DCMedical News: Wednesday, December 9, 2020
DCMedical News-DCMN
Washington, D.C.
Wednesday, December 9, 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 12-8 worldwide 68,148,400 COVID-19 cases, 15,151,472 U.S. cases. Deaths worldwide are 1,555,031, of which 286,117 are in the U.S., 18% of the world death total.
Vaccines: NEJM Journal Watch (here) reports that “Pfizer and BioNTech's mRNA vaccine against SARS-CoV-2 appears to start working soon after the first dose, according to a briefing document [here] released by the FDA in advance of its vaccine advisory committee meeting this Thursday. The data show similar incidence of COVID-19 in the vaccine and placebo groups until roughly 10-14 days after the first dose, when cases among vaccine recipients leveled off and those among placebo recipients steadily increased. In addition, the vaccine's benefits were seen across age and racial/ethnic groups, and in obese and non-obese participants.” Coverage of the vaccine’s approval in The New York Times, here. As for vaccine administration, USA Today (here) reports “50 States, 50 Plans.”
AstraZeneca vaccine: The results of randomized trials of the AstraZeneca–University of Oxford vaccine are now published in The Lancet (here). “The adenovirus vaccine showed 62% efficacy among people who received two full doses and 90% efficacy among those who received a half-dose followed by a full dose. The half-dose was given inadvertently to a subset of U.K. participants.”
Hospitals: NEJM Journal Watch reports that “Healthcare workers in the U.K. were over seven times as likely as nonessential workers to develop severe COVID-19 between March and July 2020, a study in Occupational and Environmental Medicine suggests. Overall, 0.96% of some 11,000 healthcare workers were diagnosed with severe disease. Risk was highest among medical support staff, followed by health-associated professionals like nurses and paramedics.” The Los Angeles Times reports (here) “Intensive care units struggle as virus surges. Embattled hospital staffs choreograph the care of patients as COVID-19 cases mount in the state.”
Medical Care: NEJM Guideline Watch reports (here) that “Three major organizations — the WHO, the Infectious Diseases Society of America (IDSA), and the NIH — have coincidently, but independently, published updated guidelines on the management of patients with SARS-CoV-2-infection (COVID-19), reflecting the rapidly increasing knowledge and emerging evidence from completed studies.” Improvements in treatment were charted in that state’s hospitals by the New Jersey Hospital Association (here): “Over a quarter of hospitalized COVID-19 patients (25.3 percent) died during April, more than four times the percentage in July through August (6 percent). Mortality among those with high-risk comorbidities has also decreased substantially from April through August.”
Politics and Policy: The Financial Times (here) profiles Rochelle Walensky, President-elect Biden’s choice to head the CDC. “She is relatively unknown in Washington, however, making her selection as Joe Biden’s choice to head the embattled US Centers for Disease Control and Prevention one of the biggest, and possibly most important, surprises of the president-elect’s picks so far.” And Congress is considering a one-week stop-gap funding measure (here) to keep the federal government’s lights on.
HOSPITALS, NURSING HOMES AND OTHER HEALTH FACILITIES
Racism and the Business Practices of Academic Health Centers
The Annals of Internal Medicine (here) takes aim at segregation, wages, and the financial practices of tax-exempt academic health centers in the U.S.
Expenses Up in Hospitals, But Not Equally in All Expense Categories
Connecticut’s Office of Health Strategy reported today (here) that three-year expense increases (2016-2019) in that state’s hospitals showed salaries were up, benefits down, drug costs way up. All expenses increased an average of 28%, while “Corporate parent/system” fees were up 186%, and physician fees were up 424%.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Commercial Insurers in NY Note the Price of “Reform”
A study by the Blue Cross and Blue Shield plans in New York (here) reports that “A surcharge created by the Health Care Reform Act (HCRA) of 1996 is collected from health plans in the form of a sales tax on certain hospital-based health services. The surcharge was originally designed to help reimburse hospitals for losses incurred by bad debt and charity care. Today, it is used for a variety of general fund purposes . . . The initial rate of the surcharge was 8.18 percent in 1997 and yielded $517 million. The current rate is 9.63 percent, and yielded $3.875 billion in 2020.”
DRUGS & DEVICES
Failing Forward: The American College of Physicians (ACP) Takes Aim at “Step Therapy”
The ACP (report here, position paper here) writes that “In 2020, the U.S. will spend roughly $358.7 billion on prescription drugs, nearly 9% of national health expenditures . . . one of the fastest growing health care spending categories. This rapid growth is largely attributed to anticipated higher prices, new available drugs, and fewer available rebates. Pharmacy benefit managers (PBMs) have developed a series of price management tactics to curb the rising cost of prescription drugs. Among these, step therapy policies, commonly called ‘fail-first’ policies, require patients to be initiated on lower-priced medications before being approved for originally prescribed medications. Carriers can also change coverage in an attempt to force patients off their current therapies for cost reasons, a practice known as nonmedical drug switching. In 2017, 14% of treatment denials for insured Americans were based on step therapy or nonmedical drug switching policies.”
AI Add-On Payment for Stroke Assistant
Radiology Business reports (here) that Avicenna.AI joins a growing list of vendors to earn new technology add-on payments from CMS for Medicare patients. “Its CINA Head solution—cleared by the U.S. FDA over the summer —helps radiologists to detect intracranial hemorrhages and large vessel occlusions in CT angiogram images . . . Providers are now eligible for reimbursement of up to $1,040 for using the platform.”
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.
STAT COVID-19 Tracker, 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 10 (final edition in 2020)
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.