DCMedical News: Thursday, December 9, 2021
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY Thursday, December 9, 2021
Senate Nixes Vaccination Mandate for Private Employers
The Senate Wednesday night voted against a proposed vaccine mandate for larger businesses, 52-48. The Hill (here) reports that “The resolution faces an uphill path in the House, where Republicans aren’t able to use a similar fast-track process to force a vote over the objections of Democratic leadership. Instead, Republicans are hoping to get the simple majority needed to force a vote through a discharge petition, which will require support from a handful of House Democrats.” The rule, published through the Occupational Safety and Health Administration (OSHA), orders businesses with at least 100 employees to require their workers to get vaccinated. The 5th Circuit Court of Appeals temporarily stayed the rule in November.
In a separate initiative, an emergency rule in the June 21 Federal Register (FR here, AHLA commentary on the rule here) addressed OSHA safety requirements for health workers, effective that date. “The Occupational Safety and Health Administration (OSHA) is issuing an emergency temporary standard (ETS) to protect healthcare and healthcare support service workers from occupational exposure to COVID–19 in settings where people with COVID–19 are reasonably expected to be present. During the period of the emergency standard, covered healthcare employers must develop and implement a COVID–19 plan to identify and control COVID–19 hazards in the workplace. Covered employers must also implement other requirements to reduce transmission of COVID–19 in their workplaces . . . The standard encourages vaccination by requiring employers to provide reasonable time and paid leave for employee vaccinations and any side effects . . . Finally, the standard exempts from coverage certain workplaces where all employees are fully vaccinated and individuals with possible COVID–19 are prohibited from entry.”
Healthcare organizations continue to suspend vaccination requirements (e.g. here) in the wake of a temporary halt of the CMS mandate for healthcare workers.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
The Second Surgeon
A study in JAMA Surgery (here) found that in a “population-based cohort study of 1,320,108 patients treated by 2,937 surgeons, sex discordance between surgeon and patient was associated with a small but statistically significant increased likelihood of adverse postoperative outcomes. This was driven by worse outcomes for female patients treated by male physicians without a corresponding association among male patients treated by female physicians.”
HOSPITALS AND OTHER HEALTH CARE FACILITIES
The Uneven Impact of COVID-19 Hospitalization
NBC News (here) reported that “Six states in the Midwest and East Coast account for more than half of the nation's total COVID-19 hospitalizations confirmed in recent weeks . . . Federal data shows 35 states and the District of Columbia have seen hospitalization rates increase in the last two weeks. Michigan, Ohio, Indiana, Pennsylvania, New York and Illinois are mostly driving this increase. These states make up 35 percent of the population among states with increasing hospitalizations, but comprise 60 percent of new hospital beds filled between Nov. 10 and Dec. 5 . . . Michigan topped the list, accounting for 13.2 percent of new hospitalizations over this time period.” See also “Coronavirus in the U.S.: Latest Map and Case Count” in The New York Times, here.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Interoperability? Not So Fast.
CMS will publish a notice (here) in the December 10 Federal Register indicating that it does not intend, after all, to enforce information transmission standards called for in 2020. “On May 1, 2020, we published the CMS Interoperability and Patient Access final rule (85 FR 25510) to establish policies that advance interoperability and patient access to health information. The rule required Medicare Advantage (MA) organizations, Medicaid managed care plans, Children’s Health Insurance Program (CHIP) managed care entities, and Qualified Health Plan (QHP) issuers on the Federally-facilitated Exchanges (FFEs) (collectively referred to as “impacted payers”), to facilitate enhanced data sharing by exchanging data with other payers at the patient’s request, starting January 1, 2022 . . . We also required these impacted payers to incorporate and maintain the data they receive through this payer-to-payer data exchange into the enrollee’s record, with the goal of increasing transparency for patients, promoting better coordinated care, reducing administrative burden, and enabling patients to establish a collective patient health care record as they move throughout the health care system . . . we required impacted payers to receive data in whatever format it was sent and to send data in the form and format it was received, which ultimately complicated implementation by requiring payers to accept data in different formats . . . [but] the absence of a required standard or specification for the payer-to-payer data exchange requirement is creating challenges for implementation and may lead to differences in implementation across industry, poor data quality, operational challenges, and increased administrative burden . . . Payers explained that differences in implementation approaches may create gaps in patient health information that conflict directly with the intended goal of an interoperable payer-to-payer data exchange . . . We are now announcing that we expect to extend this exercise of enforcement discretion of the payer-to-payer data exchange requirement until we are able to address the identified implementation challenges through future rulemaking. We anticipate providing an update on any evaluation of this enforcement discretion notification and related actions during calendar year 2022.”
READINGS & REFERENCES
Continuity, Fragmentation and Adam Smith
An essay by Elizabeth J. Rourke in The New England Journal of Medicine, here. “Tension between the continuity of care provided by seeing a doctor you know, and getting specialized services from a doctor you don’t, has afflicted American medicine since the postwar period, when medical knowledge began to expand rapidly. This growth in specialization has resulted in a U.S. physician workforce in which more than two thirds of practicing doctors are specialists . . . By the 1980s, however, financial considerations had driven the development of multiple ways of providing care that opened the door to even greater fragmentation in medicine. Initially, a decrease in the number of solo practices and growth of group practices led to an increase in the size of call groups and greater heterogeneity in coverage, separating patients from an individual, personal doctor. This process was intensified with the introduction of managed care in the 1990s, when patients often found that their new insurance plan no longer covered care by their old doctor, severing existing therapeutic relationships . . . [electronic medical records] technology, which allowed many more people to easily obtain background information about patients, combined with changes in the nature of ambulatory medicine, drove the rapid growth of specialized hospital medicine services. The separation of care in the hospital from care in the community made communication between these two realms and the maintenance of continuity even more challenging.”
Dr. Rourke continues, “Seen through the lens of classical economics, the health care industry is not undergoing fragmentation of care, but rather, division of labor. As Adam Smith asserted, ‘The greatest improvement in the productive powers of labor, and the greater part of the skill, dexterity, and judgement with which it is anywhere directed or applied, seem to have been the effects of the division of labor.’ . . . As economists Gary Becker and Kevin Murphy noted in the early 1990s, ‘specialization and the division of labor depend on coordination costs.’ For my practice, these coordination costs can be expressed as person-hours of faxing, as we attempt to track down lab results and consult notes from outside hospitals. Additional costs associated with fragmentation of care include tests that I repeat without knowing that they’ve already been done, mistakes that arise from poor communication, and confusion about responsibility for follow-up. ‘The cost of coordinating a group of complementary specialized workers grows as the number of specialists increases,’ Becker and Murphy note. In addition to imposing coordination costs, division of labor in medicine affects the relationships between patients and doctors, challenging interpersonal continuity. This change comes with both practical and emotional consequences.”
Select Coronavirus Public Health Resources and References may be found here.
2021 CQ Congressional Calendar here.
2022 CQ House of Representatives Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
December 10
January 10, 11, 12, 13, 18, 19, 20, 21
February 1, 2, 3, 4, 7, 8, 9, 28
Notes to Fred Hyde, MD, JD, MBA, news@dcmedicalnews.org