DCMedical News: Monday, June 13, 2022
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
Monday, June 13, 2022
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Unnecessary Surgery Continued in Pandemic, Lown Institute Reports
An article in BMJ (here) notes that “US hospitals continued to perform eight overused and unnecessary surgical procedures for older patients during the first year of the pandemic, a study has shown. Cardiologist Vikas Saini, president of the Lown Institute in Needham, Massachusetts, which carried out the research . . . looked at eight low value procedures: stents for stable coronary disease, vertebroplasty for osteoporosis, hysterectomy for benign disease, spinal fusion for back pain, inferior vena cava filter, carotid endarterectomy, and knee arthroscopy.”
“From March to December [2020], when the pandemic was at its height and no vaccines were available, hospitals performed 106,474 low value procedures. Stents for stable coronary artery disease were the most common procedure, with 45,176 performed.”
“Among the general hospitals placing the most stents were NYU Langone Medical Center, St Francis Hospital, and Mount Sinai Hospital . . . Of the 20 hospitals on the US News and World Report ‘honor roll’—a popular rating by the magazine—all were rated above the national average” in unnecessary procedures.
Excess Mortality From Omicron Greater Than Excess Mortality from Delta in Massachusetts Study
A study published in JAMA (here) found that “More all-cause excess mortality occurred in Massachusetts during the first 8 weeks of the Omicron period than during the entire 23-week Delta period. Although numerically there were more excess deaths in older age groups, there was excess mortality in all adult age groups, as recorded in earlier waves, including in younger age groups. Moreover, the ratio of observed to expected all-cause deaths was similar in all age groups, and increased during the Omicron period compared with the Delta period. Others have reported that the Omicron variant may cause milder COVID-19. If true, increased all-cause excess mortality observed during the Omicron wave in Massachusetts may reflect a higher mortality product (i.e., a moderately lower infection fatality rate multiplied by far higher infection rate).”
Monkeypox in 9 States
Since the original report in May of a case in Massachusetts, “Confirmed cases have been reported by nine states. In addition, 28 countries and territories, none of which has endemic monkeypox, have reported laboratory-confirmed cases. On May 17, CDC, in coordination with state and local jurisdictions, initiated an emergency response to identify, monitor, and investigate additional monkeypox cases in the United States.” This according to the CDC’s Morbidity and Mortality Weekly Report, here, with clinical, demographic, testing and other public health information included in the MMWR. “The last United States monkeypox outbreak was secondary to imported small mammals from Ghana in 2003.”
HOSPITALS AND OTHER HEALTH CARE FACILITIES
New York Hospitals Remember the Pandemic Peak, Patient Safety Problems
A study (here) in the Journal on Quality and Patient Safety (from The Joint Commission) recalls the height of the COVID-19 pandemic in New York hospitals, especially those in the downstate area. “The challenges presented by COVID-19 in downstate New York during the initial surge were much more daunting than in other areas of the state. For example, in a one-month timeframe between March 1 and April 4, 2020, one large 12-hospital system in the New York metropolitan area admitted more than 5,700 patients with COVID-19. Some hospitals had over 1,000 patients with COVID-19 admitted during that timeframe. Thousands of patients required intubation and mechanical ventilation, extracorporeal membrane oxygenation support, proning, high flow oxygen, and various modalities of dialysis support (continuous veno-venous hemodialysis, continuous veno-venous hemofiltration, sustained low-efficiency daily diafiltration, intermittent hemodialysis, and rapid initiation peritoneal dialysis).”
The study, convened and sponsored by the Hospital Association of New York State (HANYS), makes recommendations in eight areas: staffing, competency, education and training, communication, trusted information, human factors, environment, and equipment, also depicted in a fishbone chart (here).
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Big Spenders for Health Care in the U.S.
A report from the Medical Expenditure Panel Survey (MEPS, here) on health expenditures in the U.S. indicates that in 2019 “The majority of this spending was concentrated in a small percentage of the population. About 14 percent of the U.S. population had no personal healthcare expenditures in 2019, while 5 percent accounted for nearly half of healthcare spending.”
“In 2019, the top 1 percent of persons ranked by their healthcare expenditures accounted for 20.7 percent of total healthcare expenditures, with an annual mean expenditure of $130,087. The group within the top 1 percent is defined as persons who spent $78,125 or more during the year . . . The top 5 percent of the population accounted for 48.8 percent of total expenditures (100 minus 51.2 percent), with an annual mean expenditure of $61,007. The bottom 50 percent accounted for only 3.0 percent of total healthcare expenditures. Every person in this group spent less than $1,313 during the year, with an average annual expenditure of $374.”
COVID Made Me Do It
MedPage Today reports (here) that “Large employer coalitions and consumer advocates are angrily pushing back against a Centers for Medicare & Medicaid Services (CMS) proposed rule [here] to suppress public reporting of key measures of preventable hospital-caused harms, such as pressure ulcers or falls resulting in hip fractures. If the rule is finalized, CMS would not calculate scores under the Hospital-Acquired Condition Reduction Program (HACRP) . . . Furthermore, CMS would not dock hospitals in the worst-performing quartile 1% of their Medicare reimbursement, as it usually does, and would end up paying these hospitals what would normally be withheld -- an estimated $350 million -- an amount that would be lost to the Medicare trust fund.”
MedPage reports that “The agency gave several reasons -- all related to COVID-19 -- why hospitals need to be let off the hook, including wide variation in performance scores; unprecedented changes in clinical guidelines, treatments, and drugs; and rapid changes in what clinicians understand about a pathogen of unknown origin. In particular, they noted huge shortages of healthcare personnel and high rates of burnout, specifically among nurses, which could affect a variety of measures, such as infection rates and avoidable falls.”
Medicare Advantage Growing, May Be Dominant Form of Medicare
Leaders of The Commonwealth Fund opine in JAMA (here) on the growing impact of privatized Medicare. “Enrollment in Medicare Advantage has increased rapidly, and in April 2022 accounted for an estimated 29 million individuals, representing 46% of all beneficiaries of Medicare. Accordingly, it is likely that Medicare Advantage will be the dominant source of Medicare coverage by 2025. This development creates significant challenges for the Medicare program and some important issues for the larger health care system.”
One example: “Any quality and utilization data that traditional Medicare has accumulated on individual clinicians and health care centers are not currently accessible for those same entities serving patients enrolled in Medicare Advantage plans.” Another example: “A Medicare Advantage–dominated system also raises questions about how Medicare would work through private plans to achieve the many other public purposes that Medicare has served. Traditional Medicare’s increased payments for clinicians and health care centers in rural areas have helped to maintain access to care for rural populations.”
The authors observe that “Health care system developments often take policy makers by surprise. This should not be the case with the shift in enrollment between Medicare Advantage and traditional Medicare.”
READINGS & 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
June 14, 15, 16, 21, 22, 23, 24
July 12, 13, 14, 15, 18, 19, 20, 21, 26, 27, 28, 29
August, Congress adjourned, no editions of DCMN
Notes to Fred Hyde, MD, JD, MBA, news@dcmedicalnews.org