DCMedical News: Wednesday, January 27, 2021
DCMedical News-DCMN
Washington, D.C.
Wednesday, January 27, 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 1-26-21 worldwide 100,201,258 COVID-19 cases, 25,433,812 U.S. cases. Deaths worldwide are 2,154,921, of which 425,036 are in the U.S., 20%.
Vaccination: NEJM Journal Watch reports that “The World Health Organization has issued interim recommendations on the use of Moderna's vaccine (here). The guidelines align closely with those of the CDC. One difference: The WHO says that countries with a limited vaccine supply and high COVID-19 burden ‘may consider delaying the administration of the second dose as a pragmatic approach to maximizing the number of individuals benefiting from a first dose while vaccine supply continues to increase.’ The agency says the second dose should not be extended beyond 6 weeks and cautions that ‘the evidence base for this extension is not strong.’” Brookings reports (here) on why some states are more successful than others in vaccination. Altman of Kaiser reports (here) on how fast vaccination needs to take place to achieve “herd immunity.”
Treatment and Testing: The World Health Organization issued an updated set of clinical treatment guidelines (here) for COVID-19, with new emphasis on “long Covid,” lingering symptoms and long-term sequelae of the disease. A report in JAMA Internal Medicine (here) says “Saliva NAAT [nucleic acid amplification testing] diagnostic accuracy is similar to that of nasopharyngeal swab NAAT, especially in the ambulatory setting. These findings support larger-scale research on the use of saliva NAAT as an alternative to nasopharyngeal swabs.” A Boston team reports (here) in the Journal of the American College of Cardiology on heart failure (HF) patients hospitalized with COVID-19, finding that “Patients with HF hospitalized with COVID-19 are at high risk for complications, with nearly 1 in 4 dying during hospitalization.” The NIH published a report on blood thinning for COVID-19 patients (here), finding that “In large clinical trial conducted worldwide, full dose anti-coagulation (blood thinner) treatments given to moderately ill patients hospitalized for COVID-19 reduced the requirement of vital organ support—such as the need for ventilation. A trend in possible reduction of mortality was also observed.” The Associated Press found (here) that “analysis of federal hospital data shows that since November, the share of U.S. hospitals nearing the breaking point has doubled. More than 40% of Americans now live in areas running out of ICU space, with only 15% of beds still available.”
“This level of death”: an essay with that title is posted by Joshua Sharfstein and Olivia Veira in JAMA Network (here), a collection “Directly from the recent words of frontline health care workers and medical administrators in 19 states, with the sources linked to the first word or two of each quote. Their words reflect an unprecedented time for the US health care community in the midst of the pandemic.”
Policy: The CDC in this week’s Morbidity and Mortality Weekly Report (article here) reports that “With masking requirements and student cohorting, transmission risk within schools appeared low, suggesting that schools might be able to safety open with appropriate mitigation efforts in place.” President Biden addressed the crisis in a televised news conference, describing his plan for increased vaccine production; the President increased the national vaccine order to 600 million (from 400 million) doses, and promised information on vaccine volume being delivered to each state three weeks in advance.
Today’s Financial Times (here) reports that a bond and equity “fundraising spree marks the biggest haul of the past two decades for the comparable time period,” and quotes a fund manager as saying “Markets are priced as though coronavirus doesn’t matter any more.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH FACILITIES
Maryland “All Payer” System Cushioned Financial Blow to Hospitals from COVID-19
A research study in JAMA Network (here) indicates that “Maryland hospitals had revenue reductions in the first months of the COVID-19 pandemic, followed by an almost complete recovery for inpatient revenue and partial recovery for outpatient revenue in May through July. The HSCRC’s [Health Services Cost Review Commission] intervention hastened the pace of financial recovery by allowing hospitals to recoup $451.5 million (38.5%) of losses that would have been incurred compared with January to July 2019. Absent any intervention, revenues would have more gradually recovered through July—a finding relevant to settings unable to enact such short-term price adjustments.” The study notes, “To offset revenue losses from deferment of nonurgent care, the HSCRC allowed Maryland hospitals to temporarily increase their inpatient and outpatient service prices by up to 10% to 15% in late March and allowed further increases in inpatient prices up to 20% in May through July 2020.”
Emergency Department Visit Analysis of 2017 Published by AHRQ
A new HCUP study (here) from the Agency for Healthcare Research and Quality reports 145 million emergency department visits costing a total of $76.3 billion; more than 13% of the US population having an ED visit; more than half of hospital inpatient stays originating with an ED visit; more than half of 2017 ED costs for the incurred in large metropolitan areas; and aggregate ED visit costs and share of ED visit volume highest for hospitals in the South.
Accreditation Conflict of Interest Proposal Withdrawn
A late Trump administration proposal (here) to examine conflict of interest by national accreditation organizations (e.g., The Joint Commission, which sells “consulting” services to help hospitals prepare for accreditation surveys) was withdrawn by the Biden administration.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
MedPAC Publishes Presentations from its January 14-15 Meeting (part 2)
The Medicare Payment Advisory Commission has published presentations and discussion material from its mid-January meeting. The group received a report on payment adequacy for ambulatory surgery centers, noting that the 5,800 ASCs enrolled in Medicare were due a 2.1% payment increase in 2021. In 2019 payment per beneficiary increased 8.3%, although ASCs are still not required to submit cost reports. A report on outpatient dialysis services found that 7,700 outpatient dialysis centers spent $13 billion for 395,000 Medicare fee-for-service beneficiaries in 2019, with 46% of the beneficiaries also having payments made through the Medicaid program. Hospice services consumed $21 billon for 1.6 million beneficiaries in 4,800 facilities. Capped coverage in hospice facilities put back in place in 2019 reduced the facility margins from 22% to 11%. The cap in 2021 is $30,684; the Commission recommended that the cap be wage adjusted and reduced by 20%. Other reports presented covered Medicare vaccine coverage and payment policies (here), Medicare Part D (here), SNF VBP programs and possible replacements (here), and CMMI development of alternative payment models (here). A transcript of the proceedings is here.
Medicare Trust Fund
An essay by Harvard’s Richard Frank and Kaiser’s Tricia Neuman (here) in JAMA Network discusses the pending insolvency of the Medicare health insurance trust fund, now predicted for 2024.
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 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.