DCMedical News: Wednesday, February 24, 2021
DCMedical News-DCMN
Washington, D.C.
Wednesday, February 24, 2021
DCMedical News is published every day both the House and the Senate are scheduled to be in session. Subscription information and archives here.
THE BIG STORY IN HEALTH CARE
Coronavirus
Tracking: Johns Hopkins (here) shows at 8:00 p.m. on 2-23-21 worldwide 112,072,132 COVID-19 cases, 28,255,207 U.S. cases, 25%. Deaths worldwide are 2,483,413, of which 502,449 are in the U.S., 20%.
Vaccines and vaccination: The Hill reports (here) that “Coronavirus vaccine developers told House members Tuesday they plan to dramatically increase deliveries in the coming weeks. Executives from Pfizer and Moderna, the only two companies that have so far received emergency vaccine authorization from the U.S. government, said they will be able to deliver more than 130 million additional doses combined by the end of March. The companies said they are no longer facing shortages of raw materials and have largely solved the manufacturing challenges that limited the initial production and resulted in bottlenecks, as demand has far outstripped supply.” Pfizer goal: 120 million doses by the end of March, but only 40 million have been shipped to date. Moderna goal: 100 million doses by the end of March, with 45 million shipped to date. CDC says 82 million doses have been delivered, with 65 million actually administered.
Treatment: A study in the European Heart Journal (here) is cited as the source for finding myocardial damage by MRI examination of COVID-19 patients two months after recovery (e.g., in Medscape, “Myocardial Injury Seen on MRI in 54% of Recovered COVID.”) From the study: “During convalescence after severe COVID-19 infection with troponin elevation, myocarditis-like injury can be encountered, with limited extent and minimal functional consequence . . . A quarter of the patients had ischaemic heart disease, of which two-thirds had no previous history.” 148 patients were studied. Cardiac arrest in-hospital for COVID-19 patients had uniformly poor outcome according to a study (here) in Critical Care Medicine: “The in-hospital mortality was 100%.”
Krumholz and colleagues studied excess all-cause mortality in adults 25-44, finding (in JAMA, here) “The COVID-19 pandemic was associated with increases in all-cause mortality among US adults aged 25 to 44 years from March through July 2020 . . . Only 38% of all-cause excess deaths in adults aged 25 to 44 years recorded during the pandemic were attributed directly to COVID-19. Although the remaining excess deaths are unexplained, inadequate testing in this otherwise healthy demographic likely contributed. These results suggest that COVID-19–related mortality may have been under-detected in this population.”
Policy: HHS Secretary-nominee Xavier Becerra’s statement (here) before the Senate HELP Committee emphasized his background and personal commitment to equity in health care. Citing his father’s union-sponsored health insurance, Becerra said “We didn’t have much, but we didn’t have to face the threat of unpaid medical bills or even bankruptcy.” Republican Committee members, according to STAT (report here) attacked Becerra as being insufficiently sensitive to the needs of the pharmaceutical industry, noting “a surprising twist following years of agitation on Capitol Hill and from the Trump administration over high drug prices. But it also highlights the credibility that pharmaceutical companies may have earned after developing several Covid-19 vaccines in record time, and the challenge Becerra could face in balancing pricing frustrations with the industry’s central role in pandemic response.” Senator Cruz, comparing Becerra unfavorably to former Secretary Azar, said “he’s never worked at a pharmaceutical company.”
HOSPITALS, SKILLED NURSING FACILITIES AND OTHER HEALTH CARE FACILITIES
Just Say “No”
A report in Healthcare Financial Management (here) on the new federal price transparency requirements for hospitals (effective January 1) finds “Only about 25% of the surveyed hospitals would be deemed officially compliant.” The Wall Street Journal (here) examines some prices, finding that a C-section can cost $6,000, or $60,000—at the same hospital.
Say “Yes” to Monetizing Patient Data
Modern Healthcare reports (here) that Ascension is expanding its EHR record searching experiments with Google, notwithstanding controversy which accompanied the original announcement. Fourteen major health systems are creating Truveta (STAT+ report here): “The health systems that formed and invested in the for-profit venture span 40 states and hold data on about 13% of the care delivered in the United States . . . they are seeking to create a business that would function something like a public utility, parceling out data needed to create new devices and treatments for everything from Covid-19 to cancer. But the concept the company rests upon — that patient data is a commodity that can be bought and sold, like coal or coffee — is one that sits uneasily in American health care, where many stakeholders define that information as something owned by the individual, who has an inherent right to direct its use. Indeed, a loss of control over such data is seen as dangerous, potentially leading to a loss of privacy, discrimination, and a slew of other problems.” The Wall Street Journal reports on the venture, here.
The model: The extraordinary success of Optum (here) in marketing client data, doing business with 80% of health insurers and 90% of American hospitals, controlling 53,000 physicians and planning to add another 10,000 this year. Data and information may be the ultimate health care product: MedCity News reports (here) that tech/health insurance company Oscar is set for a public offering valuing the company at $6+ billion, notwithstanding its (small) half million total membership, $1.4 billion accumulated losses, and that its business model “relies heavily on passing on risk through quota reinsurance agreements Oscar has struck with Axa France Vie and Berkshire Hathaway Specialty Insurance Company. Last year, the company ceded 77% of its premiums to these two organizations.”
ASCs, Nursing Homes and Health Systems
Becker’s finds (here) more health insurers buying ambulatory surgery centers, and more such centers (here) entering the profitable (for hospitals and surgeons) spine surgery market. Modern Healthcare examines hospital investment in ambulatory surgery centers, here. AHRQ finds (here) that only 6% of the nation’s nursing homes are part of “integrated” (with hospitals) health systems, but that 46% of such systems own nursing homes.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Telemedicine: Payment and Training
The law firm Foley & Lardner examines telehealth laws in the 50 states (news report here, survey here), finding 22 states requiring payment for telehealth services equivalent to in-person care, while a group of Cornell researchers publishes (in Healthcare, here) a study on telehealth teaching in medical schools.
READINGS & REFERENCES
Pandemic Lessons for Economic Recovery
New York City Commissioner of Health Dave Chokshi writes (here, in JAMA) that “Despite its catastrophic effects, not enough changed after the 1918 influenza pandemic, leading some historians to label it the ‘forgotten pandemic.’ The opportunity now is to ensure that the current crisis drives forward long-term change.”
Adult Immunization
The American College of Physicians publishes (here) their recommended adult immunization schedule for 2021.
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 CQ Congressional Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
February 25, 26
March 16, 17, 18, 19, 22, 23, 24, 25
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.