DCMedical News: Tuesday, March 9, 2021
DCMedical News-DCMN
Washington, D.C.
Tuesday, March 9, 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 3-8-21 worldwide 117,119,495 COVID-19 cases, 29,041,230 U.S. cases, 25%. Deaths worldwide are 2,599,216, of which 525,728 are in the U.S., 20%.
Policy: The House begins debate today (Tuesday) on the $1.9 trillion administration proposal for stimulus of the economy, as modified by the Senate. Among the bill’s features (details from the Congressional Record, here):
COVID-19: $48 billion for COVID-19 testing and tracing efforts, $20 billion in funding for vaccine distribution, with $7.5 billion for CDC vaccination sites.
Pension plans: The New York Times reports (here) “The bailout targets multiemployer pension plans, which bring groups of companies together with a union to provide guaranteed benefits. All told, about 1,400 of the plans cover about 10.7 million active and retired workers, often in fields like construction or entertainment where the workers move from job to job. As the work force ages, an alarming number of the plans are running out of money. The trend predated the pandemic and is a result of fading unions, serial bankruptcies and the misplaced hope that investment income would foot most of the bill so that employers and workers wouldn’t have to,” a hope that led unions to invest in private equity funds which, in the main, compromise their members. “The bill would not change the funds’ investment strategies, which are widely seen as a cause of their trouble.”
COBRA relief: “Buying insurance through the government program known as COBRA would temporarily become a lot cheaper. COBRA, for the Consolidated Omnibus Budget Reconciliation Act, generally lets someone who loses a job buy coverage via the former employer. But it’s expensive: Under normal circumstances, a person may have to pay at least 102 percent of the cost of the premium. Under the relief bill, the government would pay the entire COBRA premium from April 1 through Sept. 30. A person who qualified for new, employer-based health insurance someplace else before Sept. 30 would lose eligibility for the no-cost coverage. And someone who left a job voluntarily would not be eligible, either.”
PPACA Expansion: $34 billion expanding the Patient Protection and Affordable Care Act subsidies for two years, making some middle-income Americans newly eligible for financial help to buy plans on the PPACA marketplaces, and increasing subsidies already going to lower-income enrollees.
Medicaid: Bloomberg reports (complete Senate bill here, 628 pgs.) that Medicaid expansion provisions in the bill would cover more than the full cost of expansion for the first two years for any non-expansion states that sign up, with the federal share falling to 90% after those first two years. In debate it was estimated that full expansion would add 4 million people; the number of uninsured has grown by 2 million since 2016.
Other: $362 billion to state and local governments, federal unemployment benefits of $300 per week to September 6, tax rebates of $1,400 to individuals with incomes of $75,000 or less, $40 billion grants to higher education, child tax credit of $3,000 per child, full coverage for COVID vaccines under Medicaid and CHIP, waiver of VA copayments through September, others here.
CDC: Guidance (here from the CDC, report here in The Boston Globe) for the “fully vaccinated,” that is, for activities two weeks after the second dose of two-dose vaccines, or two weeks after receiving the single dose (Johnson and Johnson) vaccine.
Testing: The FDA issued (here) an “emergency use authorization (EUA) for the Cue COVID-19 Test for Home and Over The Counter (OTC) Use. The product is a molecular nucleic acid amplification test (NAAT) that is intended to detect genetic material from SARS-CoV-2 virus present in the nostrils. The test is the first molecular test authorized for at-home use without a prescription.” InsideHealthPolicy reports that “The test was able to correctly identify positive COVID-19 samples from 96% of symptomatic patients and 100% of samples from asymptomatic patients. Before Friday, FDA had only authorized one other COVID-19 test for home use -- Ellume’s over-the-counter antigen test.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Accurate Cost Estimates to Patients May Lower Bad Debt
The American College of Radiology (here) publishes advice to practitioners, namely that providing accurate, up-front estimates of out-of-pocket costs to patients will reduce bad debt. “As healthcare finance evolves to shift more burden to patients and healthcare costs continue to soar, doctors need to consider cost as an essential part of patient care. Proactively providing reasonable out-of-pocket cost estimates and scheduling services to maximize patients’ benefits coverage is a step in the right direction. Diagnostic radiology is well positioned to provide these estimates; imaging exams rarely vary from the requested service, often resulting in predictable out-of-pocket costs.”
Labor and Hospitals
Six hundred residents and fellows voted to join the Committee of Interns and Residents (CIR) of the Service Employees International Union at UMass Medical School (here), while 800 nurses began their strike (here) at Tenet’s St. Vincent Hospital in Worcester, MA. CIR represents 17,000 physicians in training nationally.
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Nursing Home Staff Turnover
The $1.9 trillion stimulus bill (above) did not include changes in the minimum wage which might, however, have addressed the findings of Grabowski and colleagues (here, in Health Affairs) on nursing home staffing turnover. They summarize: “On July 1, 2016, the Centers for Medicare and Medicaid Services began collecting auditable payroll-based daily staffing data for US nursing homes. We used 492 million nurse shifts from these data to calculate a novel turnover metric representing the percentage of hours of nursing staff care that turned over annually at each of 15,645 facilities. Mean and median annual turnover rates for total nursing staff were roughly 128 percent and 94 percent, respectively.”
“Moving Health Home”
This new group (website here) is promoting Medicare coverage of higher-acuity home-based services, such as emergency services, making the Centers for Medicare & Medicaid Services’ “Hospital without Walls” flexibility permanent, “fair reimbursement” for home-based evaluation and monitoring codes, a bundled payment model for extended care in the home, and “greater flexibility’ for home-based care services to meet network adequacy standards.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Payor Curbs on Hospital Surgery
Kara Friedman of Polsinelli summarizes (here, in The National Law Review) limitations on reimbursement for hospital outpatient surgery. United Healthcare extols cost savings and claims fewer infections (in “new research”) with ambulatory surgery (here), as follows: “Hospital-acquired infections have long been a patient safety challenge, with 3% to 4% of hospital patients contracting infections, including infections in patients following 1% to 2.5% of joint replacement procedures. As a result, up to 26,000 joint replacement patients each year face additional treatment, longer hospital stays and potential disabilities and lost wages, while up to 800 of these patients die annually from their infections. But many joint replacement patients do not require hospital inpatient stays. Because ASCs specialize in the procedures they perform, they can concentrate on optimizing safety and quality outcomes for patients.” United follows up with policies (here) on medical necessity, outpatient surgical services, and site of service.
READINGS & REFERENCES
2021 CQ Congressional Calendar here.
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Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.