DCMedical News: Tuesday, December 8, 2020
DCMedical News-DCMN
Washington, D.C.
Tuesday, December 8, 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 12-7 worldwide 67,529,798 COVID-19 cases, 14,932,613 U.S. cases. Deaths worldwide are 1,543,190, of which 283,621 are in the U.S., 18% of the world death total. Statista shows graphically (here) the disproportionate death toll on the aged; they report, “Of the roughly 250,000 people who had died from COVID-19 in the United States as of December 2, 230,000 were older than 55, with almost 150,000 deaths occurring in the 75+ age group alone. Meanwhile, less than 2,500 people younger than 35 lost their lives to the virus, with just over 500 victims younger than 25.”
Vaccines: The White House hosts a “Vaccine Summit” today, minus the manufacturers, and with conflicting claims in the background concerning availability of sufficient quantities of vaccine for the anticipated level of U.S. vaccination in 2020 and the first quarter of 2021. Britain begins today “The biggest logistical challenge ever faced by the country’s health service, the vaccination of tens of millions of people against coronavirus in a matter of months,” reported (here) in The New York Times.
More on Vaccines: Big stakes for the future of vaccinology: genetic mRNA instructions (to make the protein, which then stimulates production of antibodies), not using protein antigens directly (JAMA Network analysis, here). “Despite the unprecedented speed, mRNA vaccines are clinically unproven. No commercially available vaccines use the platform and, until now, it hasn’t been tested in large-scale human trials. With COVID-19, that’s all set to change. Experts said in interviews that if the technology pans out, the pandemic could help to usher in a new plug-and-play approach to vaccinology.”
Medical Care: Fauci and colleagues discuss early treatment for COVID-19 in JAMA (here), noting aspects of the use of remdesivir, dexamethasone and Regeneron which limit their current availability as outpatient treatments. Rochelle Walensky (slated by President-elect Biden to be CDC Director) and colleague Robert Goldstein discuss (in JAMA, here) the road from discovery to utility of monoclonal antibodies in fighting early stage COVID-19 infection.
Public Policy: Current funding for the federal government expires this Friday, the 11th. A “stopgap” funding proposal for one additional week will be voted on in the House tomorrow, Wednesday. Remaining issues in the funding measure: $2 billion for the border wall, and spending in the private sector for Veterans’ health services (to be exempt from spending limits, or not). Also uncertain: another pandemic relief bill, and whether to include state and local assistance (pressed by Democratic party leaders) and/or immunity from liability for business (pressed by Republican party leaders).
HOSPITALS, NURSING HOMES AND OTHER HEALTH FACILITIES
New Mexico Shows That Shutdowns May Not Work. “Crisis Standards of Care” Allowed
The Washington Post (here) and the Albuquerque Journal (here) chronicle the difficulty of state shutdown policy in achieving its intended results. Reports WP, “With coronavirus cases rising exponentially and hospital beds dwindling,” the Governor “dragged her state back to the darkest days of spring, when restaurant dining was banned, nonessential businesses were closed and residents were ordered to stay inside unless absolutely necessary. She hoped it might be enough to avert catastrophe this winter . . . Three weeks later, victory remains a distant prospect.” The Governor said she would “soon allow hospitals to move to ‘crisis standards,’ a move that frees them to ration care depending on a patient’s likelihood of surviving.”
Hospital-Acquired COVID-19 Infection: Rare With Universal Masking
A summary in JAMA (here) discusses what is known about safety in hospitals during the pandemic. “What is clear is that these hospital-based outbreaks have not revealed a failure of universal masking, but rather challenges in systems such as inadequate support to maintain masking adherence and basic human nature, in which individuals tire of masking. In particular, breakdowns have occurred in small workrooms and during mealtime in facilities that were not designed to allow adequate physical distancing during a respiratory pandemic.”
Sen. Grassley Reports on Debt Collection at UVA Medical Center and Methodist Le Bonheur Hospital in Parting Shot for Charity Care
Sen. Chuck Grassley, term limited as Chair of the Finance Committee, and slated to be Chair of the Judiciary Committee if his party remains in the majority, has undertaken a final initiative in examining hospital charity care policies, focusing on the debt collection policies of two high profile institutions with an 11-page letter to his colleagues (here), 950 pages of response from the hospitals (here), chronicled in a ProPublica report (here). Sen. Grassley reports on and recognizes changes in the debt collection policies of the two organizations, but notes for future action the importance of system-wide compliance, and of transparency in pricing. Referring to a section of the Internal Revenue Code upgraded in the Patient Protection and Affordable Care Act, Grassley writes, “Since the enactment of Section 501(r) into law ten years ago, I have heard from the healthcare industry that Section 501(r)’s requirements are overly strenuous for non-profit hospitals. This inquiry unfortunately has shown that, if anything, the requirements of 501(r) need to be strengthened rather than softened. Stories about non-profit hospitals engaging in billing and debt-collection practices that defy the spirit of Section 501(r), at least, are not limited to the two hospitals discussed above. There seems to be a pattern: questionable behavior leads to negative press attention; negative press attention leads to more desirable behavior. That may create some good outcomes but it is an unsustainable way to ensure a distinction between for-profit and non-profit hospitals.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
MACPAC Meets (Virtually) December 10-11
The Medicaid and CHIP Payment and Access Commission will meet December 10 and 11 (agenda here, meeting notice here). “The meeting kicks off on Thursday with a panel discussion on the role of Medicaid in improving health equity. Meeting sessions will focus on extending postpartum coverage in Medicaid, an interim final rule affecting Medicaid provisions of the Families First Coronavirus Relief Act, recommendations on countercyclical financing adjustments, integrating care through electronic health records use in behavioral health, and highlights from the 2020 edition of MACStats . . . On Friday, the day begins with a session and a related panel discussion on access to behavioral health services for children and adolescents. Additional sessions focus on the implications of the 2020 elections for Medicaid policy, Medicaid estate recovery, quality rating systems in Medicaid managed care, and nursing facility payment methods.”
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 9, 10
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.