DCMedical News: Thursday, October 1, 2020
DCMedical News-DCMN
Washington, D.C.
Thursday, October 1, 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)
A summary of health issues discussed during the first debate, “A Night of Rapid-Fire Interruptions and Inaccuracies,” from Kaiser Health Network, here; and a report on “7 Healthcare Takeaways,” here, from Becker’s. KFF publishes (here) slides on health issues prominent in the Presidential campaign.
Congress: A resolution continuing current government funding levels through December 11 is expected to be signed by the President before midnight Wednesday. The bill has additional aid to farmers, more food assistance for low income families. No actual appropriations bills for the fiscal year beginning today have been passed. The House will decide today whether to pass its own $2.2 trillion coronavirus assistance bill (the fourth) or accept a $1.3 trillion compromise with the Administration and Senate. The Senate may vote as early as today on a Democratic initiative to block the Justice Department from intervening in support of lawsuits involving the Patient Protection and Affordable Care Act.
Coronavirus
Tracking: By Johns Hopkins (here) shows on 9-30 at 8:00 p.m. EST worldwide 33,832,124 confirmed COVID-19 cases; 1,011,282 deaths worldwide; 206,825 U.S. deaths (20% of the world death total).
Public Health: MMWR reports (here) that “The median age of U.S. patients infected with SARS-CoV-2 has dropped by almost a decade in the last few months” and that “From June through August, incidence was highest in persons aged 20−29 years and accounted for >20% of all confirmed cases. Positive test results in this age group preceded those in adults aged ≥60 years by an average of 8.7 days, suggesting that the younger group contributed to transmission to the older group.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Nurse Practitioners in California Join 21 Other States in Independent Practice
Under the new statute (report here, AB890 here) board-certified nurse practitioners with three years or more clinical experience will be able to independently see patients beginning January, 2023.
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Private Equity Owned Hospitals, Continued
Private equity ownership of hospitals continues to draw interest, with articles in JAMA Internal Medicine (here), noting “Hospitals acquired by private equity were associated with larger increases in net income, charges, charge to cost ratios, and case mix index”; Health Capital Topics (here); Bloomberg, here, “Life and Debt”; Health Leaders, here; and the Annals of Internal Medicine, here, which noted that “Fewer full-time–equivalent employees per occupied bed and lower average patient experience scores among private equity–owned hospitals raise concern.”
Pre-Operative Stress Testing for Non-Cardiac Procedures Not Useful
A report (here) in JAMA Cardiology discusses pre-operative stress testing for non-cardiac procedures and supports guidelines de-emphasizing its importance. The report notes that “Preoperative cardiac stress testing is used to assess cardiac risk in patients scheduled for noncardiac surgery. The American College of Cardiology and American Heart Association (ACC/AHA) practice guidelines for perioperative cardiovascular evaluation for noncardiac surgery aim to improve the effectiveness of perioperative care, optimize patient outcomes, and improve resource use. The guidelines have consistently deemphasized preoperative cardiac testing prompted solely by the upcoming surgery in the absence of signs or symptoms that would warrant testing outside of the preoperative setting.” The report concludes “The frequency of preoperative stress testing declined annually from 2006 through 2017 . . . no difference was observed in cardiovascular outcomes between patients who did and did not undergo preoperative testing.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
MedPAC Meets Today and Friday
The Congressional Advisory Body meets to discuss, among other topics, future directions for hospice pay, here; indirect medical education payment and Medicare policy, here; skilled nursing facilities and alternative payment models, here; Medicare’s “advanced” alternative payment models, here; and vertical integration of providers and Medicare payment policies, here.
MedPAC agenda here, transcript of September meeting here.
Medicaid and CHIP Enrollment Up 5+% Through June
CMS released the June 2020 monthly report on state Medicaid and Children's Health Insurance Program (CHIP) eligibility and enrollment data (here). From February 2020 to June 2020, national Medicaid and CHIP enrollment increased by over 4 million, or almost 5.7 percent.
DRUGS & DEVICES
The House Oversight Committee (staff summary here, CQ report here) released two reports Wednesday on the internal strategies used by Celgene (report here) and Teva (report here) to continuously increase the prices of their drugs Revlimid and Copaxone. The reports indicate the importance of high prices in the U.S. market to sustain operations and increase profitability of the companies. The reports also focus on the role of price increases—22 for one drug since 2005, for example—in enabling executives to meet bonus targets. The hearing continues today with Amgen Inc., Mallinckrodt Plc. and Novartis AG. Reuter’s reports (here) on a “stealth” war by the pharmaceutical industry to undermine the effectiveness of ICER (the Institute for Clinical and Economic Review).
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
October 2
November 16, 17, 18, 19, 20
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.