DCMedical News: Wednesday, December 2, 2020
DCMedical News-DCMN
Washington, D.C.
Wednesday, December 2, 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 12-1 worldwide 63,679,175 COVID-19 cases, 13,696,060 U.S. cases. Deaths worldwide are 1,476,949, 270,369 of them in the U.S., 18% of the world death total.
Federal government: Two new legislative proposals were unveiled Tuesday to provide support for governments, businesses and individuals financially compromised by the pandemic. The Manchin-Collins bipartisan relief bill (here) would total $908 billion, with $160 billion for state and local governments, $180 billion for additional unemployment insurance, $288 billion for small business including another round of the Paycheck Protection Program, $16 billion for vaccine development and distribution and $35 billion in healthcare provider relief. Senator McConnell offered his own $519 billion (including $429 billion of rescission offsets) proposal (here) which aims primarily to redirect and then end support from previous legislation, with new support for private and religious schools as well as home schooling expenses, small business, farming and fishery support and 100% deduction for business meal expenses.
Vaccination: The CDC’s Advisory Committee on Immunization Practices (ACIP) took action Tuesday to recommend early vaccination availability for health care workers and residents in long-term care facilities. ACIP minutes, resources and materials will be found here. The Financial Times reports here. The Daily Mail reported that Dr. Beth Bell, a member of the committee, “noted that one person is dying of COVID-19 a minute in the US.” An average of 1,466 Americans are dying daily, according to Johns Hopkins' data. FDA officials will meet December 10 to discuss whether to give emergency use authorization to Pfizer's and Moderna’s COVID-19 vaccines. Dr. Peter Marks, Director of the FDA’s Center for Biologics Evaluation and Research will discuss (here) the FDA vaccine approval process in a webinar with AMA President Dr. Susan Bailey tomorrow, at 2:00 p.m. Eastern. Politico reminds us that “It took more than two decades after the polio vaccine was approved before the United States eradicated the disease.” Statista charts (here) the projected cost of vaccines, Moderna at $37 a shot, Pfizer $20, Oxford/AstraZeneca $4. Statista notes “Cost is another inhibiting factor with Moderna's vaccine coming in at $37 per jab while Pfizer & BioNTech state theirs will cost around $20 per dose. Many governments have used taxpayer money to buy doses in bulk with the intention of distributing the vaccines to their citizens for free. This is not an option for every country, however, and cheaper vaccines that remain stable at higher temperatures are therefore expected to play a crucial role in ending the pandemic in more far flung corners of the world.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Surgical Care Coalition Leads Physician Protests of 2021 Medicare Fee Schedule
The Surgical Care Coalition (here) continued to urge Congress to up-end the final rule for physician fees for Medicare services in 2021 which reduces surgical fees by up to 9%, effective January 1. The group conducted a survey (results announced here) of 1,000 surgeons, finding that “Medicare payment cuts could result in nearly one-in-three surgeons reducing their Medicare patient intake . . . Surgeons that don’t plan to alter their Medicare patient intake will face other tough choices, such as reducing the amount of time spent with each patient, hiring fewer nurses and administrative staff, or stopping investments in new surgical technology.” Others protesting included the American College of Radiology (here), which noted “If Congress fails to mitigate these cuts, decreases in Medicare payments will further exacerbate the problems occurring across the country with practices and institution-based providers furloughing or cutting staff and an increasing number closing their doors in response to the COVID-19 pandemic.”
The final rule, published Tuesday, requires “offsets” (reductions) in specialist pay to compensate for some increases in Evaluation and Management codes commonly used by primary care practitioners. The rule also covers other Medicare outpatient payments provisions, including (as reported by CQ) “expanded coverage for 60 telehealth services, including home check-up visits for certain patients. CMS will cover a dozen telehealth services temporarily until the end of the year after the public health emergency related to the coronavirus ends, including certain home and emergency room visits.” CMS “Fact Sheet” (15 pgs.) here, final rule (2165 pgs.) here.
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Hospitals and Hospital Staff Remain a Top Challenge, For Example in California
The New York Times reports (here) that “A dearth of hospital beds has been a worldwide problem throughout the pandemic, but California, with a population of 40 million, has a particularly acute shortage. The wealthiest state in the wealthiest country has 1.8 hospital beds per 1,000 people . . . according to 2018 data compiled by the Kaiser Family Foundation. California has one-third the number of beds per capita as Poland. Many hospitals in California have maintained lower numbers of beds in part to limit the length of patient stays and lower costs. But that approach is now being tested. In addition to beds, a shortage of nursing staff will make handling the surge of virus cases ‘extraordinarily difficult for us in California,’ said Carmela Coyle, the head of the California Hospital Association, which represents 400 hospitals across the state.” Sunday California became the first state to record more than 100,000 cases per day, 12% of which end up in the hospital.
DRUGS & DEVICES
Artificial Heart and VAD Payment Criteria Changed by CMS
CMS removed the “coverage with evidence” label from artificial hearts, leaving determination of coverage to the MACs, and also altered conditions for coverage of ventricular assist devices. The Decision Memo is here and a link to the CMS web-page with Decision Memo and supporting materials is here. From the text, “Artificial Hearts: CMS is removing the NCD at § 20.9, ending coverage with evidence development for artificial hearts and permitting Medicare coverage determinations for artificial hearts to be made by the Medicare Administrative Contractors (MACs) under § 1862(a)(1)(A) of the Social Security Act. Ventricular Assist Devices: The decision is limited to durable, intracorporeal, left ventricular assist devices (LVADs), and does not include temporary VADs or extracorporeal membrane oxygen (ECMO) . . . [and this memo] modifies patient selection criteria to reflect the major inclusion criteria of contemporary trials. Facility criteria: The facility criteria remain unchanged from the current NCD.”
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 3, 4, 7, 8, 9, 10
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.