DCMedical News: Friday, March 12, 2021
DCMedical News-DCMN
Washington, D.C.
Friday, March 12, 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 next edition of DCMedical News will be Tuesday, April 13, the next date that both the House and Senate are in session.
THE BIG STORY IN HEALTH CARE
Coronavirus Vaccination
President Biden has asked the states to have vaccinations available for all adults by the first of May. Mega-centers, FQHCs (here), Dollar General Stores (in rural areas) and a wide variety of other partners, sites and strategies are in place or in process in an all-out dash for vaccination to overcome mutation.
In recognition of the anniversary of the pandemic declaration, COVID-19 resources are now moved from this place, and listed via a link at the end of this newsletter as “Select Coronavirus Public Health Resources and References,” including the Johns Hopkins Tracking project (COVID-19 Dashboard by the Center for Systems Science and Engineering, here).
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Dr. Amazon
Modern Healthcare reports that “Amazon is expanding employee health clinics in Detroit and two California metro areas . . . operated by Crossover Health, a health provider that runs clinics and virtual care for self-funded employers and health insurance plans . . . Amazon already has similar health centers near worksites in Dallas-Fort Worth, Phoenix and Louisville, and said they've provided services to over 115,000 workers and their dependents since the program first launched in late 2020 . . . In late 2019, it launched Amazon Care, which is similar to Doctor on Demand but only for Seattle-based employees and includes house calls, and contracts with primary care provider Care Medical as an employee benefit. In Feb. 2021 Care Medical filed to expand services into 17 additional states.” In contrast, Apple and Walmart are experimenting with their own company-owned clinics.
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Extending the Sequester Pause Will Benefit Hospitals
Modern Healthcare reports (here) that hospitals (and doctors), shut out of the $1.9 trillion pandemic recovery bill (with the exception of the Joe Manchin $8 billion for rural hospitals) may be on the verge of a different financial boost. The House will vote next week on extending a “pause” on Medicare cuts to providers, just weeks before they are scheduled to take effect. Says MH, “The 2% cut, which took effect since 2013, was temporarily lifted by Congress in December in response to the pandemic and its effect on providers' finances . . .AHA is pushing for the pause to extend through at least the rest of 2021.”
Sutter Will Settle
Bloomberg reports (here) that “A $575 million settlement to end litigation brought by California and a joint union-grocery employer health plan accusing Sutter Health of anticompetitive behavior was preliminarily approved Tuesday by a state judge. The closely watched case, had it gone to trial, could have resulted in a billion-dollar jury verdict against Sutter Health that analysts said could set a pattern for other regions with dominant industry players. Judge Anne-Christine Massullo of the California Superior Court in San Francisco approved the proposed settlement after initially rejecting it last fall because she said the process for selecting a settlement fund monitor was skewed toward white males. Motion for settlement here, order here. A separate class action suit on behalf of fully insured plans is still headed for trial in October, however; plans in that case are contesting “all or nothing” contracts.
Visibility of antitrust efforts in the health field is sure to increase with the publication (here) of an essay on the topic in the Harvard Business Review, authored by leaders of the Commonwealth Fund. They write: “Concentration in the U.S. health care sector has been on the rise over the past two decades. Starting with horizontal consolidation, it has spread to vertical mergers and acquisitions and megamergers of national players at multiple levels of the supply chain. Given the financial difficulty that many providers have suffered during the pandemic, this trend is likely to continue, reducing competition and increasing prices. In light of this danger, Congress and regulators should take steps now to more fully assess the impact and curb those combinations that adversely impact payers and patients. Studies to date tend to rebut the argument that acquisitions improve efficiencies, reduce costs, and lead to better care coordination. Instead, they show that consolidation increases prices and fails to improve the quality of care.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Medicaid Work Rules Are Off The Supreme Court Calendar
Bloomberg reports that the Supreme Court will not hear the dispute over work requirements for Medicaid recipients, originally scheduled for oral arguments on Arkansas and New Hampshire plans later this month. The court did not rule on the appeal of HHS to overturn appeals court rulings; it just removed the cases from the docket. HHS will now likely rescind approval or negotiate new terms for any work requirement “waivers.”
MACPAC Promotes Change in Behavioral Health Coverage for Medicaid and CHIP
The Medicaid and CHIP Payment and Access Commission took aim at its March 4-5 meeting at behavioral health coverage for children (here) and adults (here). The group also made recommendations for COVID-19 coverage (here) and for alternative approaches to payment for high cost specialty drugs (here). The group considered ways of strengthening the states (here), and also management of Medicaid in the territories (here). (Fact sheets describing the Medicaid and CHIP programs in the territories of Guam, Puerto Rico, the U.S. Virgin Islands, as well as the Commonwealth of the Northern Mariana Islands and American Samoa can be found here.)
DRUGS & DEVICES
CMS To Allow PET Payment for Infections and Inflammation
Radiology Business reports (here) that “The Centers for Medicare & Medicaid Services has relented after more than a decade of not covering PET imaging for infections and inflammation, advocates announced on Monday. It was back in 2008 that the federal agency decided not to reimburse for this exam, citing scant evidence at the time. The Society of Nuclear Medicine & Molecular Imaging has crusaded to change the policy ever since. Back in December, federal officials revoked the noncoverage policy, which took effect on Jan. 1.”
READING & REFERENCES
Select Coronavirus Public Health Resources and References (alphabetical) may be found here.
2021 CQ Congressional Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
April 13, 14, 15, 16, 19, 20, 21, 22
May 11, 12, 13, 14, 17, 18, 19, 20
June 14, 15, 16, 17, 22, 23, 24, 25
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.