DCMedical News: Wednesday, April 21, 2021
DCMedical News-DCMN
Washington, D.C.
Wednesday, April 21, 2021
DCMedical News is published every day both the House and the Senate are scheduled to be in session. Subscription information and archives from 2018 to the present at dcmedicalnews.org, here.
THE BIG STORY IN HEALTH CARE
COMEBAC, The Long Covid Story for Millions of Patients
A study published in JAMA (study here, published in March; commentary here, published 4-20) is represented as one of the first of long-term COVID-19 sequelae.
The study reports that “Four months after hospitalization for COVID-19, a cohort of patients frequently reported symptoms not previously present, and lung-scan abnormalities were common among those who were tested.” The study, known as COMEBAC, (Consultation Multi-Expertise de Bicetre Apres COVID-19) “included adult patients admitted to the Bicetre Hospital (Paris-Saclay University hospitals) in France for COVID-19 from March 1 to May 29, 2020. Inclusion criteria were survival 4 months after hospital discharge or after intensive care unit (ICU) discharge for patients who had been admitted to an ICU . . . who had been hospitalized for greater than 24 hours primarily because of COVID-19, and who had received a diagnosis of SARS-CoV-2 infection by reverse transcriptase–polymerase chain reaction (RT-PCR), by typical computed tomographic (CT) lung scan associated with clinical features, or both.”
The commentary notes that “As of early March 2021, more than 2.5 million individuals worldwide have died from COVID-19, but many more millions have survived COVID-19 and experienced lasting sequelae. As many as half of patients who survive hospitalization for COVID-19 experience prolonged work absence, financial difficulty, or emotional effects, each of which
may further impede recovery.”
The commentary explains, “The term ‘long COVID,’ coined by patients early in the pandemic, has helped to raise awareness of the life-altering effects of COVID for many patients and to drive government action . . . Although potential sequelae of COVID-19 have been widely reported in news media, smaller case series, and convenience samples, this study is among the first to systematically and comprehensively evaluate the medical outcomes of hospital survivors,” and concludes that “The heterogeneity of symptom profiles suggests that a single approach to follow-up and management of long COVID will not be effective.”
Lack of National Testing Plan
CQ reports (here) “The United States still lacks a comprehensive COVID-19 testing strategy more than a year into the pandemic, as the spread of variants and increasing case counts threaten to undermine the effects of the vaccine rollout.” The report notes, “In January, [President] Biden signed an executive order creating a pandemic testing board that would develop a national strategy. Experts point to recent moves like a study on the use of free at-home tests and the pending formation of regional testing hubs as likely pieces of an administration plan that could come together this spring.”
HOSPITALS, NURSING HOMES AND OTHER HEALTN CARE FACILITIES
Health System Accused of Abusive Billing Reverses Course
The University of Virginia Health System has reversed course, says Modern Healthcare (here, Washington Post version here) and is now eschewing hardball collection tactics (36,000 suits against patients in 6 years). The article notes that “UVA Health will wipe out tens of thousands of lawsuits against patients.” Kaiser Health Network (here) published its award-winning expose (“UVA Has Ruined Us”) in 2019. The Governor got involved. The CEO at the time left.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Surprise Billing, The Next Chapter
Politico Influence reports that “A pair of major health insurers have hired a Senate HELP [Committee on Health, Education, Labor and Pensions] veteran who helped craft last year’s bill on ending so-called surprise medical bills to lobby on how the fix gets implemented . . . Adam Buckalew will lobby for Anthem and Blue Cross Blue Shield on the No Surprises Act. It’s aimed at protecting patients from sky-high medical bills when they unwittingly receive out-of-network care, according to lobbying disclosures filed Monday.”
The “No Surprises Act” was included in omnibus legislation funding the federal government for fiscal year 2021 and also providing stimulus relief for the COVID-19 pandemic. It takes effect in January 1, 2022. Provisions of the bill (Kaiser Family Foundation KFF, here) include an implementation phase which begins this July 1.
Writes KFF, “The first implementation deadline specified in the law is July 1, 2021. By then, the federal government must publish regulations establishing the methodology used by group health plans and issuers to determine the in-network cost sharing amounts for surprise bills and the information that plans and issuers must share with non-participating providers and facilities. In most cases the in-network cost sharing amount will be based on a health plan’s median in-network rate paid for a given service in 2019, with that amount (also called the “qualifying amount”) indexed for subsequent years. Regulations will also need to specify alternate methods for determining qualifying amounts for new plans and services with no established rates in 2019.
Also by July 1, 2021, HHS must have “established a complaints process for consumers to report surprise medical bill problems. The law appropriates $500 million in funding for implementation.”
KFF has reported (see for example here) that “Surprise bills lead the list of affordability concerns for many families; 2 in 3 adults say they worry about unexpected medical bills, more than the number worried about affording other health care or household expenses.” See also Jack Hoadley, Katie Keith and Kevin Lucia in Health Affairs (here), “Unpacking The No Surprises Act: An Opportunity To Protect Millions.”
Medicaid Federal Match Extended With Public Health Emergency (PHE)
The National Association of Medicaid Directors has noted that on April 15 the PHE was extended for 90 days through July 14, 2021, “which will make the CARES Act’s 6.2 percentage point FMAP (the Medicaid program’s Federal Medical Assistance Percentage) enhancement available through Q3 of 2021.”
Commercial insurers may also take action; United, which believes the extension period to be from April 20 to July 19, notified providers (here) that “Individual Exchange, Individual and Group Market health plans: From Feb. 4, 2020 through the national public health emergency period, UnitedHealthcare is waiving cost sharing for in-network and out-of-network COVID-19 tests and testing-related services, including testing-related telehealth visits. Medicare Advantage: From Feb. 4, 2020 through the national public health emergency period, UnitedHealthcare is waiving cost sharing for in-network and out-of-network tests for COVID-19.”
Secretary Becerra’s announcement, dated April 15 (here), says the PHE extension is effective April 21.
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 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.