DCMedical News: Monday, November 1, 2021
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY Monday, November 1, 2021
Biden Building Health Policy
The White House (here) proposed changes in health proposal as part of its $1.75 trillion domestic spending package. The plan, still not accepted by a sufficient number of Democratic Representatives or Senators to pass, would reduce premiums for more than 9 million Americans who buy insurance through the PPACA marketplace; cut premiums by an average of $600 per person per year; provide tax credits to up to 4 million uninsured Americans in states that have not expanded Medicaid under PPACA; expand Medicare to “cover” hearing benefits for older Americans; but include no actions previously proposed on drug price or providing dental and vision benefits under Medicare. Projected price tags for major projects, as well as “pay fors,” are found at the end of the White House statement.
The Kaiser Foundation (here) explores ten health field provisions of the proposed Build Back Better Act, “with discussion of the potential implications for people and the federal budget . . . we summarize provisions relating to the following areas and provide data on the people most directly affected by each provision and the potential costs or savings to the federal government.” The ten essays, with useful links and history, not all included in the October 28th package (see above), are ACA Marketplace Subsidies; New Medicare Dental, Hearing, and Vision Services; Controlling Prescription Drug Prices and Spending; Medicare Part D Benefit Redesign; Medicaid Coverage Gap; Maternal Care and Postpartum Coverage and Care; Continuous Coverage for Children in Medicaid / CHIP; Permanent Extension of the Children’s Health Insurance Program (CHIP); Medicaid Home and Community Based Services and the Direct Care Workforce; and Paid Family and Medical Leave.
Global Burden of Death Falling More Often on Adolescent Males, Especially in Sub-Saharan Africa and South Asia
A report (here) in The Lancet finds that “Variation in adolescent mortality between countries and by sex is widening, driven by poor progress in reducing deaths in males and older adolescents.” The report sought to “analyse data on the number of deaths, years of life lost, and mortality rates by sex and age group in people aged 10–24 years in 204 countries and territories from 1950 to 2019 by use of estimates from the Global Burden of Diseases [GBD], Injuries, and Risk Factors Study (GBD) 2019.”
The report notes, “In 2019 there were 1.49 million deaths worldwide in people aged 10–24 years, of which 61% occurred in males. 32.7% of all adolescent deaths were due to transport injuries, unintentional injuries, or interpersonal violence and conflict; 32.1% were due to communicable, nutritional, or maternal causes; 27.0% were due to non-communicable diseases; and 8.2% were due to self-harm. Since 1950, deaths in this age group decreased by 30.0% in females and 15.3% in males, and sex-based differences in mortality rate have widened in most regions of the world. Geographical variation has also increased, particularly in people aged 10–14 years. Since 1980, communicable and maternal causes of death have decreased sharply as a proportion of total deaths in most GBD super-regions, but remain some of the most common causes in sub-Saharan Africa and south Asia, where more than half of all adolescent deaths occur.”
DOCTORS, NURSES AND OTHER HEALTH CARE PROFESSIONALS
General Practice Changing in the UK, Also
Barristers and solicitors, specialists and GPs. One has the courtroom and the operating room, the other has the office, and, most often, more continuing contact with the client or patient. So says a report in The Financial Times (here). But that tradition of continuing contact may be a victim of pandemic burnout and corporate overload: “Faced with workloads that were already becoming unmanageable long before the Covid-19 pandemic, many GPs are choosing to work part-time, retire early or become locums to avoid burnout . . . A shortage of doctors is driving the workload crisis. As people live longer, often with chronic conditions that require careful management, demands on general practice are escalating. Furthermore, GP numbers have not kept pace with demand. . . . While experienced GPs are retiring early, salaried GPs are delaying becoming partners or not doing so at all, causing smaller practices to fold or merge with larger practices. Between 2018 and 2021 the number of GP partners in England — expressed as full-time equivalent roles — shrank by almost 12 per cent, according to NHS Digital. Every time a GP partner leaves and is not replaced, the work pressures on the practice rise. That is because the partners are the most experienced practitioners and shoulder a disproportionate share of the management workload, such as organising staffing and budgets.”
Where to Have Your Heart Attack
A study in JAMA Open Network Cardiology (here) finds that for treatment of acute myocardial infarction (AMI) in adults 55 years of age or younger, “Being treated in the US (multi-payer system) relative to Canada (single-payer system) was associated with a lower in-hospital and post-AMI quality-of-care score, regardless of all SDOH [Social Determinants of Health] factors except unemployment. Lower in-hospital quality of care was associated with 1-year readmission rates in the US only . . . These findings suggest that health care systems and unemployment are associated with quality of AMI care.”
AMA and AAMC Publish Guide to Health Equity in Language and Narratives
“The AMA developed, in partnership with the Association of American Medical Colleges (AAMC), one of the most comprehensive health equity communication guides to support physicians’ conversations with patients. Designed for physicians and other health care professionals, the Advancing Health Equity: A Guide to Language, Narrative and Concepts (here) provides guidance and promotes a deeper understanding of equity-focused, first-person language and why it matters.” Further in the announcement, “Better understanding about language and dominant narratives can help ensure that we are indeed centering care around the lived experience of patients and communities without reinforcing labels, objectification, stigmatization and marginalization.”
HOSPITALS AND OTHER HEALTH CARE FACILITIES
Outrageous Hospital Prices (Again)
The Wall Street Journal, using “newly public data on hospital prices,” as well as the specific medical bills and insurance statements from a patient whose husband (later widow) paid over $100,000 for care available at far lower charges, “shows how the nation’s seemingly arbitrary hospital pricing left the couple with charges that in some cases would have been far lower for other patients, through no fault of their own.” The Journal story (here) points to the uneven results of “negotiation” between hospitals and insurers. “A weak negotiator can get stuck with a lousy deal. Trade-offs can give one insurance plan the best deals for some hospital services, but not others.” More, “Even within an insurance plan, prices aren’t consistently low or high. A plan’s prices for one service can be among the lowest a hospital negotiates, but among the highest for another.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Open Enrollment
Medicare’s open enrollment period starts today and last through December 1 for January 1 coverage. CMS fact sheet here, AHA perspective here.
Financial Impact and Consequences of COVID-19 Pandemic
A Viewpoint in JAMA (here) notes that “It is a great testament to the fragmented US health care system that insurers, policy makers, and caregivers were able to mount a rapid response to help protect patients from financial toxicity from COVID-19. But these efforts were a stopgap measure, and despite threats of further surges in cases, Congress has a waning appetite for allocating additional emergency funds. Moreover, the long-term fiscal effects of COVID-19 are now emerging: 23% of patients hospitalized with COVID-19 in a national cohort reported having exhausted their savings after the hospitalization.” In addition, “Current rates of new cases make it clear that the US will remain in the acute phases of the COVID-19 pandemic for the foreseeable future and the number of patients receiving bills for the costs of treatment for COVID-19–related hospitalizations will likely increase. Additionally, individuals experiencing the long-term health effects of COVID-19, such as kidney dysfunction and “long COVID,” may have chronic medical needs that expose them to decades of financial risk.”
READINGS & REFERENCES
Select Coronavirus Public Health Resources and References may be found here.
2021 CQ Congressional Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
November 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