DCMedical News: Thursday, March 3, 2022
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY Thursday, March 3, 2022
State of the Union, Health Focus
In the State of the Union address Tuesday night (script as planned, from The White House, here); and from CQ (here) and The New York Times, (here), as delivered, the President addressed problems with nursing homes (including "Wall Street" ownership of skilled nursing facilities), drug prices and veterans' health.
The President discussed the price of insulin and other drug prices; health insurance premium subsidies; women's health, mental health, and accelerated attacks on cancer through an Advanced Research Projects Agency for Health, ARPA-H.
Prepare for the Transition From Pandemic to Endemic
The Administration unveiled The National COVID-19 Preparedness Plan, here.
Among the goals: launch an effort to vaccinate America's youngest children as soon as the U.S. Food and Drug Administration (FDA) authorizes and the CDC recommends a vaccine for that age group; increase American manufacturing capacity to reliably produce an additional 1 billion vaccine doses per year and accelerate research and development of a single COVID vaccine that protects against SARS-CoV-2 and all its variants, as well as previous SARS origin viruses; launch a nationwide Test to Treat Initiative so Americans can rapidly access treatment, including by visiting a "one-stop" location to get a free test and free treatment pills; update the framework for recommendations on preventive measures like masking to reflect the current state of the disease.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Underdiagnosis in New Cases of Heart Failure
A study in the Journal of the American College of Cardiology, summarized in ACP Hospitalist (here), found that "In recent years, only about one-third of patients with new-onset heart failure (HF) received testing for coronary artery disease (CAD) . . . Researchers used an administrative claims database covering commercial insurance and Medicare to determine the proportion of patients with incident HF who received CAD testing from 2004 to 2019."
"The primary outcome was the occurrence of CAD testing, defined as the performance of any of the following during the 90 days before or after the initial diagnosis: exercise stress test without imaging, stress echocardiogram, nuclear stress imaging, cardiac MRI, coronary CT angiography, and coronary angiography . . . patients undergoing CAD testing were more likely to be younger, male, and diagnosed in an acute care setting."
Time and the Surgeon
A study in JAMA Network (here) examines variability and overestimation in OR procedure time. "The time involved in performing a procedure is a key factor in determining physician payments by Medicare. However, there are long-standing concerns regarding the accuracy of the time estimates generated by the American Medical Association/Specialty Society Relative Value Scale Update Committee surveys that are used in the valuation process, and there have been calls to use other data sources to estimate procedure times."
Results: "Across 4.9 million procedures in this analysis, the mean estimated procedure time was 27% lower than the time used in the valuation process. There were notable exceptions, for which the mean estimated procedure time equaled or exceeded the valuation time including total hip arthroplasty (5% longer) and total knee arthroplasty (equal duration)."
"Within a given code, older patients and those with more illness had longer procedure times. There was substantial variation across specialties in the percent difference between mean estimated and valuation procedure times ranging from gastroenterology (36% shorter) and ophthalmology (35% shorter) to cardiac surgery (2% longer) and thoracic surgery
(7% longer)."
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Outcomes, Again
A study in QMHCJournal (here) examines the question of whether root cause analyses (RCAs) have an impact on root causes.
"While root cause analysis (RCA) is used to analyze medical errors with a systems approach, evidence demonstrating its effectiveness in reducing patient harm remains sparse. The heterogeneity of the RCA methodology at different health care organizations has posed challenges to studying its value." The result of this review: "Of the studies included in this review, all reported improvements following interventions implemented after RCAs, but with variability in study definitions and methodology to assess effectiveness."
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
What Percentage of the Gross Domestic Product Should Represent National Health Care Expenditures?
Skinner, Cahan and Fuchs argue for a national budget, in The New England Journal of Medicine (here). Some compressed history, from their article: "The increase in U.S. national health care expenditures from 4% of the gross domestic product (GDP) in 1950 to nearly 18% of the GDP in 2019 is one of the most important economic changes that occurred in the United States during this period. Since the 1980s, policymakers and private health insurers have implemented interventions aimed at 'bending the cost curve,' including diagnosis-related group-based payments to hospitals, managed care, deductibles and copayments, and bundled-payment programs. But the long-term growth of health care expenditures as a share of the GDP has continued."
The overview: "The per-decade growth in health care’s share of the GDP was 1.8 percentage points between 1960 and 1979, then 2.3 percentage points between 1980 and 1999, as well as 2.3 percentage points between 2000 and 2019."
The impact: "Research has demonstrated that nearly all wage and salary increases between 1999 and 2009 for the median-income American worker were absorbed by increases in health care premiums, out of-pocket expenses, and taxes to fund Medicare and Medicaid, which has resulted in little left over for discretionary purchases or savings. There is also no evidence that life expectancy has improved more rapidly among Americans than among people in comparable countries, despite higher health care expenditures in the United States."
MA Plans, Overpaid or Under-Regulated?
A blog in Health Affairs (here) reviews research on the question of whether CMS is overpaying Medicare Advantage plans; what, if any, additional value those plans deliver, if they are overpaid; and why distinguished commentators on these questions have come to "diametrically opposite" conclusions, and published them. In general, the views of discussants reflect their current or past employment.
READING & REFERENCES
Select Coronavirus Public Health Resources and References may be found here.
2022 CQ Congressional Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
March 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