DCMedical News: Thursday, December 3, 2020
DCMedical News-DCMN
Washington, D.C.
Thursday, December 3, 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 12-2 worldwide 64,360,815 COVID-19 cases, 13,900,350 U.S. cases. Deaths worldwide are 1,489,816, 273,170 of them in the U.S., 18% of the world death total. The NY Post reports (here) “The U.S. recorded over 200,000 new coronavirus cases and 100,000 hospitalizations from the illness in a single day on Wednesday — a grim new record in the fight against the virus. The alarming new numbers comes after Centers for Disease Control and Prevention director Robert Redfield warned there could be 200,000 more deaths by February.”
Vaccination: The UK granted emergency use authorization for Pfizer’s coronavirus vaccine (FT report here), while the FDA plans a December 10 advisory group meeting.
Federal government: Democratic leaders announced support for a coronavirus relief bill, the Manchin-Collins bipartisan relief bill (here) of $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.
Other Nations: The OECD issues its comprehensive EU “Health at a Glance” (237 pgs.) report (here) noting that “countries which took rapid action to contain the virus, backed by high levels of trust and compliance from their populations, limited the spread of infection and mitigated its economic consequences. Asian nations including South Korea and Japan acted swiftly, in part reflecting their past experience with epidemics such as Sars. Finland, Norway and Estonia were among the best performers in Europe, helped by factors including their population structure and relatively low cross-border flows of people.” FT summary of the report here, noting that “The UK does not come out well. Having spent more than other European countries to tackle Covid-19 in purchasing parity terms, it suffered the largest cut in second-quarter GDP and the greatest number of Covid-linked deaths, even though it ranked after Belgium by deaths per million population.” The report contains extensive reporting on infections, hospital beds and other medical resources, and country strategies.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
CMS Announces New Procedures Eligible for Ambulatory Surgery Centers, Touts Choice for Beneficiaries
The Centers for Medicare and Medicaid Services announced “new choices” and “flexibility” for Medicare beneficiaries to receive outpatient surgical care (here). The actual policy announced, however, will eliminate a rule (here, 1312 pgs.; CMS “Fact Sheet” here, the “Inpatient Only” rule) which has limited 1,700 neurosurgical, orthopedic and cardiac procedures to hospitals. These procedures will now be paid for by Medicare in ambulatory surgery centers (ASCs). The ASCs, two-thirds of which are owned by surgeons, will now be able to bill Medicare for such complex procedures, despite not having intensive care units, blood banks, complete imaging capabilities, emergency rooms or hospital-like physician staffing. Elimination of the “Inpatient Only” rule is widely seen as a threat to the financial stability of hospitals, since surgeons who are owners of ASCs will be recommending the site of surgery to their Medicare patients. The rule also continues payment of 340B drug prices to hospitals at the “average sales price minus 22.5%” level, lower than historically paid, higher than some earlier proposals would have paid; hospitals buy low from manufacturers under the 340B legislation and sell as high as they may, using the difference as income to support general operations.
The final rule also makes possible the addition of procedure rooms, operating rooms and beds in physician-owned hospitals. CQ reports that “The lifted restrictions include a cap on the number of surgical and procedural rooms and beds; the requirement that expansions must be on the hospital’s main campus; and the limit on no more than one expansion request every two years, as long as the requests are made one at a time” and that previously “Congress limited physician-owned hospitals because they often cherry-picked more profitable patients and conducted self-referrals.”
The rule also exempts the procedures on the Inpatient Only list from the two-midnight rule (see here) for two years and any site-of-service denial.
MedPAC In Town, Santa Claus or Coal in the Stocking
The Medicare Payment Advisory Commission holds its annual discussions concerning the adequacy of payment for health services today (December 3) and tomorrow. Brief introductions to the discussions can be found for ASCs here, dialysis here, home health care here, hospice here, hospitals here, inpatient rehabilitation facilities here, long term acute care hospitals here, Medicare Advantage programs here, physicians here and skilled nursing facilities here. MSK’s Dr. Peter Bach writes in the NY Times (here) that “After Four Years of Trump, Medicare and Medicaid Badly Need Attention; Science and Objective Analysis Need to be Revived.”
DRUGS & DEVICES
Devices, Like Drugs, More Likely to be Selected by Physicians Receiving Payments from Their Manufacturers
A Yale group published (here) a study in JAMA which found that “Patients more often received an implantable cardioverter-defibrillator or cardiac resynchronization therapy-defibrillator device made by the manufacturer that provided the largest payments to the physicians than to each of 3 other manufacturers individually.”
Thirty-six studies and 101 analyses of pharmaceutical prescribing behavior were summarized in the Annals of Internal Medicine (here), finding that “The association between industry payments and physician prescribing was consistent across all studies that have evaluated this association. Findings regarding a temporal association and dose-response suggest a causal relationship.”
READINGS & REFERENCES
The Arts in Medicine
JAMA has a feature (here) on “Graphic Medicine—the Best of 2020,” with “notable efforts in emergent categories of instructional, personal stories, and therapeutic comics, highlighting some of the most interesting exemplars in each category.”
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
2021 House Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
December 4, 7, 8, 9, 10
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.