DCMedical News: Tuesday, December 1, 2020
DCMedical News-DCMN
Washington, D.C.
Tuesday, December 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
Coronavirus
Tracking: By Johns Hopkins (here) shows at 8:00 p.m. on 11-30 worldwide 63,154,049 COVID-19 cases, 13,525,889 U.S. cases. Deaths worldwide are 1,466,346, 267,888 of them in the U.S., 18% of the world death total. Dr. Anthony Fauci predicts a “surge superimposed on the surge.” Estimates vary widely, but seem to indicate four million new cases (of 13 million total in the U.S.) in November, with hospitalization of more than 90,000 individuals currently, nearly 160,000 new cases each day and more than 1,500 deaths per day, both of these measures for the past week.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Financial Conflict-of-Interest Rules Updated in the Name of Value Based Payment, etc.
Tomorrow’s (December 2) Federal Register (here) will contain an “update” of Stark law conflict-of-interest rules, effective January 19, 2021. The 627-page pre-publication version notes “This final rule establishes exceptions to the physician self-referral law for certain value-based compensation arrangements between or among physicians, providers, and suppliers. It also establishes a new exception for certain arrangements under which a physician receives limited remuneration for items or services actually provided by the physician; establishes a new exception for donations of cybersecurity technology and related services; and amends the existing exception for electronic health records (EHR) items and services. This final rule also provides critically necessary guidance for physicians and health care providers and suppliers
whose financial relationships are governed by the physician self-referral statute and regulations.”
Some commentary (here, Radiology Business) finds the rules “still beyond comprehension,” while others (AHLA, here) applaud “innovation” and “reduction of administrative burden.” Says the Medical Group Management Association (here), “We support the new value-based arrangement exception to the Stark Law, which will provide some group practices with greater protection when entering into care coordination arrangements . . . the final rule could have gone further to reduce the overall complexity and regulatory intrusion into group practice operations. Despite countless rulemakings, each of which identified legitimate problems with Stark Law regulations and attempted to fix them, the regulatory scheme has grown in complexity to the point where it is beyond comprehension to the average physician or practice administrator.”
Primary Care Most Endangered Among Many Financially Shaky Physician Practices
Kaiser Health News reports (here) that 82 million Americans live in primary care health professions shortage areas, that the nation needed more than 15,000 additional primary care practitioners even before the pandemic began, and that “Once the coronavirus struck, some practices buckled when patients stayed away in droves for fear of catching it, said Dr. Gary Price, president of the Physicians Foundation, a nonprofit grant-making and research organization. Its survey, based on 3,513 responses from emails to half a million doctors, found that 4 in 10 practices saw patient volumes drop by more than a quarter. On the West Coast, a survey released in October by the California Medical Association found that one-quarter of practices in that state saw revenues drop by at least half.”
Private Equity Disclosure May Increase Under Proposed FTC-DoJ Rule
Bloomberg reports (here) that a proposed FTC-DoJ rule (here) “would subject more mergers and acquisitions to extensive reporting requirements. The proposed rule from the Federal Trade Commission and Justice Department’s Antitrust Division would expand the meaning of a ‘person’ that must report a transaction for antitrust review under the Hart-Scott-Rodino Act. The new definition would include the acquiring company’s associated entities, such as affiliates. That would enlarge the size of many prospective acquirers, one of the considerations in whether a deal gets antitrust scrutiny. The tweak in particular would push more private equity-driven deals over the threshold that triggers regulatory reporting requirements for antitrust review prior to closing.” Private equity has been important in “rolling up” physician practices, decreasing competition and increasing prices for medical care.
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Hospital Staff, Margins, Suffer in Pandemic
Nurses, doctors and other care givers across the nation are working in understaffed, overstressed conditions, with New York State, for example (here), looking to augment hospital ranks with retired doctors and nurses. KaufmanHall predicts continued pressure on operating margins (report, here), down nearly 1.9% through ten months, 6% without relief funds. On the expense side the KaufmanHall report shows expense per adjusted discharge up 13.5% over the 10-month period through the end of October, while on the revenue side emergency department visits fell 16%, discharges 11% and OR minutes 12% in the same period. Some efforts have appeared (here) to redefine the responsibilities of hospitals to their patients, positing a “Critical Standard of Care,” compared to your non-pandemic standard of care. The New York Times (here) reports on hospitals “running out of beds,” but the story is more accurately “running out of staff.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
The Hospital-at-Home, or in the Ambulatory Surgery Center, Just In Time for COVID-19
CMS announced (here) new “flexibilities” to allow “for safe hospital care for eligible patients in their homes and updated staffing flexibility designed to allow ambulatory surgical centers (ASCs) to provide greater inpatient care when needed. Building on CMS’s previous actions to expand the availability of telehealth across the nation, these actions are aimed at allowing health care services to be provided outside a hospital setting while maintaining capacity to continue critical non-COVID-19 care, allowing hospitals to focus on the increased need for care stemming from public health emergency (PHE).” One of the first waivers went to New York’s Mount Sinai (announcement here).
DRUGS & DEVICES
WARP Speed Income to Pharma Executives
Kaiser Health News reports (here) that “The Trump administration relied on an unusual maneuver that allowed executives to keep investments in drug companies that would benefit from the government’s pandemic efforts: They were brought on as contractors, doing an end run around federal conflict-of-interest regulations in place for employees. That has led to huge potential payouts — some already realized, according to a KHN analysis of SEC filings and other government documents.”
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
December 2, 3, 4, 7, 8, 9, 10
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.