DCMedical News: Tuesday, November 17, 2020
DCMedical News-DCMN
Washington, D.C.
Tuesday, November 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
Vaccine: Moderna reported 95% positive results from its vaccine, leading to the DJIA closing at a record high of 29,950, up 471 points (1.6%). The Moderna vaccine will remain viable in a refrigerator for 30 days (Boston Globe report here), unlike the Pfizer vaccine which requires -103°F freezing until used. “Stocks of companies that would benefit the most from the economy climbing out of its recession led the way higher.”
Tracking: By Johns Hopkins (here) shows on 11-16 worldwide 54,826,773 COVID-19 cases, 11,190,611 U.S. cases. Deaths worldwide are 1,323,093, 247,116 in the U.S., 19% of the world death total. California (here) prepares for a lockdown which will affect 9 in 10 state residents (“All individuals living in the State of California are currently ordered to stay home or at their place of residence, except for permitted work, local shopping or other permitted errands, or as otherwise authorized.”)
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Imaging Fall Off in CT, Not Fully Recovered; CT Use in COVID-19 Dx Has 8 to 10-Fold Variation in Dosage
Radiology Business (here) reports that “The United States imaging industry has delivered nearly 3.7 million fewer CT exams than anticipated in 2020,” that “During the pandemic’s worst points, providers recorded roughly 38,000 fewer such scans in an average day, and areas with higher population density and greater unemployment rates suffered steeper declines.” Researchers noted “The fact that CT volume never recovered to predicted levels suggests that a substantial proportion of reduced care likely was not just deferred, but was not provided at all.” Results were based on analysis from 2,398 practices—representing all 50 states, in hospitals, academia and freestanding imaging—participating in the American College of Radiology’s Dose Index Registry.”
Aside from diminished overall volume, CT usage in the pandemic for COVID-19 diagnosis has also been examined for variation in CT use and dosage. A study published in the journal of the Radiologic Society of North America (here) found that “Although CT is justified in high disease prevalence sites with low availability of antigen or antibody assays for the coronavirus, overuse of CT remains an important concern.” Radiology Business reports on this study that “Roughly 76% of sites used computed tomography to assess the severity of COVID-19 pneumonia while 22% used the modality to make an initial diagnosis. The latter practice in not recommended by groups including the U.S. Centers for Disease Control and Prevention and the American College of Radiology. Another 80% of respondents said they typically used single-phase, non-contrast CT scans on COVID patients and 20% delivered multiphase exams (found to be unnecessary for most clinical indications, especially routine chest CT, experts noted). The researchers reported eight-fold variations in the median volumetric CT dose index, and ten-fold variations in median dose-length product. About 30% of patients underwent upward of eight chest CT exams in less than a month.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
National Nurses United (NNU) Attacks For-Profit Hospitals, Publishes Report on Charge-to-Cost Ratios
Modern Healthcare (here) reports that the 92-page NNU study finds (here) “All but five of the 100 hospitals with the highest price markups in 2018 were for-profit hospitals, and 53 of them were owned by HCA Healthcare.” The report used hospitals' Medicare cost reports to calculate the ratio between hospitals' charges and the cost of providing care, which doubled (on average) between 1999 and 2018, from 200% to 417%. The report shows a ranking of high charge-to-cost hospitals and systems, and also organizes them by state and hospital referral region, also showing the lowest ranking hospitals, generally public and independent non-profits.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Health Plan Transparency Guidelines Examined
The Healthcare Financial Management Association has examined (here) the final regulations for health care plan transparency requirements. The rule requires “group health plans and health insurance issuers in the individual and group markets: 1) to disclose, upon request, cost-sharing liability including in-network provider negotiated rates, and out-of-network allowed amounts to a participant, beneficiary or enrollee (hereinafter referred to as an “enrollee”) through an internet self-service tool and in paper form; 2) to publicly disclose in-network provider negotiated rates, historical out-of-network allowed amounts, and drug pricing information in machine readable data files; and 3) to permit insurers to claim credit towards their medical loss ratios (MLR) for ‘shared savings’ when an enrollee selects a lower-cost, higher-value provider.”
DRUGS & DEVICES
Flurry of Activity from Administration on Drug Price Controls
The Hill (here) reports that “The Trump administration is preparing to move forward [through publication of an interim final rule] with a major proposal to lower drug prices and rulemaking could come as soon as this week.” The move would implement the “most favored nation” drug “index” pricing extolled by the President through an executive order in September, to lower certain Medicare drug prices to match prices in other wealthy countries. According to The Hill, “the proposal is similar to ideas proposed by Democrats to lower drug prices, increasing the odds that the incoming Biden administration would choose to continue the program if it’s implemented.” CQ reports that “A series of executive orders President Donald Trump issued in September instruct the Department of Health and Human Services to apply the model both in the Medicare Part B outpatient program as well as the Part D prescription drug program. The order goes further than a previous iteration known as the international pricing index, which was expected to have pegged Part B prices to an average of the prices paid in other wealthy countries. That rule was never formally proposed, and has been parked at the Office of Management and Budget since June 2019. The international pricing index concept had more Democratic supporters than Republican supporters on the Hill when it was first put forward.”
Also moving forward, “On a separate drug pricing front, a rule to eliminate rebates that drugmakers pay to pharmacy benefit managers [PBMs], in a bid to simplify the pricing system and lower out of pocket costs for patients,” could also come soon, now under review at the Office of Management and Budget. PhRMA supports the initiative, PBMs oppose it.
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.
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 18, 19, 20
December 1, 2, 3, 4, 7, 8, 9, 10
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.