DCMedical News: Tuesday, March 15, 2022
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY Tuesday, March 15, 2022
Excess Mortality and the Pandemic
A study in Lancet (here; coverage in The Financial Times, here) measured excess mortality during the COVID-19 pandemic to be three times that previously estimated. The study: "All-cause mortality reports were collected for 74 countries and territories and 266 subnational locations (including 31 locations in low-income and middle-income countries) that had reported either weekly or monthly deaths from all causes during the pandemic in 2020 and 2021, and for up to 11 years previously."
The results: "Although reported COVID-19 deaths between Jan 1, 2020, and Dec 31, 2021, totaled 5·94 million worldwide, we estimate that 18·2 million people died worldwide because of the COVID-19 pandemic (as measured by excess mortality) over that period . . . The number of excess deaths due to COVID-19 was largest in the regions of south Asia, north Africa and the Middle East, and eastern Europe. At the country level, the highest numbers of cumulative excess deaths due to COVID-19 were estimated in India (4·07 million), the USA (1·13 million), Russia (1·07 million), Mexico (798 000]), Brazil (792 000), Indonesia (736 000), and Pakistan (664 000). Among these countries, the excess mortality rate was highest in Russia (374·6 deaths per 100 000) and Mexico (325·1 per 100 000) and was similar in Brazil (186·9 per 100 000) and the USA (179·3 per 100 000)." (Confidence intervals omitted.)
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Public Worries About the Health Field
A CVS Health-Harris poll (reported here) found that "Healthcare's workforce shortages have 80 percent of Americans concerned . . . The strong majority of respondents (78 percent) are also concerned about shortages of hospital beds. Just over half (51 percent) of respondents have experienced one or more healthcare shortages, most of which are centered around their primary care physician: 45 percent reported trouble scheduling appointments; 36 percent reported their physician's office operating on reduced hours; 25 percent have experienced delays in treatments or surgeries; 21 percent reported their physicians stopped practicing; 13 percent reported their healthcare facilities closed completely."
Other Worries
Hospitals reportedly are worried (here) that CMS will base the allocation of new Medicare-paid residency slots too much on Health Professions Shortage Areas, with not enough consideration for other rural areas, or for new medical schools, or teaching of residents which may take place outside of the HPSA.
They Did the Surgery, Then the EMR
A study in Health Policy and Technology (here) focused on this problem: "Usability issues common to EMRs have been noted. Given the time demands of a clinic and surgery schedule, as well as the association between EMR usage and burnout, continued investigation into the utility of EMRs is important. We investigated . . . time expended on EMRs by surgeons and advanced practice providers (APPs) across several surgical specialties."
The results: Surgeons spent less time than APPs, but both spent about two hours per workday on the EMR (1.76, 2.10 hours), with orthopedic surgeons the most enmeshed (2.33 hours), neurosurgeons the least (1.42).
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Feds Again Eye Hospital (and Other Health Field) Merger Guidelines
The Federal Trade Commission and the Department of Justice received more than double the number of merger filings in 2021 they received in any of the previous five years (here). The agencies have embarked (once again) on a quest to review the guidelines they use in evaluating measures, to see, for example, whether they have taken into account such factors as the role of monopolies in the health field in suppressing the growth of nurses' wages; the "distance" mergers put between executive decision makers and clinical decision makers, with resulting dysfunction; and the degradation of quality—contrary to advertising claims—which takes place when larger systems engulf independent hospitals. The President's Executive Order on competition (here) guides the process.
Just in time to contribute, Zack Cooper and colleagues ask this question: "Do Higher-Priced Hospitals Deliver Higher-Quality Care?" (here). The answer (spoiler alert): "Being admitted to a hospital with two standard deviations higher prices raises spending by 52% and lowers mortality by 1 percentage point (35%). However, the relationship between higher prices and lower mortality is only present at hospitals in less concentrated markets. Receiving care from an expensive hospital in a concentrated market increases spending but has no detectable effect on mortality."
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Divergence in Mortality Rates Reflects State Priorities: Laboratories, With Deadly Experiments
A study in JAMA (here) highlights the impact of differing state policies concerning health services and public health. The background: "For decades, the population of the US has experienced shorter life expectancy and higher disease rates than populations in other high-income countries. The gap in life expectancy between the US and 16 peer countries increased from 1.9 years in 2010 to 3.1 years in 2018 and 4.7 years in 2020." The differences between states: "The US health disadvantage is even worse in certain states, with states such as Alabama and Mississippi having the same life expectancy as Latvia (75 years)."
The differences are growing: "Disparities in health across the 50 states are growing, a trend that began in the 1990s. For example, in 1990, life expectancy in New York was lower than in Oklahoma, but the trajectories separated sharply in the 1990s and, by 2016, New York ranked third in life expectancy, whereas Oklahoma ranked 45th. By 2019, mortality rates at ages 25 to 64 years [showed] the highest mortality rate (565.1 per 100 000) and the lowest rate (261.9 per 100 000)."
Policy matters: "Health outcomes changed as states took different approaches to Medicaid, workplace and product safety, the environment, tobacco control, food labeling, gun ownership, and needle exchange programs. These policies had predictable consequences. For example, states that raised cigarette taxes experienced fewer tobacco-related illnesses. Injury deaths increased in states that relaxed speed limits and motorcycle helmet laws."
Pandemic policy: "The COVID-19 pandemic removed any doubt that state policies can affect health outcomes. East Coast states (e.g., New York, New Jersey) that responded to the first wave of the pandemic in the spring of 2020 with strict protective measures achieved relatively quick control of community spread within as much as 8 weeks, and they blunted subsequent surges by reinstating those policies. In contrast, states that had spent decades opposing public health provisions were among the most resistant to COVID-19 guidelines and took active measures to resist restrictions . . . excess death rates in Florida and Georgia (more than 200 deaths per 100 000) were much higher than in states with largely vaccinated populations such as New York (112 per 100 000), New Jersey (73 deaths per 100 000), and Massachusetts (50 per 100 000)."
Only the Papa Pals
The Washington Post focuses on a "companionship" service of some Medicare Advantage plans (here) meant to address loneliness in seniors, which also helps the MA plans financially. "Known as 'Papa pals,' their primary aim is to provide companionship to seniors along with helping with errands and light housework duties. Since 2020, more than 65 Medicare Advantage plans nationwide have signed up with Papa, a Miami-based company, to address members’ loneliness — a problem exacerbated by the pandemic . . . SummaCare and other health plans also stand to benefit by sending Papa pals into members’ homes. The workers can help the plans collect more money from Medicare by persuading members to get annual wellness exams, fill out personal health risk assessments and undergo covered health screenings."
READINGS & REFERENCES
Select Coronavirus Public Health Resources and References may be found here.
2022 CQ Congressional Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
March 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