DCMedical News: Monday, November 16, 2020
DCMedical News-DCMN
Washington, D.C.
Monday, November 16, 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
The Daily Mail reports “US coronavirus cases rise in all 50 states for the first time as country sets all-time record with 184,514 COVID-19 infections in a single day.”
Tracking: By Johns Hopkins (here) shows on 11-15 worldwide 54,299,446 COVID-19 cases (compared to 34,136,078 on 10-1 in our most recent DCMN edition) and 11,025,046 U.S. cases. Deaths worldwide are 1,315,897 (compared to 1,016,970 on 10-1), 246,108 in the U.S. (compared to 207,651 on 10-1), 19% of the world death total.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
On the Front Lines
Politico reports that “New legislation led by Reps. Ami Bera (D-Calif.) [a general practitioner] and Larry Bucshon (R-Ind.) [a thoracic surgeon] would offset planned cuts to Medicare reimbursement rates for the next two years . . . The proposal . . . would send temporary payments to fully mitigate pay cuts for various services currently baked into next year's Medicare Physician Fee Schedule. CMS had planned these cuts to meet budget neutrality constraints tied to its decision to increase reimbursements for certain other office or outpatient evaluation and management services. But Bera and Bucshon contend that doctors shouldn’t see their pay reduced while they’re on the front lines of the pandemic response.” An overview of the proposed Calendar Year 2021 physician fee schedule rule from HFM is here. The New York Times (here) reports today on physicians closing practices due to pandemic pressures and loss of patients, citing a summer survey on the subject (here) from The Physicians Foundation.
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
The Public Health Emergency, Extended to the Inauguration Date
HHS renewed the Public Health Emergency (PHE) on 10-2, effective for an additional 90 days from October 23. The announcement (here) stated “As a result of the continued consequences of the Coronavirus Disease 2019 (COVID-19) pandemic, on this date and after consultation with public health officials as necessary, I, Alex M. Azar II . . . do hereby renew, effective October 23, 2020, my January 31, 2020, determination, that I previously renewed on April 21, 2020 and July 23, 2020, that a public health emergency exists and has existed since January 27, 2020, nationwide.” At the link, information about the PHE and HHS programs, waivers, etc.
Hospitals and COVID-19
NPR reports (here) on hospitalizations in the hardest hit states, “It’s like we opened up a spigot.” USA Today puts the focus on small towns and rural hospitals (here), noting “Many of the nation’s nearly 1,800 rural hospitals lack the equipment, workforce and expertise to handle a surge of COVID-19 patients. Nurses and doctors are getting sick, leaving already short-staffed hospitals more desperate for workers,” and “‘These rural hospitals are designed for primary care, general surgery,’ said Alan Morgan, CEO of the National Rural Health Association. ‘They were never designed for a global pandemic response.’” Researchers from Dartmouth and Tacoma’s Sound Physicians report on the impact of COVID-19 on hospitals (so far) in Health Affairs, here. The University of Washington looks back on lessons from its first-in-the-nation experiences, in The Joint Commission’s Journal of Quality and Patient Safety, here.
This study in JAMA summarizes what has been found with hospital-acquired COVID-19 infections in hospital workers, namely that many come from fellow workers: “In the few outbreaks that have been reported in hospital settings during universal masking, several recurrent features have emerged. Duke Health in North Carolina found that ‘unmasked exposure to another [health care worker] rather than exposure to known infected patients resulted in the most [SARS-CoV-2] cases among staff after implementation [of universal masking].’ Transmission leading to a cluster of at least 55 infections at Baystate Medical Center in Massachusetts in July 2020 was traced back to ‘staff who convened in a break room and removed their masks.’ In an outbreak at Brigham and Women’s Hospital in Boston in September 2020 that was associated with infections in 42 health care workers and 15 patients, hospital epidemiologists identified a number of important contributing factors, including that ‘many patients were not masked during clinical care’ and [that there was a] lack of physical distancing among staff while unmasked while eating.’ This pattern is unsurprising . . . most patients with SARS-CoV-2 who require hospitalization are admitted at least 5 to 7 days after symptom onset, by which point they are probably minimally or noninfectious.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Medicare and COVID-19
CMS has published (here) a summary of nearly 300,000 hospitalizations from Medicare FFS and MA claims, January 1-August 15.
DRUGS & DEVICES
Newly FDA-Approved Oncology Drugs: So Expensive They Should Not Be Used Widely
A study in JAMA Internal Medicine (here) of all 2018 newly FDA-approved oncology drugs found “The average price per patient per treatment course was $150,384 . . . To maintain the recent trend of cancer drug spending, the 2018 cancer drug approvals need to be used in fewer than 20%of eligible patients,” since “New cancer drugs approved by the FDA in 2018 would drastically increase cancer drug spending in the US if used widely.”
READINGS & REFERENCES
AHRQ publishes “Developing Consistent and Useful Quality Improvement Study Data Extraction for Health Systems,” here.
Emanuel and colleagues publish (here) a comparison of current and propose U.S. drug price regulation with the systems in six other countries. They find, “The US has nearly 4.5% of the world’s population but accounts for more than 40% of global drug spending . . . the drug price mechanisms and government regulations used in 6 representative peer countries are evaluated: Australia, France, Germany, Norway, Switzerland, and the United Kingdom. . . bills currently making their way through the US Congress are evaluated . . . None of these bills is as systemic or comprehensive in its drug pricing mechanisms and regulations as the schemes in the other countries.”
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.
HHS Protect Public Data Hub, https://protect-public.hhs.gov/datasets/state-representative-estimates-for-hospital-utilization/data?orderBy=state_name&page=4
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.
The COVID Tracking Project (The Atlantic Monthly), 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 17, 18, 19, 20
December 1, 2, 3, 4, 7, 8, 9, 10
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.