DCMedical News: Friday, January 22, 2021
DCMedical News-DCMN
Washington, D.C.
Friday, January 22, 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
War Moving Toward a Half Million Fatalities
“President Joe Biden unveiled sweeping measures to battle COVID-19 on his first full day in office on Thursday, with his chief medical adviser, Anthony Fauci, praising his new boss’ willingness to ‘let the science speak’” Reuters reports. Executive Summary text of the Biden COVID-19 plan here, summary booklet here, complete plan (198-pgs.) here. Dr. Fauci predicted that America will soon have 500,000 deaths from COVID-19.
Ten Executive Orders followed, the first of which (here) would direct federal agencies to deploy wartime powers if necessary to increase personal protective equipment and other needed supplies; the second (here) charges the Occupational Safety and Health Administration with development of guidance to shield workers from COVID-19, to establish emergency temporary standards requiring businesses to implement infection control measures; the third (here) directs the departments of Education and Health and Human Services to issue new guidance on opening schools and directs the Federal Communications Commission to improve internet coverage for students learning remotely. A further order would “centralize information about different states’ pandemic plans to create more transparency into what approaches are working and what approaches are not in key areas like vaccine distribution,” reports CQ.
A fifth order (here) “establishes a COVID-19 Health Equity Task Force with the aim of counteracting the pandemic’s toll on hard-hit low-income families and communities of color.” A sixth order (here) will “require mask-wearing in airports and on many trains, airplanes, maritime vessels, and intercity buses. International travelers must supply a negative COVID-19 test to fly.” A seventh order (here) “creates a COVID-19 Pandemic Testing Board designed to federalize diffuse state and private efforts on testing. The order will state the Biden administration’s goal of spurring more domestic manufacturing of tests and expanding the public health workforce,” per CQ. An eighth will “direct large randomized trials to beef up research into potential COVID-19 treatments and ensure diverse populations are represented in clinical trials,” while a Presidential Memo (here) will direct FEMA to begin constructing at least 100 federal vaccination centers and to increase federal reimbursement to 100 percent for National Guard personnel and supplies.
Coronavirus
Tracking: Johns Hopkins (here) shows at 8:00 p.m. on 1-21-21 worldwide 97,446,550 COVID-19 cases, 24,611,923 U.S. cases. Deaths worldwide are 2,088,069, of which 409,667 are in the U.S., 20%.
Hospitalization: Donnelly and colleagues at the University of Michigan and the VA Center for Clinical Management Research, Ann Arbor, report (here) on readmissions, reasons for readmission and rate of death after hospital discharge among patients with COVID-19 in the VA health care system. 27% of survivors of COVID-19 hospitalization were readmitted or died by 60 days after discharge. Readmissions were for COVID-19, sepsis, pneumonia, and heart failure. Some 22.6% of the patients were treated in intensive care during readmission.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Frauds Pardoned
At least 10 of the 143 individuals pardoned or whose sentences were commuted by former President Trump were health care executives or physicians, list here.
HOSPITALS, NURSING HOMES AND OTHER HEALTH FACILITIES
2019 Hospital Profits Up, Due in Part to Investment Income
The American Hospital Association has reported (Modern Healthcare, here) that “U.S. hospitals together generated more than $100 billion in profit in 2019, almost 23% more than in the prior year,” and that “The more than 5,100 community hospitals operating in 2019 produced an aggregate total margin of 8.8%, up from 7.6% in 2018, when they drew $83.5 billion in profit.” A portion of the increase ($21 billion) came from higher non-operating (investment) income.
Hospital Prices Hard to Find, But Revealing When Found
Modern Healthcare reports (here) that “Many hospitals are breaking new federal rules that seek to make public the prices they negotiate with insurers. But even among those hospitals that post their payer-negotiated rates, such information is often difficult to find, unclear and nearly impossible for the vast majority of consumers to understand or use effectively, experts said.”
Even with limited data, some studies emerge which reflect on price mark-ups, for example one (here) from STAT in which an analyst found that “some hospitals mark up prices on more than two dozen medicines by an average of 250%, underscoring the incentives to use more expensive brand-name treatments than lower-cost biosimilars. For instance, hospitals charged more than five times the purchase price for Epogen, which is used to treat anemia caused by chronic kidney disease for patients on dialysis. And the price for Remicade, a rheumatoid arthritis medication, was raised 4.6 times above the purchase price, according to Bernstein analyst Ronny Gal, who examined newly released pricing data disclosed by 30 hospitals.” The report also disclosed that “administering treatments to commercially insured patients is 20 times more profitable than administering the same drugs to Medicare patients.”
Vertical Integration Increases Cost Unnecessarily
Cutler, Dafny, Grabowski and colleagues publish (NBER, paper here) a study entitled “Vertical Integration of Healthcare Providers Increases Self-Referrals and Can Reduce Downstream Competition: The Case of Hospital-Owned Skilled Nursing Facilities.” They “find that a 1 percent increase in a patient’s expected profitability to a SNF increases the probability that a hospital self-refers that patient (i.e., to a co-owned SNF) by 2.5 percent. We find no evidence that increased self-referrals improve patient outcomes or change post-discharge Medicare spending . . . the results suggest vertical integration in this setting may reduce downstream competition without offsetting benefits to patients or payers.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Expansion of Coverage: Marketplace v. Medicaid
Sommers and colleagues, in research published in JAMA Network (here), compare health expense coverage through “marketplace” (subsidized commercial) versus Medicaid plans, finding “Marketplace coverage was associated with fewer emergency department visits and more office visits than Medicaid, total costs were 83% higher in Marketplace coverage owing to much higher prices, and out-of-pocket spending was 10 times higher in Marketplace coverage; results for quality of care were mixed.”
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 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.