DCMedical News: Friday, October 2, 2020
DCMedical News-DCMN
Washington, D.C.
Friday, October 2, 2020
DCMedical News is published every day both the House and the Senate are scheduled to be in session this year. The House adjourns today, the Senate later in the month; DCMN resumes publication November 16. Subscription information and archives here.
THE BIG STORY IN HEALTH CARE
The Presidential and Other Campaign(s): Biden transition team profiled by Business Insider, here.
Government Agencies: GAO issues comprehensive report (371 pages here, summary here) on federal government activity in COVID-19, noting that it could be improved. The CDC reports (here) on Halloween and other fall and winter holidays.
Congress: Obamacare procedural vote in the Senate: The Hill reports that “Six GOP senators who had previously voted to repeal Obamacare voted with Democrats Thursday on a motion to proceed to debate on a bill that would block the Department of Justice from arguing against the law in court . . . Republican Sens. Cory Gardner (Colo.), Joni Ernst (Iowa), Martha McSally (Ariz.) and Dan Sullivan (Alaska), who are all in tough reelection races that could determine who controls the Senate next year, voted with Democrats, illustrating the party’s growing struggles with opposing the popular Affordable Care Act (ACA) and its protections for people with preexisting conditions . . . GOP Sens. Susan Collins (Maine), who is also facing a tough reelection bid, and Lisa Murkowski (Alaska), also voted with Democrats, but both had previously stated their opposition to the lawsuit . . . Other Republican incumbents running competitive races voted no, including Sens. Steve Daines (Mont.), Thom Tillis (N.C.) and Kelly Loeffler (Ga.). Sen. Lindsey Graham (R-S.C.) did not vote.
The House passed its $2.2 trillion COVID-assistance bill, but with no further action imminent (details from CQ, here). In the Continuing Resolution (CR) signed into law Tuesday, night hospitals and doctors found some respite. In the repayment of funds received through the Medicare Accelerated Payment Program the CR extends the start of the recoupment period from 120 days to one year from date of loan issuance, reduces payment withholding from 100% to 25% for the first 11 months and then 50% for the next 6 months, and provides that if full payment has not been completed after 29 months from loan issue date, interest will accrue at 4% on the unpaid balance. The bill is here, see Division C, Title V.
Coronavirus
Tracking: By Johns Hopkins (here) shows on 10-1 at 8:00 p.m. EST worldwide 34,136,078 confirmed COVID-19 cases; 1,016,970 deaths worldwide; 207,651 U.S. deaths (20% of the world death total).
Vaccines: Kaiser Health News reports (here) on “secret” FDA and company panels who will declare “winners.”
Testing, Incidence and Prevalence of Coronavirus and COVID-19: A study of dialysis patients in The Lancet (here) found that “During the first wave of the COVID-19 pandemic, fewer than 10% of the US adult population formed antibodies against SARS-CoV-2, and fewer than 10% of those with antibodies were diagnosed.”
Medical Care: The Commonwealth Fund reports (here, chart pack here) on the affordability of COVID-19 treatment for Medicare patients.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Coding Changes for Physician Services (Common Procedural Terminology) Most Significant in 25 Years
Changes primarily aimed at the evaluation and management codes for office and outpatient services were announced by the AMA for implementation January 1, 2021, and will be used by all payers. The changes (story here, Q&A here) eliminate history and physical exams as key components in selecting the level of service for billing; time, including pre- and post-visit time, may be included in that selection; definitions of medical decision making are revised. One complication is that “there will now be two sets of rules for evaluation and management (E/M) codes: one for office and outpatient codes 99202-99215, and the original rules for all other E/M services, defined by the key components of history, exam, and medical decision-making. The original guidelines will still govern inpatient and observation services, emergency department visits, nursing facility care, domiciliary care and home visits.”
AMA Joins the ACLU and Planned Parenthood in Appeal for Family Planning Funds
The Hill reports that “The American Medical Association (AMA), the nation’s largest doctors’ group, filed a petition to the Supreme Court Thursday asking it to strike down a rule from the Trump administration barring clinics funded by taxpayers from referring women for abortions.”
Deep Learning, in Three States
A study in JAMA (here, STAT+ report here) notes that most of the “deep learning” in artificial intelligence algorithms in health care involves patients from only three states, concentrated in leading academic medical centers of those states. “Fifty-six studies (76%) trained algorithms using at least 1 geographically identifiable cohort. Cohorts from California appeared in 22 of the 56 studies (39%), cohorts from Massachusetts in 15 (27%) and cohorts from New York in 14 (25%) . . . Among the remaining 47 states, 34 did not contribute any patient cohorts.” The report concludes “In clinical applications of deep learning across multiple disciplines, algorithms trained on US patient data were disproportionately trained on cohorts from California, Massachusetts, and New York, with little to no representation from the remaining 47 states . . . algorithms trained primarily on patient data from these states may generalize poorly.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Skyrocketing Use of Brain Imaging in ED Visits, Emory Research in JACR
Radiology Business reports (here) that “U.S. healthcare providers have dramatically escalated their use of brain imaging to assess patients for seizures and epilepsy in the emergency department since 2006. And yet at the same time, the frequency of ED visits increased more modestly, or even dropped in some patient populations . . . For instance, annual ED trips among adult patients climbed 8.2% during the eight years ending in 2014, while head CT use for the two indications leapt nearly 95%. Brain MRI increased 400% during the same period and electroencephalography climbed 220%, while brain MRI skyrocketed 300% . . . The results raise questions about imaging overuse and healthcare spending, with seizures accounting for just 1% of adult ED visits and 2% among children, tallying $500 billion each year.”
Five Most Expensive Inpatient Hospital Diagnoses
HCUP (here) reports that (for 2016) “The five most expensive inpatient conditions were septicemia, osteoarthritis, liveborn (newborn) infants, acute myocardial infarction, and heart failure. The 20 most expensive conditions accounted for slightly less than half of aggregate hospital costs. The share of aggregate inpatient hospital costs by primary expected payer was
66 percent for Medicare and Medicaid combined, 27 percent for private insurance, and 3 percent for self-pay/no charge stays.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Employer Health Plan Expenses Projected to Increase 4% in 2021
Mercer reports that its “2020 National Survey of Employer-Sponsored Health Plans, which just closed, asked employers how much they expect cost to rise next year. The average projected increase looks surprisingly ‘normal’ – until you view it in the context of the Consumer Price Index and workers’ earning at near zero. Yet, even as they contend with a troubled economy, employers are holding off on cost-cutting changes that would affect employees.”
Short Term Limited Duration Insurance (STLDI) May Be Very Limited
The Congressional Budget Office reports (here) that “In August 2018, after a change in Administrations, the new Administration issued another rule governing STLDI that reverted to the previous limit on the duration of such plans (364 days) and also allowed people to renew their policies for up to three years. That rule took effect in October 2018. The rule was challenged in federal court, but a district court upheld it in July 2019, and that ruling was affirmed on appeal. The insurance plans newly allowed by the rule started to become available in the fall of 2019,” making it too early, according to CBO, to reach definitive conclusions, but also not justifying any change in CBO’s judgment, especially that “Some recent research has found that many of the STLDI plans currently being sold provide very limited benefits to enrollees, and that research raises questions about whether such plans constitute insurance.”
MedPAC Meeting Concludes Today
The Congressional Advisory Body concludes its October meeting today, discussing 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.
DRUGS & DEVICES
Fraud Meets Opioids and Telehealth
Government officials announced (here, graphic here) “a historic nationwide enforcement action involving 345 charged defendants across 51 federal districts, including more than 100 doctors, nurses and other licensed medical professionals.
These defendants have been charged with submitting more than $6 billion in false and fraudulent claims to federal health care programs and private insurers, including more than $4.5 billion connected to telemedicine, more than $845 million connected to substance abuse treatment facilities, or “sober homes,” and more than $806 million connected to other health care fraud and illegal opioid distribution schemes across the country.”
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
November 16, 17, 18, 19, 20
December 1, 2, 3, 4, 7, 8, 9, 10
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.