DCMedical News: Friday, September 25, 2020
DCMedical News-DCMN
Washington, D.C.
Friday, September 25, 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 Campaign(s)
President Unveils America First Health Plan: A White House announcement (here) that “We will ensure the highest standard of care anywhere in the world: cutting-edge treatments, state-of-the-art medicine, groundbreaking cures, and true health security for you and your loved ones,” the President said. Three goals noted were wider choice of Obamacare plans, control over surprise medical bills, and coverage for those with pre-existent conditions. Calling the actions largely symbolic, The Hill reported (here) that “President Trump signed an executive order seeking to protect coverage for preexisting conditions, while his Department of Justice is supporting a lawsuit that would overturn the Affordable Care Act. Meanwhile, the White House put off action on surprise medical bills, and rising coronavirus cases are sparking fear of a tough winter to come.”
Congress: Movement on a fourth coronavirus aid package is reported, for example by CQ, as follows: “House committee leaders put together a more slender coronavirus relief package than the one that previously passed the chamber, in their latest offer in talks with the White House . . . Democrats say they're hoping for renewed talks with Treasury Secretary Steven Mnuchin and a compromise agreement that can actually become law. Democrats will need to trim about $1 trillion from the legislation (HR 6800) the House passed in May that previously served as their starting point in the talks.”
Coronavirus
Tracking: By Johns Hopkins (here) shows on 9-24 at 8:00 p.m. EST worldwide 32,068,225 confirmed COVID-19 cases; 979,862 deaths worldwide; 202,692 U.S. deaths (21%).
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
COVID-19 Peril for Health Care Personnel: HCP are at special risk, according to a report (here) from the CDC in MMWR. “HCP with COVID-19 who died tended to be older, male, Asian, Black, and have an underlying medical condition when compared with HCP who did not die. Nursing and residential care facilities were the most commonly reported job setting and nursing the most common single occupation type of HCP with COVID-19 in six jurisdictions.” Daily Nurse reports (here) that “Data from National Nurses United (NNU) suggests that while only 4% of US nurses are Filipinos, some 30% of the nearly 200 RNs who have died from COVID-19 are Filipino Americans. NNU believes that overall, nurses are primarily endangered by PPE shortages and restrictive guidelines limiting access to tests, but Filipino nurses tend to face additional risks . . . One reason for their vulnerability is based on sheer numbers, particularly in California and New York. One fifth of California nurses are Filipino, and according to a ProPublica analysis of 2017 US Census data, 25% of the Filipinos living in New York work in the health care industry. The types of jobs they take also increase the likelihood of exposure. A 2018 Philippine Nurses Association of America survey found a large proportion of respondents working in bedside and critical care.” A metanalysis of HCP in the American Journal of Epidemiology (here) shows 40% were asymptomatic when tested positive. The Guardian and Kaiser Health Network report on health professionals dead from COVID-19, here.
Continuing Resolution for Government Funding Eases Medicare Advance Repayment Terms for Doctors, Hospitals
Medscape reports (here) that the CR “Postpones the recoupment of disbursed funds until 365 days after the advance payment has been issued to a physician practice, with the balance due by September 2022, reduces the amount to be recouped from each claim from 100% to 25% of the claim for the first 11 months and to 50%of claims withheld for an additional 6 months, and lowers the interest rate from 10.25% to 4%.” The AMA credits its efforts, here. Hospitals also have a reprieve in the CR: the funding bill would extend the start date for when CMS would begin recouping the Medicare loans--originally due 120 days after issued--to one year after the loan was issued, paid now over 29 months, at 4%.
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Hospital Finances Imperiled by Shift of Profitable Surgery Cases to Surgeon-Owned Ambulatory Surgery Centers
The proposed rule (here) for 2021 outpatient and ASC payments (comment period closes October 5) will shift 1,740 procedures from hospital inpatient care settings to ambulatory surgery centers over a three-year transitional period, with total elimination of the “inpatient only” list by Calendar Year (CY) 2024. For example, Becker’s reports (here) on 67 spine surgery procedures which will be removed from the inpatient only list in 2021. For another, Medtronic reports (here) “The Floodgates Have Open for Total Joints,” and Becker’s reports on 266 orthopedic procedures moving out, here.
The Neighborhood Hospital
Allegheny Health Network (part of Highmark) has opened its fourth “neighborhood hospital,” a 25,000 sf, 10-bed facility in Hamar Township, developed in partnership with Emerus.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
MA Premiums Down, According to CMS
Announcement of 2021 Medicare Advantage premiums and benefits (here) says “The Medicare Advantage average monthly plan premium is expected to decrease 11 percent to $21.00 (estimated) in 2021 from an average of $23.63 in 2020. Since 2017, the average monthly Medicare Advantage premium has decreased by an estimated 34.2 percent. This is the lowest that the average monthly premium for a Medicare Advantage plan has been since 2007.” In addition, “For the first time, seniors who use insulin will have over 1,600 Medicare Advantage and Part D prescription drug plans to choose from that will offer insulin at no more than a $35 monthly copay beginning in January.” Forty-two per cent of Medicare beneficiaries are expected to be enrolled in MA plans in 2021.
DRUGS & DEVICES
Canadian Drug Imports to be Allowed Under Final Rule Published Thursday
From the Federal Register (here), “The Secretary of Health and Human Services (Secretary) is issuing a final rule to implement a provision of the Federal Food, Drug, and Cosmetic Act (FD&C Act) to allow importation of certain prescription drugs from Canada . . . States and Indian Tribes, and in certain future circumstances pharmacists and wholesalers, may submit importation program proposals to the Food and Drug Administration for review and authorization . . . [the] sponsor [should] demonstrate that their importation program will pose no additional risk to the public’s health and safety . . . [and] explain how they will ensure their program will result in a significant reduction in the cost of covered products to the American consumer.” “Industry Guidance” from the FDA to accompany the rule, here.
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.
CDC information page for professionals here, Morbidity and Mortality Weekly Reports on Coronavirus, here.
CMS (Centers for Medicare & Medicaid Services) Current Emergencies website, here.
JAMA Network’s COVID-19 resource center 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.
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 30
October 1, 2
November 16, 17, 18, 19, 20
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.