DCMedical News: Monday, December 7, 2020
DCMedical News-DCMN
Washington, D.C.
Monday, December 7, 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 12-6 worldwide 67,004,543,192 COVID-19 cases, 14,748,838 U.S. cases. Deaths worldwide are 1,535,038, of which 282,231 are in the U.S., 18% of the world death total.
Vaccination, Public Health: The Washington Post reports (here) that “The administration pledged several hundred million doses in 2020. Companies will actually ship about 10 percent of that.” The report added, “Lower-than-anticipated allocations have caused widespread confusion and concern in states, which are beginning to grasp the level of vaccine scarcity they will confront in the early going of the massive vaccination campaign.” The GAO says (complete report, 401 pgs. here, summary here) that “Urgent Actions [are] Needed to Better Ensure an Effective Federal Response.” The GAO report, including testing, PPE, vaccination plans and other aspects of pandemic control, notes that one problem has been spending the money Congress has already provided: Of the $2.6 trillion appropriated by the CARES Act and three other relief measures only $1.6 trillion had been expended as of September 30. A fifth pandemic “stimulus” bill could be taken up today; FT report here. The CDC issues a new summary of public health measures (here) for the pandemic, a “battle plan” for coming months according to coverage of the document in The New York Times (here).
Medical Care: CMS is promoting experiments (here) in the “hospital at home” in a half dozen locations, building on earlier announcements concerning the use of ambulatory surgery centers in lieu of hospitals. “CMS believes that treatment for more than 60 different acute conditions, such as asthma, congestive heart failure, pneumonia and chronic obstructive pulmonary disease (COPD) care, can be treated appropriately and safely in home settings with proper monitoring and treatment protocols.” HHS is also acting (here) to allow telehealth across state lines and otherwise to use the Public Readiness and Emergency Preparedness Act (PREP Act) “to increase access to critical countermeasures against COVID-19.”
Hospitals: Statista (here) charts the waves of hospitalizations from COVID-19 in U.S. hospitals. The New Jersey Hospital Association (here) charts that state’s 2020 COVID-19 hospitalizations by age and gender. USA Today (here) summarizes numerous reports on the state of the nation’s hospitals, “'A very, very dark place': Hospitals brace for crisis-care mode with too many patients, not enough staff,” and FT reports (here) “US states sound alarm on soaring Covid-19 hospitalisations,” while an essay in The Atlantic (here) notes “The U.S. Has Passed the Hospital Breaking Point.”
Health Policy: President-elect Biden has selected California Attorney General Xavier Becerra as Secretary for the Department of Health and Human Services. The Los Angeles Times reports (here) that Becerra has been a leading defender of the Patient Protection and Affordable Care Act and a leading foe of hospital monopolies and monopoly pricing. As a Member of Congress Becerra favored “Medicare for All.” Commentators noted that Becerra was chosen after one Governor (offered another Cabinet position) proved difficult, and a second was found to be consistently anti-labor. After twelve terms in Congress Becerra was named Attorney General, succeeding now Vice President-elect Harris.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Thrombolysis for Strokes May Be Less Dependent on Time
The Lancet publishes a study (here) indicating that “Patients who have had a stroke with unknown time of onset have been previously excluded from thrombolysis. We aimed to establish whether intravenous alteplase is safe and effective in such patients when salvageable tissue has been identified with imaging biomarkers.”
Cardiologists Express Concern Regarding Over-Interpretation of Cardiac MR and COVID-related Myocarditis
A large group of cardiology and public health authorities have written (here) to their respective professional societies concerning one of the potentially serious long-term sequelae of COVID-19. They note “prevalence of myocarditis in patients with recent COVID-19 have found features of subclinical myocarditis on cardiac magnetic resonance (CMR) imaging in patients without symptoms. Some commentators have raised concern that COVID-19 may lead to frequent, serious long-term cardiac sequelae even among people who have had mild infection and are currently asymptomatic. We wish to emphasize that the prevalence, clinical significance and long-term implications of CMR surrogates of myocardial injury on morbidity and mortality are unknown. Further, it is unclear if the elevated T1 and T2 flagged in these studies are clinically significant, particularly in isolation, if treatment is needed, and, if so, what the management should be. These important questions should inspire future prospective studies.”
Medicare Puts Medical Necessity Responsibility for Imaging Studies on Ordering Physician
CMS has announced (Medicare Learning Network here, instruction to MACs here) that the ordering physician, not the radiologist, will be responsible for justifying the medical necessity of imaging studies. The American College of Radiology (here) welcomed the change.
CABG Without Catheterization
An Irish group (here) has announced a study in which non-invasive CT imaging substituted for catheterization in guiding coronary artery bypass graft operations.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
MedPAC Reports on Hospital Payments
At its December 3 meeting, the Medicare Payment Advisory Commission (here) took note of the continued decrease (2%) in inpatient hospitalization, and the corresponding growth in the complexity of outpatient care; the continued decline in hospital mortality and readmissions; the slowing but continued acquisition of physician practices by hospitals; and the high rate of satisfaction of Medicare beneficiaries with hospital care (73% rate it 9 or 10 on a scale of 10). MedPAC also noted the 7.6% all payer hospital margin, although MedPAC and Medicare may measure operating and all payer margins in a manner different from the hospitals themselves. The group received a recommendation to “maintain fiscal pressure on hospitals to constrain costs” and “minimize difference in payment rates for similar services across sites of care.”
The 2021 meetings of MedPAC will take place January 14-15, March 4-5, April 1-2, September 2-3 and October 7-8.
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
2021 House Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
December 8, 9, 10
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.