DCMedical News: Tuesday, April 13, 2021
DCMedical News-DCMN
Washington, D.C.
Tuesday, April 13, 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 Vaccination
Bloomberg’s Vaccine Tracker reports (here) that “The biggest vaccination campaign in history is underway. More than 797 million doses have been administered across 154 countries . . .18 million per day. In the U.S., more Americans have received at least one dose than have tested positive for the virus since the pandemic began. So far, 190 million doses have been given. In the last week, an average of 3.21 million doses per day were administered,” with the CDC reporting a record 4.6 million jabs Saturday. At 3.2 million per day average, 75% vaccination of the population will be reached in three months. Christopher Murray, MD, Director of the Institute for Health Metrics and Evaluation (IHME) at the University of Washington in Seattle, predicts (here, in Medscape) “’a considerable surge will occur over next winter,’ because the new variants are more transmissible, and people will likely relax social distancing and mask wearing. The IHME predicts that the percentage of Americans who usually don masks will decline from 73% today to 21% by August 1.”
Cornucopia
Congress returns today.
The $2.3 trillion “infrastructure” proposal marks time, popular with the public, needing support in the Senate, under attack for the inclusion of social and health programs, the largest of which is a proposed $400 billion Home and Community -Based Services Medicaid program expansion. The HCBS expansion (Kaiser Family Foundation, here, Associated Press report here) is described as “a historic and profound opportunity to build a stronger framework of services surrounding vulnerable people who need considerable ongoing assistance,” and “comes as the coronavirus pandemic has wreaked havoc in nursing homes, assisted living facilities and group homes, killing more than 174,000 people and triggering awareness of the need for more long-term care options.”
The President’s first proposed budget (and the first budget since 2011 to be considered by Congress without caps on discretionary spending) includes (Modern Healthcare link here) “the creation of a new agency dedicated to cancer research, billions of dollars in funding to help end the opioid epidemic and an investment in the rural health workforce,” with Medicare and Medicaid provisions still pending.” In addition to increased mental health, rural health and opioid treatment funds, the budget “Requests $6.5 billion to launch the Advanced Research Projects Agency for Health within the National Institutes of Health. The initial focus of the agency would be on cancer and other diseases like diabetes and Alzheimer's.” All told, the budget calls for a 16% rise in nondefense discretionary spending, to $769 billion, and a 1.7% increase in defense spending, to $753 billion, for a total budget of $1.5 trillion. A comprehensive budget overview will be found in this 58-page April 9 letter from OMB. A first presentation of the HHS portions of the budget will be given by Secretary Becerra Thursday morning (the 15th) at 10:00 a.m., before the Labor/HHS/Education Subcommittee, livestreamed
at https://youtu.be/me0llK8_8_V_A4.
Coronavirus, Prevention
A study in JAMA Internal Medicine (here) of Coronavirus success (thus far) in Taiwan, avoiding school closures and lockdowns, credits the combination of “case-based (including contact tracing and quarantine) and population-based (including social distancing and facial masking) interventions for COVID-19 in Taiwan,” and reports that neither “alone were estimated to have been sufficient to contain COVID-19.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Rep. Clyburn Reads the Riot Act to Scott Atlas (and others), in Pursuit of a History of the Trump Administration’s Actions
The veteran Biden backer, and Chair of the Select Subcommittee on the Coronavirus Crisis, wrote (12 pages, here) to Atlas and others that “Our investigation has shown that Trump Administration officials engaged in a persistent pattern of political interference in the nation’s public health response to the coronavirus pandemic, overruling and bullying scientists and making harmful decisions that allowed the virus to spread more rapidly. The Select Subcommittee’s investigation has revealed that you may have played a role in the Trump Administration’s efforts to suppress scientific information. Documents recently obtained by the Select Subcommittee indicate that you were aware of, and may have participated in, efforts to attack reports issued by the Centers for Disease Control and Prevention (CDC) in order to justify President Trump’s push to reopen. The investigation has also revealed that you advocated for policies that would allow the virus to spread widely among many Americans.” Documents, depositions, hearings to follow, in May.
“New predators were introduced into an ecosystem of lizards . . .”
Drs. Jane Zhu and Daniel Polsky discuss “Private Equity and Physician Medical Practices — Navigating a Changing Ecosystem” in the New England Journal of Medicine, here.
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Hospital Ownership Debated Again, Alternatives to Monopolies and Mega-Systems
Three doctors blog in Health Affairs (here) in favor of repealing section 6001 of the Patient Protection and Affordable Care Act, and in support of physician-owned hospitals as a fix to what ails the hospital system. And not just any three doctors: the authors are a Board Member of the AMA, a Trustee of the ACC (American College of Cardiology) and a Board member of the AAOS (American Academy of Orthopedic Surgeons).
Citizens in Riverton, Wyoming (here, from the Wall Street Journal ) are attempting to start a new hospital, in the face of actions by private-equity (Apollo) backed owners (LifePoint) of their hospital to strip critical services, to combine Riverton services with those of another (30 miles away) LifePoint hospital (mammography here, ObGyn there, notes the LifePoint spokesman). And not just any citizens: leaders of the existing hospital, backed by the Governor, with favorable comments from “Wyoming Sen. John Barrasso, a Republican [and an orthopedic surgeon], [who] said he supported the Riverton community exploring a new hospital. Sen. Cynthia Lummis, also a Republican, said she supported choice in healthcare, ‘especially if the people of Wyoming feel that the lack of it is reducing quality of care.’” The WSJ noted problems, aside from the loss of services, with the LifePoint facility: “The state found the hospital had used unsanitary surgical tools, some containing the dried blood of previous patients,” and “A psychiatric patient charged into the room of another patient and gouged her eye from its socket, leaving it to dangle on the victim’s cheek, according to state report on the matter. The patient had to be airlifted out of state and later died. Hospital staff told the state that the person assigned to watch the psychiatric patient hadn’t received special training to deal with a dangerous situation.”
Scattershot, Incomplete and Misleading
FierceHealthcare reports (here) on CMS holding back, so far, on forcing compliance with the January 1 hospital price transparency regulations, with links in the article to studies and reports on hospital and health system compliance.
DRUGS & DEVICES
ICER Continues Work on “Unsupported [Drug] Price Increases”
The Boston non-profit announces its protocol (here) for examination in 2021 of over-priced drugs. The 2020 report is here, the 2019 report on 2017-2018 price jumps is here. “In 2017 and 2018, out of nine identified drugs that had substantial price increases on top of already high current spending, seven drugs had no new important evidence to support their price increases. The net price increases on these seven drugs alone cost American insurers and patients an additional $4.8 billion over two years.” The results from the 2019 report (in descending order of dollar impact) read like a list of evening news commercial sponsors: Humira, (adalimumab, AbbVie), Lyrica (pregabalin, Pfizer), Truvada (tenofovir disoproxil fumarate, Gilead), Rituxan (rituximab, Genentech), Neulasta (pegfilgrastim, Amgen), Cialis (tadalafil, Eli Lilly), and Tecfidera (dimethyl fumarate, Biogen). Nominees from 2020 for the November 16, 2021 report are due May 10.
READINGS & REFERENCES
Select Coronavirus Public Health Resources and References (alphabetical) may be found here.
2021 CQ Congressional Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
April 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.