DCMedical News: Thursday, July 29, 2021
DCMedical News-DCMN
Washington, D.C.
Thursday, July 29, 2021
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY
“Breakthrough” on Infrastructure Bill as Congress Prepares to Adjourn, Tomorrow
The Boston Globe reports (here) that “The Senate voted Wednesday evening to launch work on a bipartisan infrastructure plan in a key step forward for the Biden administration. The vote came after President Biden and a group of Democratic and Republican senators reached agreement on the $1 trillion national infrastructure package.” The Hill reports “Schumer has vowed the Senate will vote before leaving for a weeks-long break on both the bipartisan deal and a budget resolution that will allow Democrats to pass a second, substantially larger bill without Republican support.”
Bad news for hospitals: “The five-year spending package would be paid for by tapping $205 billion in unspent COVID-19 relief aid and $53 billion in unemployment insurance aid some states have halted. It also relies on economic growth to bring in $56 billion, and other measures.” The unspent COVID-19 relief funds were the object of an appeal by the AHA (here), which noted that “December 2020 was the last funding distribution announced and made by HRSA. This is despite the fact that, as reported by the Government Accountability Office, about 25% of PRF funds ($43.7 billion of $178 billion) still have not been distributed. In addition, HRSA has not announced any plans to distribute the $8.5 billion in relief funds appropriated under the American Rescue Plan Act for rural providers.”
New money in the Senate measure is approximately $550 billion. The Globe reports, “Democrats are readying the broader $3.5 trillion package that is being considered under budget rules that allow passage with 51 senators in the split Senate, with Vice President Kamala Harris able to break a tie. It would be paid for by increasing the corporate tax rate and the tax rate on Americans earning more than $400,000 a year.”
CDC Updates Guidance on Vaccination, Masks
CDC publications (7-28-2021) on “Interim Public Health Recommendations for Fully Vaccinated People (here) and on “Vaccination to Prevent COVID-19 Outbreaks with Current and Emergent Variants,” (here). In this latter publication, “The number of COVID-19 cases jumped more than 300 percent in a little over a month through July 23.”
The President will announce today (CQ, here) a requirement for the 2.1 million federal employees to be vaccinated or to take protective measures, testing, masks, social distancing. “Once considered a controversial third rail, many experts have embraced vaccine requirements as the highly infectious and potentially more virulent delta variant has torn through the country, putting vulnerable populations at risk.”
DOCTORS, NURSES AND OTHER HEALTH CARE PROFESSIONALS
Cancer Death Rates Dropping, Dramatically
STAT reports (here) that “Death rates are declining for more than half of the most common forms of cancer in the U.S., according to a sweeping annual analysis released Thursday (here). The new report — released by the American Cancer Society, the National Cancer Institute, the Centers for Disease Control and Prevention, and other collaborators — found that between 2014 and 2018, death rates dropped for 11 out of 19 of the most common cancers among men and 14 of the 20 most prevalent cancers among women.”
“Accelerating declines in lung cancer deaths may account for much of the overall progress seen in recent years, the authors of the report said. Over the past two decades, the death rate for lung cancer has declined even faster than the rate at which patients are diagnosed with the disease. And while part of the early success in preventing lung cancer can be attributed to the massive drop in smoking rates, the authors note the most recent downward trends seem to correspond with the approval of new treatments for non-small cell lung cancer that improved the likelihood of survival. Death rates from melanoma also saw an accelerated decline in the past decade, despite a growing number of diagnoses. Like in lung cancer, authors point to the introduction of novel treatments around the same time as the turnaround on the death rate. New targeted and immune checkpoint inhibitors were approved by the Food and Drug Administration in 2011, one year before major declines in death rates were seen in women and two years before they were seen in men.”
Cautionary notes in the report: “Others, such as prostate, colorectal, or female breast cancers, have seen progress stalled or stopped. Breast cancer continues to be one of the three deadliest cancers for women of all races, and the most frequently fatal cancer for Hispanic women. While the rates of death from breast cancer are declining, the pace of the decline has slowed over the past two decades.”
HOSPITALS AND OTHER HEALTH CARE FACILITIES
Don’t Try This at Home. Or, Maybe, Try It: the Home Hospital Movement Comes to Surgery
A coterie of prestigious Harvard-Chicago authors writes in JAMA Surgery (here) that the “home hospital” movement, for pre and post care, may be right for surgery. “In addition to improving capacity by decoupling operating rooms and inpatient beds, HH programs create the opportunity to reimagine how care is delivered with a focus on location of the patient, instead of location of clinicians. We outline a sample of the components needed for a postoperative HH program.”
Zombie Hospitals Continue to Sue Patients
NPR and Kaiser Health News report (here) that hospitals formerly owned by CHS continue, even after acquired by new owners, to sue patients, in large numbers. “An investigation by CNN found CHS sued at least 19,000 patients during the pandemic, though the number is likely an undercount given the lawsuits filed on behalf of its former hospitals . . . CHS held on to its debt in the deals with Vanderbilt and continues to try to pursue patients that owe it money.” According to the report, “Many of those institutions are like zombie hospitals — little more than a legal entity still taking patients to court even after being sold to new owners who don't sue over medical bills.”
Why EHR Systems May Fail to Detect Sepsis
Failure to update vital signs; upcoding; inadequate sample size and generalizability for modeling; and lack of consensus for treating before a sepsis diagnosis metrics are met. These four (and probably other) reasons are given in a blog post (here), discussing why “Epic, the largest electronic health record (EHR) system in the United States, is in the news for the poor performance of its sepsis predictive model when tested under real-world conditions. The goal of a sepsis alert system is to avoid missing a diagnosis of sepsis before it is too late, but Epic's sepsis algorithm only detected 7% of sepsis cases missed by clinicians. This is both unacceptable and totally understandable: if you are in the business of wanting to see data science succeed in healthcare, it is worth understanding how and why sepsis prediction models can fail to deliver the anticipated benefits to patients and their providers.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Kaiser Reports on Out-of-Pocket Spending in MA vs. Traditional Medicare
KFF says (here) “Cost-Related Problems Are Less Common Among Beneficiaries in Traditional Medicare Than in Medicare Advantage, Mainly Due to Supplemental Coverage.”
Rate Filings May Reveal Near Term Future for COVID-19 Claims and Insurance Premiums
A Peterson-KFF analysis of rate filings by insurers (here) shows that “Initial 2022 premium rate filings for Marketplace-participating individual market insurers in 13 states and the District of Columbia. . . [shows] most of these insurers expect health utilization patterns to return to pre-pandemic levels and therefore most are factoring in no additional costs or savings into their 2022 premiums. We found that these insurers tended to make similar assumptions about how COVID-19 would affect their group market costs.”
READINGS & REFERENCES
Select Coronavirus Public Health Resources and References may be found here.
2021 CQ Congressional Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
July 30
August - none
September 20, 21, 22, 23, 24, 27, 28, 29, 30
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.