DCMedical News: Wednesday, November 18, 2020
DCMedical News-DCMN
Washington, D.C.
Wednesday, November 18, 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
Tracking: By Johns Hopkins (here) shows on 11-17 worldwide 55,547,836 COVID-19 cases, 11,340,563 U.S. cases. Deaths worldwide are 1,336,670; 248,429 in the U.S., 19% of the world death total.
Politics and Policy: The Hill reports (here) that “The country’s top associations representing hospitals, doctors and nurses are calling on the Trump administration to share information on its coronavirus response with President-elect Joe Biden's team ‘so that there is no lapse in our ability to care for patients.’ The American Hospital Association, American Medical Association, and American Nurses Association wrote in a letter to President Trump on Tuesday that cooperation on the coronavirus response with Biden transition officials is crucial. ‘Real-time data and information on the supply of therapeutics, testing supplies, personal protective equipment, ventilators, hospital bed capacity and workforce availability to plan for further deployment of the nation’s assets needs to be shared to save countless lives,’ the groups wrote.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Primary Care Loss and Health Expense Increase
A group of Notre Dame and Harvard researchers publish (here) a study on loss of primary care practitioners (PCP) by Medicare beneficiaries. They found that “Loss of a PCP was associated with lower use of primary care and increased use of specialty, urgent, and emergency care among Medicare beneficiaries. Interrupting primary care relationships may negatively impact health outcomes and future engagement with primary care.”
United Chooses Anatomic Over Functional Assessment of Coronary Artery Disease
The American Society of Nuclear Cardiology (letter here) and the American College of Cardiology have protested the now six-month old policy of United Healthcare to disfavor functional and to support anatomic studies of patients with stable chest pain. United favored the CT angiogram with these instructions in April: “Effective April 1, 2020, we will reimburse for Coronary CT Angiograms when ordered to evaluate stable chest pain in members with low and intermediate risk for coronary artery disease (CAD) as first-line testing (CCTA-First). Computed tomographic angiography (CTA) is expected to replace the need for other functional stress testing in this population.” The tests no longer routinely allowed under the United program include nuclear stress tests, stress echocardiograms and PET stress tests. Providers who want to deliver such exams are now subject to prior authorization, according to the ASNC in a Nov. 11 update. The ASNC wrote “There are multiple real-world studies of myocardial perfusion imaging involving thousands of patients which demonstrate powerful risk stratification and effective treatment options based on the severity of ischemia. Despite the advent of CCTA and CT-FFR, this technique has failed to demonstrate, in large real-world studies, that a strategy of anatomy-first is more effective than functional imaging. CCT-FFR remains a Category III CPT code, and it is inappropriate that it should replace well-established functional imaging as a first-line test.”
MedPAC and Telehealth
The Medicare Payment Advisory Commission continued to mull (here) permanent expansion of the fee-for-service Medicare telehealth payments begun or expanded during the pandemic. At the group’s November 9-10 meeting a MedPAC staff presentation noted that telehealth had the potential to increase spending, was susceptible to fraud, and had mixed reviews concerning quality. Before the pandemic, Medicare paid for about 100 telehealth services in rural areas. In the Public Health Emergency (pandemic) era, telehealth expanded to cover all beneficiaries, and added about 140 additional telehealth services. A study of telemedicine in commercial health insurance plans (here) found that “Telemedicine use during the early COVID-19 pandemic only partially offset a drop in total outpatient care,” and that there was substantial geographic variation (“By the last 4 weeks of the study period, May 20 through June 16, there was wide geographic variation in the percent of total visits delivered by telemedicine ranging from 8.4% in South Dakota to 47.6% in Massachusetts”).
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
TAVR Overtakes Surgery for Aortic Valve Replacement
A report from the Society of Thoracic Surgeons (STS) and American College of Cardiology (ACC) (here) studied results of 276,316 TAVR procedures done between 2011 and 2019. The patients underwent “transcatheter aortic valve replacement (TAVR) at sites in all U.S. states. Volumes have increased every year, exceeding surgical aortic valve replacement in 2019 (72,991 vs. 57,626), and it is now performed in all U.S. states. TAVR now extends from extreme- to low-risk patients. This is the first presentation on 8,395 low-risk patients treated in 2019. In 2019, for the entire cohort, femoral access increased to 95.3%, hospital stay was 2 days, and 90.3% were discharged home. Since 2011, the 30-day mortality rate has decreased (7.2% to 2.5%), stroke has started to decrease (2.75% to 2.3%), but pacemaker need is unchanged (10.9% to 10.8%). Alive with acceptable patient-reported outcomes is achieved in 8 of 10 patients at 1 year.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
AHRQ on High Deductible Health Insurance Plans, Now in the Majority
The Agency for Healthcare Research and Quality published (here, 173 pgs.) a report on “high deductible” health insurance plans, originally intended to provide “motivation” for the insured to comparison shop, but increasingly relied on by corporate benefit managers to “control” the cost of health insurance. Says the report, “About 55 percent of private-sector workers who received single-coverage health insurance in 2019 were enrolled in high-deductible plans, according to a new chartbook from AHRQ. The percentage of employees in high-deductible plans has grown steadily since 2006, when only about 11 percent of private-sector workers with single coverage were in such plans . . . AHRQ’s annual survey of private-sector employers . . . quantify increases in the percentage of employees working at establishments where insurance was offered, as well as employees’ share of premiums and deductible amounts.”
READINGS & REFERENCES
From the Hastings Law/Petris Center: “Preventing Anticompetitive Contracting Practices in Healthcare Markets,” here. Also from this group, “Atrium Health Settlement Encourages Enforcement of Anti-tiering/Anti-steering Clauses in Healthcare Contracts,” here.
From the AMA: The 19th edition of the American Medical Association’s study of concentration in health insurance markets, “COMPETITION in HEALTH INSURANCE, A comprehensive study of U.S. markets,” here.
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 19, 20
December 1, 2, 3, 4, 7, 8, 9, 10
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.