DCMedical News: Tuesday, January 26, 2021
DCMedical News-DCMN
Washington, D.C.
Tuesday, January 26, 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 1-25-21 worldwide 99,645,496 COVID-19 cases, 25,253,671 U.S. cases. Deaths worldwide are 2,137,931, of which 420,747 are in the U.S., 20%. STAT commissioned a report (here) finding that “Tens of thousands of Covid-19 deaths are going unreported in the U.S., with far more missed in counties that strongly supported former President Trump, according to new research. . . The figures suggest that political leanings have helped suppress the true scale of deaths. In cases where the deceased didn’t have a Covid-19 test, a coroner or medical examiner has the freedom to interpret symptoms,” and that “Overall, the true Covid-19 death toll is 31% higher than official figures, according to the study, which has been submitted to PLOS Medicine.”
Vaccination: NEJM Journal Watch (here) reports that “Moderna says that it will test whether an extra booster dose of its two-dose COVID-19 vaccine will provide additional protection against emerging strains of SARS-COV-2. Additionally, the company is beginning a phase 1 trial of a booster candidate, mRNA-1273.351, to test a booster with spike proteins specific to the B.1.351 variant, first detected in South Africa. In an in vitro study posted on the preprint server bioRxiv, the company's FDA-authorized mRNA vaccine produced neutralizing antibodies against B.1.351 and B.1.1.7, the reportedly more contagious strain first detected in the United Kingdom. However, the neutralizing titers were six times lower with the B.1.351 variant than with earlier variants. Nonetheless, the company said that the levels of neutralizing antibodies were ‘above levels that are expected to be protective.’” See also The Financial Times, here.
A study in the Annals of Internal Medicine (here) reports that “at least one third of SARS-CoV-2 infections are asymptomatic . . Control strategies for COVID-19 should be altered, taking into account the prevalence and transmission risk of asymptomatic SARS-CoV-2 infection.”
Policy: The Hill report (here) that “The Biden White House announced it will resume regular briefings with public health experts focused on the response to the coronavirus pandemic, reviving an approach that had fizzled out during the Trump administration even as the outbreak worsened. The White House anticipates holding three briefings each week,” with the first next Monday.
CQ reports (here) on budget mechanics through which minimum wage, coronavirus assistance and other administration priorities may be passed with only Democratic votes in the Senate. InsideHealthPolicy reports that “President Joe Biden is expected to release executive orders Thursday on Medicaid and the Affordable Care Act. Acting HHS Secretary Norris Cochran told governors Friday (Jan. 22) the public health emergency is likely to last through 2021.” IHP reported “The temporary 6.2% bump in federal Medicaid matching funds and a slew of other Medicare and Medicaid emergency waivers put in place during the pandemic will not end soon. HHS will give states 60 days' notice before the public health emergency ends so they can plan for the end of the higher Medicaid match rates . . . A year-long extension of the PHE would leave in place emergency use authorizations for diagnostics, treatments, and vaccines and potentially could lead to new HHS policies to help states respond to the COVID-19 emergency.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
PCP Fee Bump Under PPACA Had No Effect on Visit Volume
A study in JAMA Network Open (here) found that “The ACA fee bump was not associated with increases in primary care visits for dual-eligible Medicare and Medicaid beneficiaries. Visits for dual-eligible beneficiaries with primary care physicians decreased after the ACA, a decrease that was partially offset by increases in visits with nonphysician clinicians.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH FACILITIES
Flash Report Illuminates Financial Danger to Hospitals
The January KaufmanHall “Flash Report” on hospitals (here) says “The pressures of the pandemic continued to strain hospital resources. The median KaufmanHall hospital Operating Margin Index for all of 2020 was 0.3%, not including federal CARES funding. With the funding, it was 2.7%” and that “Total Expense per Adjusted Discharge and Labor Expense per Adjusted Discharge both increased 14.4% throughout 2020 and 19% YOY in December.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
MACPAC Meets Virtually Thursday and Friday
The Medicaid and CHIP Payment and Access Commission (MACPAC) will meet virtually Thursday, January 28 from 10:30 am–4:30 pm EST and Friday, January 29 from 10:30 am–4:30 pm EST, agenda here. The meeting will include discussion of “extending postpartum coverage in Medicaid and estate recovery.” The day concludes with a panel discussion on the outlook for state budgets and the implications for Medicaid, and a presentation on value-based payment for maternity services. The Friday session begins with a panel discussion on how Medicaid serves people with intellectual or developmental disabilities. The Commission will then vote on all recommendations for its March 2021 report to Congress. Additional sessions focus on a MACPAC study of non-emergency medical transportation, new analyses of care integration for dually eligible beneficiaries, and a discussion of potential new models for payment and coverage of high-cost specialty drugs. The meeting concludes with a discussion of mental health parity in Medicaid.
MedPAC Publishes Presentations from its January 14-15 Meeting (part 1, continued tomorrow)
The Medicare Payment Advisory Commission has published presentations and discussion material from its January meeting. Assessing payment adequacy and updating payments for hospital services (here) recommends against permanent provider payment changes for coronavirus effects; proposes a 2.4% increase for IPPS and OPPS rates; projects a negative 6% profit margin for all IPPS hospitals in 2021 (compared to negative 8.7% in 2019), in part due to suspension of Medicare sequestration from May 2020 through March 2021. The presentation noted that, overall, during the pandemic, Medicare payments and costs per stay had both increased. The report also noted no change in timely access to hospice care, following expansion to include hospice in the post-acute care (PAC) transfer policy which reduces IPPS payments for short stays followed by a transfer to PAC.
A report on pay adequacy for physicians and other health professional services (here) noted that there is no update to base payment rates for 2022, but there are possible increases or decreases in “performance-based adjustment” for clinicians in MIPS, and a 5% bonus for clinicians in “advanced alternative payments models.” MedPAC had supported policy of the previous administration increasing E&M RVUs in a “budget-neutral manner” (specialist compensation went down as office visit compensation went up), overridden, however, by the Congress in the year-end budget act.
Additional reports were presented on the adequacy of payment for skilled nursing facilities, home health services, inpatient rehabilitation services and LTCHs (here), and on the future of telehealth in Medicare after the end of the “public health emergency” (here).
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.
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.
2021 House Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
January 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.