DCMedical News: Tuesday, April 26, 2022
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY Tuesday, April 26, 2022
Congress Returns
The House and Senate are back, to an uncertain agenda, lacking major initiatives. The appropriations process begins this week, for the fiscal year which begins this October 1 (FY2023).
The Administration is undertaking actions on "long COVID" and the mental health consequences of the pandemic (Presidential actions listed here).
A commentary on the President's actions in JAMA Health Forum (here) notes that "It is not yet clear how many people are affected by long COVID. According to a March 2022 federal government report [a GAO infographic, here], findings from US studies suggest that 10% to 30% of people with COVID-19 will develop symptoms that last longer than 4 weeks, with some resulting in significant disability. Based on these estimates, 7.7 million to 23 million people in the US may have developed long COVID as of February 2022." Long-COVID as a disability is discussed in another JAMA Health Forum article, here.
In the UK, health groups have accused the government of abandoning all interest in COVID; The Financial Times reports (here) that "Health leaders [are] . . . accusing Number 10 of having 'abandoned any interest' in managing the disease. The strongly worded intervention from the NHS Confederation, which represents organisations across the healthcare sector, comes as clinicians struggle to clear waiting lists that stand at more than 6mn, against a backdrop of record numbers of coronavirus infections."
President Biden also focused (Earth Day) on a new effort to control the carbon footprint of the health care industry. InsideHealthPolicy reports that "HHS and the White House call on U.S. health care stakeholders, including pharmaceutical companies, health systems and hospitals, to commit to reducing greenhouse gas emissions . . . Stakeholder commitments will be highlighted at a White House event in June . . . The Biden administration asks stakeholders to voluntarily commit to: reducing their organization’s emissions by 50% by 2030 and net-zero by 2050; completing an inventory of supply chain emissions; and developing climate resilience plans for their facilities and communities. It also asks them to designate an executive lead for their work . . . Pledge forms are due by June 3."
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Cancer Screening: Disease Prevention or Revenue Generation?
Brigham's H. Gilbert Welch writes in JAMA Surgery (here) that "[Cancer] screening itself provides misleading feedback that always suggests it is more beneficial than it really is . . . Over time, 5-year survival rises owing to the combined association of lead time and overdiagnosis bias, even if the age of death is unchanged. Survivor stories are particularly pernicious: the more overdiagnosis from screening, the more people there are who believe that they owe their life to the test—and the more popular screening becomes. Screening campaigns routinely make use of this misleading feedback; they point to higher survival rates and cancer survivors as evidence supporting screening."
Welch cites the work of pioneering cancer surgeon George Crile ("medical care should be driven by patient needs, not surgeon needs, or now, system needs"). Cancer screening says Welch "has also become an important revenue stream for volume-driven medical care systems . . . US expenditures related to screening are substantial: my back-of-the-envelope estimate is $40 to $80 billion per year. These expenditures represent revenues for the system—revenues not only from screening itself but also from the diagnostic and therapeutic services it triggers. The importance of this revenue stream was highlighted after the substantial decline in screening that occurred after the onset of the COVID-19 pandemic. Although other services and businesses remained closed, screening was rapidly restored within a few months."
Welch's conclusion: "Although cancer screening may make sense in selected high-risk individuals, I believe general population screening, as currently practiced in the US, has become a huge distraction to our core work. It distracts the system away from acutely ill and injured patients: as physician performance is measured in terms of how frequently they test the well and not how well they care for the sick."
HOSPITALS AND OTHER HEALTH CARE FACILITIES
Labor Trouble
Stanford nurses (5000) strike, Stanford stops health benefits (here). Sutter nurses (8000) hold a one day (staffing issues) strike. Cedars-Sinai SEIU workers (2000) vote to strike.
Hospital Expense Per Patient Day, Ownership Changes
Becker's publishes (here) what it and the Kaiser Family Foundation believe to be the average cost per patient day for public, private non-profit and for-profit hospitals, by state, "based on information from the 2020 American Hospital Association Annual Survey," and "adjusted higher to reflect an estimate of the volume of outpatient services."
CMS releases (here) "data publicly -- for the first time -- on mergers, acquisitions, consolidations, and changes of ownership from 2016-2022 for hospitals and nursing homes enrolled in Medicare," including in this publication links to the data.
Maryland Global Budgeting and Cancer Care
JAMA Surgery examines the impact of the Maryland hospital global budgeting experiment on quality and utilization measures in cancer care (here). "In 2014, Maryland initiated the global budget revenue (GBR) model, placing caps on total hospital expenditures across all care sites. The GBR program aims to reduce unnecessary utilization while maintaining or improving care quality. To date, there has been limited examination of program effects on cancer care." The study found that "Global budget revenue was not associated with changes in expenditures, ED utilization, or clinical outcomes after cancer-directed surgery through 4 years. There was a modest decline in 30-day readmissions."
Merrill Goozner Takes Aim at Academic Health Centers ("Is A Misguided Hospital Building Boom Coming?")
Alarmed by the prospect of a new wave of massive AHC building, the legendary former editor of Modern Healthcare aims both barrels, higher cost and variable evidence on quality, here.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
CRGs
3M reports in a blog (here) that "Medicare beneficiaries in low socioeconomic status (SES) areas have fewer physician and care management visits and are less likely to be admitted from the emergency department for low severity medical care or admitted to a skilled nursing or rehabilitation facility following hospital discharge, as compared to Medicare beneficiaries in high SES areas, according to a recent research study [here]."
Beneficiaries in low SES areas have more per capita inpatient complications, admissions and emergency department visits, and readmission and post-discharge returns to the emergency department, as well as higher surgical mortality rates.
The senior author, Rich Averill, a pioneer in the development of DRGs, now touts the CRG, 3M™ Clinical Risk Groups (CRGs), which "identifies medically complex individuals and assigns them to a severity-adjusted group" providing "the basis for comparing the outcomes for patients with the same severity of illness and overall health status."
READING & REFERENCES
Select Coronavirus Public Health Resources and References may be found here. The JAMA Patient Page explains the current status of oral anti-viral medications for COVID-19, here.
2022 CQ Congressional Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
April 27, 28, 29
May 10, 11, 12, 13, 16, 17, 18, 19
June 7, 8, 9, 10, 13, 14, 15, 16, 21, 22, 23, 24
Notes to Fred Hyde, MD, JD, MBA, news@dcmedicalnews.org