DCMedical News: Thursday, November 18, 2021
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY Thursday, November 18, 2021
100,306 Drug Overdose Deaths in U.S. May 2020-April 2021
The Centers for Disease Control’s National Center for Health Statistics reported (CDC press release here, interactive on-line report here) that “There were an estimated 100,306 drug overdose deaths in the United States during 12-month period ending in April 2021, an increase of 28.5% from the 78,056 deaths during the same period the year before. The new data documents that estimated overdose deaths from opioids increased to 75,673 in the 12-month period ending in April 2021, up from 56,064 the year before. Overdose deaths from synthetic opioids (primarily fentanyl) and psychostimulants such as methamphetamine also increased in the 12-month period ending in April 2021. Cocaine deaths also increased, as did deaths from natural and semi-synthetic opioids (such as prescription pain medication).”
A report on the CDC’s findings in The New York Times (here) notes that “Though recent figures through September suggest the overdose death rate may have slowed, the grim tally signals a public health crisis whose magnitude was both obscured by the Covid pandemic and accelerated by it, experts said. ‘These are numbers we have never seen before,’ said Dr. Nora Volkow, director of the National Institute on Drug Abuse. The fatalities have lasting repercussions, since most of them occurred among people aged 25 to 55, in the prime of life, she added. ‘They leave behind friends, family and children, if they have children, so there are a lot of downstream consequences . . . This is a major challenge to our society.’ The rise in deaths — the vast majority caused by synthetic opioids — was fueled by widespread use of fentanyl, a fast-acting drug that is 100 times as powerful as morphine. Increasingly fentanyl is added surreptitiously to other illegally manufactured drugs to enhance their potency.”
DOCTORS, NURSES AND OTHER HEALTH CARE PROFESSIONALS
PCI v. CABG for Left Main Artery Disease: A Toss-Up
A report in The Lancet (here) finds that “Among patients with left main coronary artery disease and, largely, low or intermediate coronary anatomical complexity, there was no statistically significant difference in 5-year all-cause death between PCI and CABG.” A comment in NEJM Journal Watch (here) says “These findings demonstrate that, for patients undergoing revascularization for LMCAD, 5-year mortality does not differ substantially between contemporary PCI and CABG, while key secondary outcomes including spontaneous MI and repeat revascularization are less likely with CABG. When interpreting these findings, it's important to keep in mind that most of the study patients had low or intermediate angiographic complexity; thus, extrapolation to those with extensive multivessel CAD (as is often seen with left main disease) is likely inappropriate. Nonetheless, given the faster recovery with PCI, many patients may find these results sufficiently reassuring to choose PCI as an initial revascularization strategy. Given the important role of patient preference in this decision, I believe they should be informed of both options — optimally through a heart team discussion.”
Immigrant Medical Professionals, More Opportunities
A report in the Nevada Independent (here) calls attention to the skills of medical professionals, for example immigrants from Afghanistan, in meeting the medical care needs of patients in their new country.
Point of Care Ultrasonography: A New Tool (and New Reimbursement) for Primary Clinicians, With Cautions
A review in The New England Journal of Medicine (here) says “With the advent of smaller and more affordable ultrasound machines, combined with evidence that nonradiologists and noncardiologists can become competent in the performance of POCUS [Point of Care Ultrasonography], it is now used in many practice settings and in all phases of care — from screening and diagnosis to procedural guidance and monitoring — and has become associated with changes in clinical decision making in medical practice. A recent study showed that POCUS facilitated confirmation of the suspected clinical diagnosis in up to 50% of cases and supported a change in the initial diagnosis in 23% of cases. . . it differs from consultative ultrasonography, in which the test is ordered by the clinician, typically performed by a technician, and then interpreted by a consultant who is not directly involved with the care of the patient. Since POCUS challenges the traditional approach to ultrasonography and involves the clinician directly, it may well result in a reduction in the use of consultative ultrasonographic services. A 2015 retrospective study showed that the introduction of point-of-care echocardiography performed by intensivists led to a decreased number of comprehensive diagnostic echocardiographic studies overall but led to a recommendation to perform full diagnostic echocardiographic studies in 10.7% of patients who had undergone the point-of-care studies. This change in practice occurred without adverse clinical outcomes. However, such practice changes may engender concern in the radiology and cardiology communities about reduced reimbursement and potential quality issues.”
MEDICARE, MEDICAID, AND COMMERCIAL HEALTH INSURANCE
GAO Reports on MIPS 2017-2019: No Provider Left Behind
The General Accountability Office reports (summary here, full report here) on the Merit-based Incentive Payment System (MIPS).
Background: “The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) changed how Medicare pays for physician services, moving from a payment system that largely rewarded volume and complexity of health care services to the Quality Payment Program, which is a payment incentive program intended to reward high-quality, efficient care. [MACRA consolidated three Medicare legacy payment incentive programs—Promoting Interoperability program, Physician Quality Reporting System, and Value-based Payment Modifier—under MIPS. See Pub. L. No. 114-10, § 101(b), 129 Stat. 87, 91]. Providers participate in the Quality Payment Program through one of two tracks: MIPS or advanced alternative payment models . . . About 950,000 providers (about half of all Medicare Part B providers) were eligible to participate in MIPS in 2019. Congress included a provision in MACRA for GAO to examine the MIPS program. This report describes (1) the distribution of MIPS performance scores and related payment adjustments, and (2) stakeholders’ perspectives on the strengths and challenges of the MIPS program.”
Results: “At least 93 percent of providers earned a small positive adjustment in 2017 through 2019, with the largest payment adjustment in any year being 1.88 percent . . . About 72 to 84 percent of providers earned an exceptional performance bonus, depending on the year. A report (here) in Modern Healthcare says “Stakeholder groups interviewed for a new Government Accountability Office report said the Merit-based Incentive Payment System doesn't improve quality and the bonus for participating often isn't worth the cost.”
DRUGS & DEVICES
ICER Reports on “Unsupported” Price Increases in 2020
The Institute for Clinical and Economic Review reports (here) on a dozen drugs in this, the third ICER report concerning price increases which have taken place in the absence of new or more powerful information concerning the efficacy of the drugs in question. “The price of many existing drugs, both brand and generic, can increase substantially over time, and questions are frequently raised regarding whether these price increases are justified. State policymakers have been particularly active in seeking measures to address this issue. Despite these initiatives, there had been no systematic approach at a state or national level to determine whether certain price increases are justified by new clinical evidence or other factors. Starting in 2019, the Institute for Clinical and Economic Review (ICER) has published reports assessing whether new clinical evidence or other information has appeared that could support the price increases of drugs whose recent, substantial price increases have had the largest impact on national drug spending.”
Results of the evidence assessments for these 12 drugs: “Nine were judged to have price increases unsupported by new clinical evidence and three were found to have price increases with new clinical evidence. Net price increases for the drugs reviewed were mostly lower than in prior years of the UPI Report, and this is consistent with published data showing overall reductions in net prices in the US . . . their significant revenue meant that even a small increase in net price would have a relatively large impact on national drug spending . . . The total increase in spending in the US over one year due to price increases for seven of the nine drugs found to have unsupported price increases amounted to $1.67 billion,” but $1.4 billion of that total was due to price increases for Humira. Details on ICER funding and support: https://icer.org/who-we-are/independent-funding/.
READINGS & REFERENCES
Select Coronavirus Public Health Resources and References may be found here.
2021 CQ Congressional Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
November 30
December 1, 2, 3, 6, 7, 8, 9, 10
Notes to Fred Hyde, MD, JD, MBA, news@dcmedicalnews.org