DCMedical News: Friday, July 15, 2022
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY Friday, July 15, 2022
A “Stay-Tuned” Moment
COVID-19 patients are reappearing, admitted for COVID, not just incidental findings in patients with unrelated diagnoses. The chief executive of SUNY Downstate Medical Center in Brooklyn told Crain’s Health Pulse (here) that “Staff has seen an uptick in Covid patients within the last two weeks. Most of the patients included in the count are patients being seen for Covid symptoms, unlike previous phases of the pandemic where patients there for other health concerns wound up testing positive.”
Across the globe, according to the World Health Organization’s Director-General Tedros Adhanom Ghebreyesus, PhD (here), "The virus is running freely and countries are not effectively managing the disease burden based on their capacity." WHO reported that over the last two weeks, global cases have increased 30 percent, driven by the highly transmissible BA.5 strain and other omicron relatives, also pointing to widespread lifting of social public health measures like masking as a reason for new surges.
The New York Times COVID-tracker (here) reports that “Following a long period in which new reports of cases were relatively consistent, the number of cases announced in the U.S. each day is again on the rise. The daily case average grew to more than 129,000 on Tuesday, and cases are rising in more than 40 states. Since cases have always been an undercount, it is likely that the true number of cases is far higher — particularly since test positivity rates are also increasing sharply nationwide. These increases come as the BA.5 variant, believed to be the most transmissible variant yet of the coronavirus, is emerging as the country's dominant virus strain. Hospitalizations are also rising in the U.S. That pattern is similar to hospitalization surges seen earlier this summer in countries where BA.5 first began to circulate. More than 37,000 people are in American hospitals with the coronavirus on an average day, an increase of 17 percent since the start of the month. Reporting on deaths tied to the coronavirus is volatile at the moment, partly because of gaps in reporting over recent holidays. About 400 deaths are being reported each day nationwide, down from more than 2,600 a day at the height of the Omicron surge.”
Michael Osterholm, PhD, director of the Center for Infectious Disease, Research and Policy at the University of Minnesota in Minneapolis, commented to Becker’s (here) that the current situation is a "stay-tuned moment."
COVID In Hospitals
The Hospital Cost and Utilization Project (H-CUP) has published summaries of hospitalizations and in-hospital deaths in U.S. hospitals during the COVID-19 pandemic. In rural areas (here), “Across 29 States, the average number of hospitalizations for patients from rural areas decreased 19 percent in April–June while the average number of in-hospital deaths increased 71 percent to about 1,200 in October–December 2020 compared with the same months in previous years.” In urban area hospitals (here), HCUP found “Across 29 States, the average number of hospitalizations for patients from urban areas decreased 20 percent to about 138,000 while the average number of in-hospital deaths increased 47 percent to about 4,700 in April–June 2020 compared with the same months in previous years.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
The Solution Shop and the Production Line
Two Chicago-land observers of the American medical scene, writing in The New England Journal of Medicine (here), bemoan that “As physicians, we know that we often spend our days doing the wrong work for our patients. The current care delivery model requires physicians to do both ‘solution shop’ work (solving unstructured problems and building trusting relationships with patients) and ‘production line’ work (process oriented activities such as completing preventive screenings, renewing prescriptions, and entering orders). In the past several decades, well intended technologies and policies have inadvertently crowded out the solution-shop work that is most valuable to both patients and physicians.
Any clinician who has faced the daunting task of getting through all the checkboxes in the electronic health record (EHR) . . . knows that they can consume nearly an entire physician visit . . . The mention of a symptom that shifts our attention elsewhere — I had a worrisome dizzy spell the other day — feels like a derailment and a burden, when in reality addressing that symptom may be the most important use of the physician’s time and cognitive energy. In the current practice model, physicians spend their days racing through the steps of the production line and rarely have the time to look up and engage with the patient in front of them. When physicians spend most of their time on tasks for which their medical education is not required, capacity, access, continuity, cost, and quality are all unnecessarily compromised. We believe a frameshift is needed in conceptualizing what is valuable work in health care, who should do it, and how.” The authors proceed to provide a frameshift recipe and direction.
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
The Hospital That Isn’t a Hospital
. . . . may be found after January 2023 in some rural areas. Touted as a solution to rural health deficits by the Biden-Harris administration (here), and sponsored by Senator Grassley, Iowa’s staunch ally of rural projects, the Rural Emergency Hospital made its debut in the Federal Register, with “Conditions of Participation” (here) for a newly invented category of hospital. See also a report in InsideHealthPolicy (here), and a CMS news release (here). But with no inpatient services, and therefore with limited or no access to specialists, and with CMS providing no specific targets for reimbursement or other funding, the REH concept has fallen flat with the industry (here).
More Than One In Ten VA Patients Receive “Low Value” Treatment
A study in JAMA Internal Medicine (here) reviewed five million services to VA patients, finding that “19.6 low-value services per 100 veterans were delivered in VA facilities or by VACC [VA Community Care] programs, involving 13.6% of veterans at a total cost of $205.8 million. Overall, the most frequently delivered low-value service was prostate-specific antigen testing for men aged 75 years or older (5.9 per 100 veterans); this was also the service with the greatest proportion delivered by VA facilities (98.9%). The costliest low-value services were spinal injections for low back pain ($43.9 million; 21.4% of low-value care spending) and percutaneous coronary intervention for stable coronary disease ($36.8 million; 17.9% of spending).”
MEDICARE, MEDICAID and COMMERCIAL HEALTH INSURANCE
The Federal Cost of Subsidies to Health Insurance For Persons Under Age 65
The Congressional Budget Office (here) has projected the cost of “Federal Subsidies for Health Insurance Coverage for People Under 65: 2022 to 2032.” In sum, “net federal subsidies . . . in 2022 for insured people under age 65 are $997 billion, or 4.0 percent of gross domestic product (GDP). In 2032, that annual amount is projected to reach $1.6 trillion, or 4.3 percent of GDP. Over the 2022–2032 period, subsidies are projected to total $13.4 trillion. Medicaid and the Children’s Health Insurance Program (CHIP) account for about 42 percent of the federal subsidies annually during the period; subsidies for employment-based coverage, about 37 percent; payments for Medicare enrollees under age 65, about 14 percent; and subsidies for coverage obtained through the [ACA] marketplaces . . . about 7 percent.
On projections for health insurance coverage, CBO writes “In an average month each year during that period, between 240 million and 246 million people are projected to have health insurance, mostly from employment-based plans. Between 25 million and 29 million people are projected to be uninsured.”
READINGS & REFERENCES
The Senate Finance Committee publishes (here) the results of an investigation which reveals that pharma giant AbbVie generates most of its sales in the U.S., while reporting virtually no income in the U.S. for tax purposes. “In 2020, over 75% of AbbVie’s sales were made to American consumers yet only 1% of AbbVie’s income was reported in the United States for tax purposes.
Select Coronavirus Public Health Resources and References may be found here.
Monkeypox resources, CDC (here), JAMA Patient Page (here).
2022 CQ Congressional Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
July 18, 19, 20, 21, 26, 27, 28, 29
August, Congress adjourned, no editions of DCMN
September 13, 14, 15, 16, 19, 20, 21, 22, 28, 29, 30
Notes to Fred Hyde, MD, JD, MBA, news@dcmedicalnews.org