DCMedical News: Tuesday, January 5, 2021
DCMedical News-DCMN
Washington, D.C.
Tuesday, January 5, 2021
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: Johns Hopkins (here) shows at 8:00 p.m. on 1-4-21 worldwide 85,604,744 COVID-19 cases, 20,786,001 U.S. cases. Deaths worldwide are 1,851,153, of which 353,131 are in the U.S., 19% of the world death total.
New Variant: The new coronavirus variant is accelerating an explosion of cases (chart, here), according to The New York Times, which reports that “cases have surged in Britain and South Africa since the variant first surfaced—while holding fairly steady in the rest of western Europe and southern Africa.” The report says, “This suggests the rest of the world may now be at risk of a new Covid-19 surge.”
Vaccination: Splitting the vaccine supply in half in order to double the number of persons who can be vaccinated with the Moderna vaccine has been recommended by Operation Warp Speed’s Dr. Slaoui, (here). The British “doubling” alternative is to lengthen the interval between shots. The British Medical Association is opposed to the lengthening, (here), noting “Healthcare workers in England have been told to reschedule appointments for the second dose of the Pfizer and BioNTech covid-19 vaccine after the government’s advisory committee decided that vaccinating as many people as possible with a first dose should be the priority. The BMA has called the decision ‘unreasonable and totally unfair’ and said it could cause ‘huge logistical problems’ for general practices and vaccination centres.”
The “doubling” discussion takes place against the backdrop (primarily but not exclusively in the U.S.) of troubled distribution, vaccines going bad in the freezer (here), slow-rolling in hospitals (here), efforts hobbled in and by the states and localities (here), with little evidence of advance planning for actual vaccine administration during the past ten months. The CDC reports (here) 15.5 million doses distributed, 4.5 million first doses received to date. Politico reports that “Even experts who argue for the delayed-second-dose idea say it’s out of sheer desperation: No studies show the safety and efficacy of delaying a second shot, and many people might just forgo it all together.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Haven to Close in February
STAT+ reports that Haven, the joint venture of Amazon, JPMorgan Chase and Berkshire Hathaway, will close in February, having lost much of its executive staff, and lacking a “big, executable idea.” STAT+ notes that Amazon itself “has built out a health care empire of its own, debuting a smattering of efforts geared toward employees and consumers over the past year, including the health tracking wearable Halo and a partnership with Crossover Health, a venture-backed startup, to build health clinics for Amazon staff. The crown jewel of those efforts is Amazon Pharmacy, the shipping giant’s prescription medication service, which offers discounts to members of its subscription delivery service, Amazon Prime. After the launch of the service in November, online pharmacy rivals including GoodRx and Ro rolled out new offerings that could set them up to compete with the shipping giant, such as free delivery and telehealth services.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH FACILITIES
Hospitals Without Hospital Walls
The “Acute Care Hospital at Home” and the “ASC Flexibility” programs announced by CMS in March and updated as reported by MedPage, here, “Will reimburse hospitals to provide in-home, hospital-level telehealth care for patients with acute conditions and will pay for both inpatient and outpatient care in ambulatory surgical centers (ASC) temporarily designated as hospitals.”
The waiver (CMS detail here) requirements include these: “Hospitals must submit the waiver request for individual CMS Certification Numbers (CCNs), not entire systems. For those hospitals which have provided at home acute hospital services to at least 25 patients previously, an expedited process will be conducted . . . For those hospitals which have treated fewer than 25 patients or have never provided at home acute hospital services, a more detailed waiver request will be required which emphasizes internal processes that prove capability of treating acute hospital care at home patients with the same level of care as traditional inpatients.” The programs provide that, with approval of the waiver, the hospitals and ambulatory surgery centers “Can then bill CMS at the same rate they would bill for hospital inpatient services, wherever patients receive care.” A Healthcare Financial Management Association blog (here) on the waiver program reports “This is a short-term waiver designed to address COVID-19-driven capacity issues. CMS has been clear that, much like many of the telehealth provisions, when the PHE [Public Health Emergency] expires, so does the waiver (and the ability to get paid the full MS-DRG payment for acute services provided to Medicare beneficiaries in their homes).”
ASCs Continue Ascendance in Acute Care; Tenet Bets (Much of) The Company
MedTechDive reports (here) that at Tenet, historically a hospital company, “Surgery centers far outnumber its hospital portfolio, and its ambulatory earnings will account for nearly half of overall earnings next year.” Tenet (now in Texas) was the result of the combination of American Medical International (Beverly Hills) and National Medical Enterprises (Santa Monica), two of the “big four” (the others being HCA, in Nashville, and Humana, in Louisville) hospital companies which grew dramatically in the wake of Medicare’s passage in 1965. Medicare from 1965-1983 (when DRG-based payment was substituted) provided cost-based reimbursement (including interest expense and depreciation) for hospital services (built on the model of defense contracting); no limit on the step-up of the cost basis for acquisitions (leading doctors who owned smaller hospitals to sell them to companies in which the doctors then owned more valuable shares); a guaranteed return on equity (2%); and in general, fueled capital growth in the hospital field. Six years ago, according to the MedTechDive report, Tenet’s ambulatory income was 4% of its total.
Tenet will now operate 320 ambulatory surgery centers in 33 states. Amsurg/Envision, private equity controlled, will be the second largest ASC chain, with 250, and Surgical Care Affiliates/Optum, controlled by UnitedHealth Care, will be third, with 230. Room for growth: “There are more than 5,700 Medicare-certified ASCs operating in the U.S., according to MedPac's latest March report.” Tenet’s bet on surgery centers, and shedding of hospitals, also includes disposing of its urgent care business.
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.
2021 House Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
January 6, 7, 8, 21, 22, 25,26, 27, 28
February 8, 9, 10, 11, 23, 24, 25, 26
March 16, 17, 18, 19, 22, 23, 24, 25
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.