DCMedical News: Tuesday, June 22, 2021
DCMedical News-DCMN
Washington, D.C.
Tuesday, June 22, 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
80 Million in Medicaid and CHIP, More State Expansions Possible, HCBS Increase Pending
The Centers for Medicare & Medicaid Services (CMS, here), released a new “Enrollment Trends Snapshot” showing a record high (at the end of January, 2021) of over 80 million individuals have health coverage through Medicaid and the Children’s Health Insurance Program (CHIP). Nearly 9.9 million individuals, a 13.9% increase, enrolled in coverage between February 2020, the month before the public health emergency (PHE) was declared, and January 2021.
Said CMS, “The increase in total Medicaid and CHIP enrollment is largely attributed to the impact of the COVID-19 PHE, in particular, enactment of section 6008 of the Families First Coronavirus Response Act (FFCRA). FFCRA provides states with a temporary 6.2% payment increase in Federal Medical Assistance Percentage (FMAP) funding. States qualify for this enhanced funding by adhering to the Maintenance of Effort requirement, which ensures eligible people enrolled in Medicaid stay enrolled and covered during the PHE.”
InsideHealthPolicy reports (here) that “CMS Administrator Chiquita Brooks-LaSure and HHS Secretary Xavier Becerra on Friday stressed a willingness to work with states interested in expanding their Medicaid programs, saying there’s still time for those that want to take advantage of the increased federal matching money in the American Rescue Plan.”
HCBS Money Also Coming: InsideHealthPolicy reports (here) that “Forty-two states reportedly have applied and been approved for extensions to submit to CMS their initial spending plans and narratives required to access the increased federal Medicaid matching funds for home- and community-based services [HCBS] from the American Rescue Plan . . . Only nine states have submitted plans so far . . . The American Rescue Plan outlined a one-year, 10 percentage point increase in federal Medicaid dollars for states’ HCBS programs. CMS released guidance on how states can use the extra funding in mid-May, over a month after the federal match dollars were authorized to be released to states.”
Some in Congress (reports The Hill, here) will push to compel the 12 states which have not expanded Medicaid (to 138% of the federal poverty level) to do so.
DOCTORS, NURSES AND OTHER HEALTH CARE PROFESSIONALS
Medicare Advance Care Planning Benefit “Not Widely Used”
Reports on a new Medicare benefit in 2016 in Health Affairs (here) with commentary in JAMA (here), found that “A much-anticipated advance care planning (ACP) benefit [described in a Medicare Learning Network document here] that pays physicians to counsel patients about living wills, advance directives, and end-of-life care options” was supported by “Numerous medical and patient advocacy organizations . . . asserting that compensation for physicians would encourage proactive end-of-life care discussions,” but “only 2.9% of beneficiaries overall had an ACP claim in 2017, including 4.7% who were older than 85 years and 7.2% of beneficiaries who ultimately died that year.”
NIH Recommends Another Monoclonal Antibody for COVID-19 Treatment
ACP Internist reports (here) that “The NIH's guidelines panel updated its recommendations to include sotrovimab among the monoclonal antibody options for treatment of non-hospitalized patients with mild to moderate COVID-19 who are at high risk of progression to severe COVID-19. As of June 11, the panel recommends bamlanivimab plus etesevimab, casirivimab plus imdevimab, or sotrovimab for such patients.” FDA EUA Fact Sheet here, CMS coverage page for monoclonal antibody use in COVID-19 treatment here.
More on recent clinical COVID-19 news on the NEJM COVID-19 page, https://www.nejm.org/coronavirus; see also “Select Coronavirus Public Health Resources and References found here.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
State Public Option Programs in Nevada, Colorado, Washington
States taking action to introduce a “public option” for health insurance on their exchanges are the focus of The Wall Street Journal (here), on Nevada, and a summary in InsideHealthPolicy, here. WSJ reports “Nevada recently adopted a law that increases the state’s role in healthcare, a move that is being closely watched as an experiment in what the future of healthcare might look like across the nation. Nevada’s Democratic lawmakers say the law, passed at the end of May and signed this month by the governor, will reduce costs for consumers by creating a ‘public option’ that would have private insurers offer lower-priced health plans. Republicans and health care industry officials say it represents government overreach and could drive healthcare providers out of business . . . A public option generally involves a government-run health insurance agency that is lower-priced and competes with commercial insurers, but there are many variations that are being explored. Democratic lawmakers in several states say they are frustrated by the sluggish pace of federal action and are moving ahead with their own plans. Washington state was the first to pass a public option, which took effect this year, and Colorado Democratic Gov. Jared Polis signed his state’s public option legislation Wednesday.” Other states showing an interest include Illinois, New Mexico and Oregon. Jaime King and colleagues examine the trend in a forthcoming law journal article (“Are State Public Option Health Plans Worth It?” here), with a trend map (here) by state.
Supremes Leave Trade Off of Cost Sharing Reduction vs. Silver Loading In Place
CQ reports (here) that “The Supreme Court on Monday declined to hear a case involving insurance subsidies halted by former President Donald Trump in 2017, cementing a lower court ruling that grants health plans partial reimbursement.” After the “Cost Sharing Reduction” subsidies were stopped “Insurance companies raised premiums to recover the losses. Because the cost-sharing subsidies only applied to silver-level plans, nearly all insurers restricted the premium increases to silver plans as well. Last August, the U.S. Court of Appeals for the Federal Circuit ruled that insurers should be made whole for the subsidies, taking into account profits from increased premiums.”
DRUGS & DEVICES
Bias Identified in Checklists, Algorithms, AI “Machine Learning”
STAT reports that a University of Chicago group has published (here) a study on racial and economic bias in algorithms which “carry out an array of crucial tasks: helping emergency rooms nationwide triage patients, predicting who will develop diabetes, and flagging patients who need more help to manage their medical conditions.” The report “Points to a gaping hole in oversight that is allowing deeply flawed products to seep into care with little or no vetting, in some cases perpetuating inequitable treatment for more than a decade before being discovered.”
EPIC Sepsis Model Faulted, With Results “Substantially worse than the performance reported by its developer.”
In a JAMA Internal Medicine article (here) reviewing the sepsis prediction model of EMR company EPIC, Michigan Medicine (University of Michigan) researchers found “The Epic Sepsis Model poorly predicts sepsis; its widespread adoption despite poor performance raises fundamental concerns about sepsis management on a national level.” The authors note that “Many models have been developed to improve timely identification of sepsis, but their lack of adoption has led to an implementation gap in early warning systems for sepsis. This gap has largely been filled by commercial electronic health record (EHR) vendors . . . More than half of surveyed US health systems report using electronic alerts, with nearly all using an alert system for sepsis.”
An editorial (here) accompanying the Epic study says “Models with poor combined specificity and sensitivity, defined as less than 1.5 (in which 1 is a coin flip and 2 is perfect), must be incorporated into care with caution, particularly when a validation study is not published, as Epic failed to do. Alerts that are generated based on an algorithm that has only modest discriminant capacity threaten not only to exacerbate alert fatigue, but also to undermine value-based patient care by potentially increasing inappropriate triage, unnecessary diagnostic testing, and antibiotic prescriptions.”
READINGS & REFERENCES
Select Coronavirus Public Health Resources and References (alphabetical) may be found here.
2021 CQ Congressional Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
June 23, 24, 25
July 19, 20, 21, 22, 26, 27, 28, 29, 30
August - none
September 20, 21, 22, 23, 24, 27, 28, 29, 30
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.