DCMedical News: Wednesday, October 27, 2021
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY Wednesday, October 27, 2021
Scaling Back Expansion Proposals for Medicare and Medicaid
Bloomberg reports that “Two significant elements of Democrats’ ambitious health agenda, expanding Medicare and Medicaid, face an uphill battle after a key party moderate signaled his opposition Monday. Sen. Joe Manchin (D-W.Va.) said Monday he doesn’t want to expand Medicare benefits without first protecting the rest of the program from insolvency later this decade.
He also rebuffed legislation to extend coverage to millions of Americans in states that have refused to expand their Medicaid programs. Extending federally funded coverage to people in the 12 non-expansion states effectively amounts to a penalty for states such as his that have paid a portion of growing their own safety nets, Manchin told reporters. “For states that held out to get rewarded with 100% that’s not fair,” he said.
More Scaling Back
A summary of paid leave policies (here, in The New York Times) finds that “The U.S. is one of six countries with no national paid leave. The Democrats have cut their plan to four weeks, which would still make it an outlier.”
DOCTORS, NURSES AND OTHER HEALTH CARE PROFESSIONALS
When Patients See The Results First
A discussion in JAMA Network Open (here) says “The 21st Century Cures Act mandates the immediate electronic release of all test results, medication lists, and clinical notes to patients without delay unless a rare allowable exception exists. Before implementation of the Cures Act . . . this information was often suppressed or delayed when it was considered by the health system to be highly sensitive or there was a risk of misinterpretation. The requirement that all electronic health information be immediately available to patients—who may see it before their clinicians—has raised concerns about unintended implications on clinical workflow and patient well-being.”
Results of this study, comparing views and follow up inquiries before and after compliance with the Cures Act, showed that “Among tests categorized to be released after any delay before January 20, 2021, patients viewed 10.4% of results before clinicians, compared with 40.3% of the same results after January 20, 2021. The number of daily messages sent by patients within 6 hours of reviewing a test released after any delay changed from a median of 77.5 messages before the transition to Cures Act compliance to 146 messages after the transition.”
HOSPITALS AND OTHER HEALTH CARE FACILITIES
Gentrification May Not Benefit Safety Net Hospitals
A report in Modern Healthcare (here) on gentrification notes that proponents of “gentrification contend it often leads to economic revitalization and increased diversity in impoverished neighborhoods. Critics argue when the process occurs too rapidly, it can drive up living expenses for existing residents so fast that they are often forced to move to more affordable areas,” and may also bring new competition for health services.
For safety net hospitals, too-rapid economic improvement in a neighborhood may be a mixed blessing. For Humboldt Park hospital in Chicago, “The 200-bed independent hospital’s history as a point of care for vulnerable patients has been an important part of its identity as an inclusive healthcare provider. But that label could work against providers like Humboldt Park Health as they try to attract many of its community’s newer residents, who aren’t flocking to the hospital.”
Medicaid Expansion States See Hospital Emergency Department Use Increase
A study in Value in Health (here) found “Medicaid Expansion Program shifted ED payer mix to Medicaid ED visits from private insurance and uninsured ED visits for adults at age of 19 to 64 years, whereas its effect on total ED volume is mixed among states. States that experienced the largest increase in Medicaid enrollment seem to experience an increase in ED visits although such results did not reach statistical significance.”
COVID Pandemic Impact on Hospitals No Easier in the UK
A report in BMJ (here) says “Ambulance services in England are struggling to cope with huge numbers of calls, as crowded hospitals are unable to take patients and queues of ambulances waiting outside emergency departments have become an everyday occurrence. The Association of Ambulance Chief Executives has said that every ambulance service in England is now at the highest level of alert, and paramedics have warned that services are regularly holding up to 300 calls at a time when no ambulances are available.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Infrastructure and the Uninsured
The Urban Institute and the Commonwealth Fund publish a report (here) showing how the social spending and climate change infrastructure bill would “Put the United States back on a path to reducing its persistent pool of uninsured people, with estimates ranging from 4 million to 7 million Americans gaining health coverage.” Coverage “would include about one-third of uninsured Black Americans.”
DRUGS & DEVICES
Aduhelm Clinical Trials: Real World Evidence?
A research letter in JAMA (here) calls attention to the fact that the FDA’s approval of Aduhelm (aducanumab) for treatment of Alzheimer’s disease would make that drug available for a population far more diverse than the one studied in clinical trials conducted to obtain that approval.
Referring to the clinical trials, the researchers wrote that “Though both trials excluded patients based on age, certain chronic diseases, and use of antiplatelet agents and anticoagulants, FDA approval was granted without contraindications or precautions for these unstudied patient populations. We evaluated whether patients enrolled in the trials of aducanumab were representative of patients with dementia enrolled in Medicare by estimating the proportions of Medicare beneficiaries with AD [Alzheimer’s Disease] or MCI [mild cognitive impairment] who would have been excluded from the trials.”
Results: “Clinical trials of aducanumab used exclusion criteria that would have excluded more than 92% of Medicare beneficiaries with ADRDs [Alzheimer’s Disease and Related Disorders] and 85% of those with MCI based on their age or comorbid conditions. These findings are concerning given the broad FDA labeling for aducanumab. Though labeling has recently been narrowed to focus on patients with MCI or mild-stage dementia, no contraindications to use have been added. The increased risk of vascular edema and hemorrhages observed in the clinical trials are likely to be higher in trial ineligible populations, particularly patients with prior stroke or chronic conditions treated with antiplatelets or anticoagulants.”
Axios reports “It prompted analysts at Raymond James to call the Alzheimer's drug "potentially the worst drug launch of all time" amid Biogen's "persistent hyperbole about the drug's purported benefits."
READINGS & REFERENCES
Drug Channels Charts Pharma Flow
The specialty drug information firm publishes (here) a channel flow chart illustrating the buy-and-bill process in the distribution of patient-administered drugs.
Select Coronavirus Public Health Resources and References may be found here.
2021 CQ Congressional Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
October 28
November 1, 2, 3, 4, 5, 15, 16, 17, 18, 30
December 1, 2, 3, 6, 7, 8, 9, 10
Notes to Fred Hyde, MD, JD, MBA, news@dcmedicalnews.org