DCMedical News: Monday, July 26, 2021
DCMedical News-DCMN
Washington, D.C.
Monday, July 26, 2021
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY
Infrastructure
Details are expected today on a $579 billion infrastructure bill which is dependent in part on delaying a Medicare regulation, while last-minute priorities of individual Senators are accommodated. The Medicare rule, from the Trump administration, would eliminate rebates that drug companies pay pharmacy benefit managers under Medicare Part D, aimed at reducing out-of-pocket expenditures by patients outside of Medicare. Elimination of this rule would reduce expenditures by the Medicare program, producing, reports Bloomberg, a “windfall negotiators want to use to help pay for roads, bridges and other projects, cutting Medicare spending by $177 billion over a decade.”
COVID-19
Dr. Anthony Fauci says the U.S. is “heading in the wrong direction,” the CDC considering whether to recommend a mask mandate for the vaccinated while indoors. Vaccine refusal (The New York Times, here); “Confronting Our Next National Health Disaster— Long-Haul Covid,” (in the New England Journal of Medicine, here); comparison of COVID-19 policies in Canada, Ireland, the US and the UK, (in Health Policy, here); how Latino individuals have done better in avoiding and surviving COVID-19 in Los Angeles County, where they constitute 49% of the 10 million population (here); and “nine lessons” from the pandemic for U.S. health care delivery (here). See below (Readings & References) for an updated list of Select Coronavirus Public Health Resources and References.
DOCTORS, NURSES AND OTHER HEALTH CARE PROFESSIONALS
Telemedicine and Primary Care Practice Models
A study in JAMA Health Forum (here) notes that “Patterns of outpatient care shifted dramatically during the early stages of the COVID-19 pandemic, with deferred in-person care leading to substantial revenue losses for primary care organizations. This shift created a strong financial incentive to move visits to telemedicine, especially among organizations reimbursed under fee-for-service payment models.” But a study of more than 1 million patients concluded that “Telemedicine use rose faster and reached higher absolute levels among those patients attributed to primary care organizations reimbursed via advanced value-based payment models compared with those reimbursed via fee-for service.”
Open Payments
The newsletter Policy & Medicine features news of the Open Payments program (here), and a new California requirement for physicians to inform patients of such payments. “On June 30th, the Centers for Medicare & Medicaid Services (CMS) published 6.38 million records, accounting for $9.12 billion in payments and ownership and investment interests. Over the past seven years, CMS has published over 78 million payments, accounting for over $67 billion in spend[ing].”
HOSPITALS AND OTHER HEALTH CARE FACILITIES
Joint Ventures in Ambulatory Surgery Centers (ASCs) Accelerate
Becker’s ASC Review (here) lists 31 new joint venture ASCs opened or announced since January 1, 2021, including physician group joint ventures, physician group and health systems, physician groups and management companies, health system and management companies, and health system-management company-physician group three-way ventures.
Hospital Prices Continue to Make News
The high and often mystifying prices charged by hospital in the U.S. continue to make news. Giant swings in prices (sometimes within the same hospital) are described in Healthcare Dive (here); the AHA unveils a study (news release here, study of cancer patient treatment here) showing hospital outpatient department patients to be sicker and poorer than those in physician offices, an argument in the “site-of-service-differential” controversy; overuse of tests and treatments in hospitals is evaluated by the Lown Institute (here), in a JAMA Network Open study of Medicare patients (here, supplemental information here, results: “highest scores in this Medicare population were associated with nonteaching and for-profit hospitals, particularly in the South”); and the Bloomberg editorial board concludes (here) that “Hospital Mergers Are Driving Up Health Care Costs.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Public Charge Rule No Longer in Effect
“The Centers for Medicare & Medicaid Services (CMS) released an Informational Bulletin to states about the DHS 2019 Public Charge Final Rule that has been vacated and is no longer in effect. Effective March 9, 2021, DHS started applying the 1999 Interim Field Guidance for public charge inadmissibility determinations, which is the policy that was in place before the 2019 Public Charge Final Rule. Under the 1999 Interim Field Guidance, DHS will not consider an individual’s receipt of Medicaid benefits as part of the public charge determination, with one exception for individuals who are institutionalized on a long-term basis (such as nursing facility residents) and are receiving Medicaid coverage for their institutional services.”
DRUGS & DEVICES
Off Label Prescribing May Be Subject to New Review
Bloomberg Health and Law (here) has an essay on the possible use of diagnosis codes to curb off-label prescribing. “The Department of Health and Human Services Office of Inspector General recently advocated for new mandates that physicians include a diagnosis code with each prescription and that claims data capture this information. This followed on the heels of a Congressional Research Service report suggesting that Congress should pass legislation requiring prescribers to include diagnostic information in prescriptions.”
Opioid Overdose Deaths Reach 93,000, Double the Highest Annual Number of Gun Deaths
The New York Times (here) reports that “Drug overdose deaths rose nearly 30 percent in 2020 to a record 93,000, according to preliminary statistics released Wednesday by the Centers for Disease Control and Prevention. It’s the largest single-year increase recorded. The deaths rose in every state but two, South Dakota and New Hampshire, with pronounced increases in the South and West. . . Several grim records were set: the most drug overdose deaths in a year; the most deaths from opioid overdoses; the most overdose deaths from stimulants like methamphetamine; the most deaths from the deadly class of synthetic opioids known as fentanyls. ‘It’s huge, it’s historic, it’s unheard of, unprecedented, and a real shame,’ said Daniel Ciccarone, a professor of medicine at the University of California, San Francisco, who studies heroin markets. ‘It’s a complete shame.’”
Automated Intelligence
Coronavirus Detection
AI in Healthcare reports (here) that, “Aided by AI, a tiny device may offer nearly instant testing for COVID . . . Researchers have developed a nanopore that uses AI to detect COVID-19 and other viruses in easily obtained saliva specimens. In testing, the device needed just five minutes to confirm positive cases at a 90% clip and rule out negatives with 96% specificity. A nanopore is a miniscule device—around a billionth of a meter wide—that replicates a pore on the skin. It can be placed on a membrane to measure the flow of electric current through its opening. These measurements can reveal processes taking place at molecular and genetic levels. The COVID advance in nanopore technology for virology unfolded at Osaka University in Japan and is described in a study published June 17 in Nature Communications,” (here).
READINGS & REFERENCES
Select Coronavirus Public Health Resources and References (alphabetical) may be found here.
2021 CQ Congressional Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
July 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.