DCMedical News: Wednesday, May 19, 2021
DCMedical News-DCMN
Washington, D.C.
Wednesday, May 19, 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
Coronavirus in the U.S.
Sixteen states reported no deaths Monday, total U.S. deaths were about 500, vaccination began with Pfizer for 12–15-year-olds. The Hill reported (here) that vaccination rates follow the election results (the top 21 states in vaccination rates voted for Biden), while “An NPR-PBS-Marist poll this month found that 41 percent of Republicans said they are not going to get vaccinated, compared to just 4 percent of Democrats who said the same.” The Kaiser Family Foundation (here) collects suggestions on actions employers could take to promote vaccination among their employees. HHS’ Office of the Inspector General and California justice officials warn providers (here) not to charge for the vaccine: “Noncompliance with the terms of the Provider Agreement, such as by billing vaccine recipients for the COVID-19 vaccine or denying an individual a vaccination because they are unable to pay any out-of-pocket fees, may result in the provider’s suspension or termination from the CDC COVID-19 Vaccination Program and potential criminal and civil penalties.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
U.S. Preventive Services Task Force Reports That “45 is the New 50” for Colorectal Cancer Screening
A report in JAMA (report here, commentary here) finds that “The USPSTF recommends screening for colorectal cancer in all adults aged 50 to 75 years. (A recommendation) The USPSTF recommends screening for colorectal cancer in adults aged 45 to 49 years. (B recommendation) The USPSTF recommends that clinicians selectively offer screening for colorectal cancer in adults aged 76 to 85 years. . . [but] the net benefit of screening all persons in this age group is small.”
Quality Reporting a Burden for Physicians Even in Mature, Large Health Systems
A report in the Annals of Family Medicine (here) focused on “family physicians [who] provide nearly 20% of all clinical outpatient visits, nearly 200 million visits in the United States annually. Frontline clinicians continue to report failures of certified electronic health records (EHRs) to meet federal certification requirements and to meet electronic reporting needs, the latter of which is estimated to cost them $15 billion per year.” The study found that “The secure transfer of standardized, physician-level quality measures from 4 health systems with mature measure processes proved difficult. There were many errors that required human intervention and manual repair, precluding full automation.”
Facilities for Training Medical and Health Professionals May Move State Bond Actions
The Texas Tribune (here) reports that “Texas public university leaders are crossing their fingers that the Legislature will pass a bill this year that would open up billions of dollars of funding for construction of new and existing campus buildings. Many of the projects named in the bill would add health care education and research infrastructure as the state continues to face a shortage of physicians and nurses amid the COVID-19 pandemic. Officials say the pandemic has exacerbated the needs for these construction projects that will expand public health education.”
The report adds “The state has not passed a tuition revenue bond package funding higher education construction since 2015. For years, higher education leaders grew accustomed to the Legislature passing construction bills for their projects every other session. But the time between the bills passing has widened over the past two decades. Before 2015, the state hadn’t passed a tuition revenue bond bill since 2006.”
New Behavioral Health Funds for the States, From the $1.9 Trillion COVID-19 Relief Package Passed in March
Modern Healthcare (here) reported that “HHS' Substance Abuse and Mental Health Services Administration will give states and territories $3 billion in block grants to support behavioral health . . . half the money will help states and territories provide comprehensive community-based mental health services and improve existing services for people with severe mental health conditions. The rest of the funding will go toward substance use disorder prevention and treatment.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Some Electronic Healthcare System Warnings Cause More Harm Than Good
Automatic warnings discouraging cephalosporin use in penicillin-allergic patients promote inappropriate use of antibiotics according to a report in JAMA Open Network (here). A commentary on that research in NEJM Journal Watch (here) notes that “almost all electronic health record (EHR) systems warn that penicillin-allergic patients should not receive cephalosporins. This practice is problematic, because being labeled as allergic to β-lactams is associated with use of more-expensive broad-spectrum antibiotics, leading to higher healthcare costs and more nosocomial infections. This cephalosporin warning was removed in the Kaiser Southern California healthcare system at the end of 2017, while the Kaiser Northern California system kept the warning in place . . . In penicillin-allergic–labeled patients in Southern California, cephalosporin prescriptions increased by 47% in 2018, compared with the number of prescriptions before the EHR warning removal in 2017 and compared with the number of cephalosporin prescriptions in similar Northern California patients in 2017 and 2018. Researchers identified no difference in allergic reactions or treatment failures in the two systems. Mortality, length of hospital stay, and nosocomial infection were all higher in penicillin-allergy–labeled patients, and these rates trended lower after the EHR warning was removed.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Obamacare in the Biden Era
The Commonwealth Fund reports (here) on priorities recommended to the Biden administration for amendment, update and improvement in the Patient Protection and Affordable Care Act, an “Analysis of nine key publicly available recommendations to the Biden–Harris presidential transition team made by patient and consumer advocates, health insurers, hospitals, physicians, state marketplace officials, and state insurance commissioners.”
One finding of interest: the use of regulatory authority under the Administrative Procedures Act, often challenged, upheld 70% of the time in past administrations, only 23% in the Trump years. The recommendations include improvement in marketing, outreach and enrollment assistance; increased oversight (especially to provide enrollment options and coordination with state Medicaid programs) of the Direct Enrollment organizations; reversal of Medicaid waivers for compulsory work, block grants and other Trump administration initiatives.
MIPS Administration Takes $12,000+ and 200 Hours Per Physician Per Year
The Merit-based Incentive Payment System (MIPS) is a Medicare “value-based” program influencing payment for more than 1 million clinicians annually. A report in JAMA Health Forum (here) finds that “An average of $12 811 per physician was spent to participate in MIPS in 2019. Clinicians and administrators spent more than 200 hours per physician on MIPS related activities . . . the time and financial costs of MIPS participation are considerable; policy makers should consider ways to reduce the administrative and financial burden of MIPS participation for physician practices.”
DRUGS & DEVICES
House Committee on Oversight and Reform Attacks AbbVie Pricing, Tactics, for Humira
A staff report (here) was the centerpiece for a hearing, reporting that “Today, AbbVie charges approximately $77,000 for a year’s supply of Humira—470% more than when the drug was launched in 2003.” CQ reported that “A single syringe of Humira, the highest grossing drug in the world, cost as much as $1,000 more in the U.S. than in Canada or the U.K. in 2015,” and that the Committee’s findings would “Push House Democrats’ drug pricing bill, which would force companies to negotiate Medicare Part D prices directly with the government.” Company CEO Richard Gonzalez noted that the company provided free medication to 99 percent of uninsured Humira patients and that Medicare’s Part D program is a problem, with fewer cost-sharing protections and the prohibition on patient assistance as reasons many Medicare enrollees pay more for their drugs.
READINGS & REFERENCES
Select Coronavirus Public Health Resources and References (alphabetical) may be found here.
2021 CQ Congressional Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
May 20
June 14, 15, 16, 17, 22, 23, 24, 25
July 19, 20, 21, 22, 26, 27, 28, 29, 30
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.