DCMedical News: Wednesday, March 2, 2022
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY Wednesday, March 2, 2022
CDC Doubles Estimates of COVID-19 Cases in the U.S., Based on Seroprevalence
The Washington Post reports (here) that "More than 140 million Americans have had the coronavirus, according to estimates from blood tests that reveal antibodies from infection — about double the rate regularly cited by national case counts." The CDC estimates (here) "show that about 43 percent of the country has been infected by the virus. The study shows that the majority of children have also been infected."
The CDC adds, "In response to recent data, 23 jurisdictions in the nationwide antibody seroprevalence survey switched to an assay with increased sensitivity to detect past infection in September 2021, which could impact trends. This survey estimates the percentage of people that have detectable antibody indicating resolving or past infection with SARS-CoV-2, but not how much antibody is present. Therefore, the estimates do not necessarily indicate the percentage of people with sufficient antibody to protect against reinfection."
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Telehealth's Next Step: Showing Value
3M's head of regulatory and government affairs writes (here) that telehealth is a technical success, but whether it has added value in health care is still an open question. The basic problem, says Megan Carr, is that "To date, technology has not driven down health care costs. Spending trends have remained on a seven percent compound annual growth rate (CAGR) trend each year since 1970. Much new technology has hit the health care scene over the past half century, but the cost growth trend has remained stubbornly persistent."
Carr writes, "Telehealth essentially went primetime during COVID-19 as a vital technology to meet patientcare needs in unusual times. Its expansion in use by some (or new adoption by others) flew past traditional mile markers for new technologies or methods of care . . . We know it can decrease no-show rates, allows insights into a patient reality by observing their home experience, and can alleviate patient anxiety related to in-office physician visits. But now, as the health care system slowly returns to a new version of normal, there is a need to assess how this telehealth technology has changed or is changing the health care experience . . . Is telehealth managing patients in a way that reduces the need for potentially avoidable ER visits or hospital admissions? Do patients feel they are receiving the same level of care and services through telehealth?"
Carr notes that value should be determined by outcomes measures, not disease process. "Using disease process indicators is a highly granular way to perform quality measurement that creates a significant burden of work for clinicians in practice, often articulated as a great loathing of clinical documentation, resulting in clinician burnout. In spite of advances in technology that mitigate this burden, the emphasis on granular process indicators misses too much of what is important in health care delivery. It implies that guideline-driven care processes are the pinnacle of practice, reducing the clinician patient relationship to a series of gaps in care transactions."
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Electronic "Deprescribing" in Hospitalized, Older Patients
A study in JAMA Internal Medicine (here) asks this question: "Does providing clinical decision support during an acute care hospitalization improve deprescribing of potentially inappropriate medications and 30-day post discharge adverse drug events (ADEs) in older adults?" The short answer was "No," it made no difference in the measurement period on adverse drug events among 6,000 patients participating in a randomized trial.
Hospital at Home, Continued . . .
The Financial Times reports (here) that the "hospital at home" has helped the National Health Service (NHS) cope with COVID-19. CMS (here) publishes FAQs on the hospital at home in the U.S.
Robotic Technology Diffusion Aided by High Number of Urologists, Patient Wealth
A pre-publication study from Health Policy (here) examines diffusion of robotic surgery technology in hospitals of the NHS. "We analyse 173 hospitals performing radical prostatectomy, the most prevalent and earliest surgical area of adoption of robotic surgery. Our empirical analysis first identifies substitution effects, with robotic surgery replacing the incumbent technology, including the recently diffused laparoscopic technology. We then quantify the spillover of robotic surgery as it diffuses to other surgical specialties. Finally, we perform time-to-event analysis at the hospital level to quantitatively examine the adoption. Results show that a higher number of urologists and a wealthier referral area favour robot adoption."
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
CMS Announces FPL for 2022
CMS announces Federal Poverty Level standards (here). "For a family or household of 4 persons living in one of the 48 contiguous states or the District of Columbia, the poverty guideline for 2022 is $27,750. Separate poverty guideline figures are developed for Alaska and Hawaii, and different guidelines may apply to the Territories. The guidelines can be found here. To determine eligibility for Medicaid and CHIP, states generally use a percentage multiple of the guidelines (for example, 133 percent or 185 percent of the guidelines)."
DRUGS & DEVICES
Supermarket Pharmacies Prevail Over Drugstores, Walmart, in Part D Plan Sales Volume
Adam Fein's Drug Channels reports that "The Centers for Medicare & Medicaid Services (CMS) has recently released its 2022 data on enrollment in Medicare Part D prescription drug plans (PDPs) . . . for 2022, an astounding 99% of seniors are enrolled in the wonderland of PDPs with preferred pharmacy networks . . . For the second year, the big supermarket chains—Albertsons, Kroger, and Publix—outpaced the big three drugstore chains and Walmart."
Fein and Drug Channels report (summary here) that "Supermarket pharmacies gained overall prescription market share in 2021 . . . Expect supermarkets to run even faster in 2022."
The Infinite Variability of Clinical Circumstance v. AI
STAT reports (here) on a study undertaken with MIT researchers to help determine why artificial intelligence algorithms fail in clinical circumstances. The group found that "subtle shifts in data fed into popular health care algorithms — used to warn caregivers of impending medical crises — can cause their accuracy to plummet over time, raising the prospect AI could do more harm than good in many hospitals."
STAT followed "Algorithms past their early days of peak performance into the grinding years that follow, when the hype has faded, and they must prove their reliability . . . the algorithms withered in the face of fast-moving clinical conditions — unable to keep up with the pace of change. Their frailty exposes gaping holes in the governance of products whose quiet deterioration in hospitals around the country threatens to mislead doctors and undermine patient safety. The initial signs of dysfunction are often faint, making it difficult to root out faulty information before it bleeds into decision making."
"While selling AI tools to hospitals has become a lucrative and fast-growing business for digital health companies, there is little to no oversight once they hit the market . . . The most severe drop occurred with a sepsis prediction algorithm modeled after a widely used product developed by Epic Systems, the nation’s largest vendor of electronic health records. Its accuracy fell sharply during the study period, ending at . . . little better than a coin flip."
READING & REFERENCES
Select Coronavirus Public Health Resources and References may be found here.
2022 CQ Congressional Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
March 3, 7, 8, 9, 10, 15, 16, 17, 18, 28, 29, 30, 31
April 1, 4, 5, 6, 7, 26, 27, 28, 29
May 10, 11, 12, 13, 16, 17, 18, 19
Notes to Fred Hyde, MD, JD, MBA, news@dcmedicalnews.org