publishes (here) a summary of its findings on out-of-network COVID-19 testing price gouging.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
AMA and Nurse Practitioner Supervision in Proposed California Legislation
The AMA has undertaken a campaign (here) in opposition to pending California legislation which would allow nurse practitioners to practice without physician supervision. Among the issues, “Nurse practitioners have long claimed that expansion of their scope of practice will result in increased access to care in rural and underserved areas and will help fill the gaps in primary care. Despite these promises, however, the evidence demonstrates nurse practitioners tend to practice in the same areas of the state as physicians.” In addition, “recent workforce studies suggest newly graduated nurse practitioners are choosing to pursue specialty or subspecialty degrees rather than primary care.” Also, says the AMA, “In states that allow independent prescribing, nurse practitioners were 20 times more likely to overprescribe opioids than those in prescription-restricted states. . . and nurse practitioners order more diagnostic imaging than physicians.”
The Journal of the American Association of Nurse Practitioners publishes (here) “The perils of not knowing the history of the nurse practitioner role.”
Physician Fatigue and Electronic Medical Records
A study in JAMA Network (here) finds that “The use of electronic health records (EHRs) is directly associated with physician burnout” and that “Physicians experience electronic health record–related fatigue in short periods of continuous electronic health record use, which may be associated with inefficient and suboptimal electronic health record use.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Skilled Nursing Commission Report
Skilled Nursing News reports that “A special federal commission on nursing homes and COVID-19 on Wednesday released its formal report, focusing on testing, personal protective equipment, and visitation as the nation’s long-term care facilities continue to grapple with the novel coronavirus. The Coronavirus Commission for Safety and Quality in Nursing Homes laid out 27 primary recommendations for the Centers for Medicare & Medicaid Services (CMS)” (here, 186 pgs.)
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
The Source Flags Provider-Insurer Contract Provisions as Health Cost Driver
UC Hastings College of Law (“The Source”) and the Petris Center publish an analysis (here) of provider-insurer contract provisions driving health costs. “The Source conducted a 50-state survey that examines the potential . . . to increase scrutiny over five contracting practices - most-favored-nations clauses, all-or-nothing provisions, exclusive dealing arrangements, anti-tiering/anti-steering clauses, and gag clauses – that have the potential to create anticompetitive harms.” The Source also is publishing (here) a compilation of health care price and competition policies, by state.
DRUGS & DEVICES
Portable MRI at the Bedside in the ICU
A study in JAMA Neurology (here) says “with a portable, bedside MRI device, including patients with ischemic stroke, hemorrhagic stroke, subarachnoid hemorrhage, traumatic brain injury, brain tumor, and COVID-19 and altered mental status, abnormal neuroimaging findings were detected in 29 of 30 patients without COVID-19 (97%); 8 of 20 patients with COVID-19 (40%) demonstrated abnormalities. There were no adverse events or complications. This study demonstrates the capability of low-field, portable MRI to obtain neuroimaging at the bedside in intensive care settings.”
When Cost Increases There is Lower Use of Drug for HIV Prevention
STAT reports that “The escalating cost of the only HIV prevention pill may have been a key factor hindering widespread use in recent years . . . underscoring long-standing concerns over the ability to eradicate the virus.” The study (here) in the Annals of Internal Medicine, says “Use of HIV preexposure prophylaxis (PrEP) has increased nationwide . . .from 73,739 prescriptions per year to 1,100,684 during 2014 to 2018” but that “High costs to the health care system may hinder PrEP expansion.”
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 22, 23, 24, 25, 30
October 1, 2
November 16, 17, 18, 19, 20
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.