DCMedical News: Thursday, October 13, 2022
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY Thursday, October 13, 2022
Maternity Care Deserts in the News
A new March of Dimes report (here) finds an increase in the number of counties in the U.S. lacking access to obstetrics care. “Nationwide, five percent of counties have less maternity access than just two years ago,” according to the Oct. 11 report, titled “Nowhere to Go: Maternity Care Deserts Across the U.S..” “These areas of combined low or no access affect up to 6.9 million women and almost 500,000 births in the U.S. In maternity care deserts alone.” Between 2018 and 2020 an additional 1,119 counties lost access to care. Of all U.S. counties, 36% are designated as maternity care deserts.
“In maternity care deserts there is a higher risk for poor maternal and infant health outcomes . . . In the U.S. an average of two women die every day from complications of pregnancy and childbirth and two babies die every hour.”
The report offers recommendations, as follows: (1) Medicaid expansion. States should expand Medicaid if they have not. (2) Eligibility thresholds. Raising income eligibility thresholds specifically for parents, which could improve access to postpartum care. (3) Postpartum coverage. Expanding Medicaid postpartum coverage to 12 months after a birth. (4) Midwife and doula coverage. The March of Dimes recommends expanding access to care from midwives and doulas, which it says could help reduce health outcomes disparities. Five states reimburse for doula services under Medicaid and seven are in the process of extending such coverage.
STAT reports on the March of Dimes report, here.
NBC news has provided coverage (here) of attempts to avoid maternity care deserts in Connecticut, with a focus on Sharon Hospital and its owner, Nuvance Health.
Commonwealth Fund Studies
From April of this year, the Commonwealth Fund examined the more general problem of “Health and Health Care for Women of Reproductive Age. How the United States Compares with Other High-Income Countries,” issue paper here, charts here.
The Fund’s researchers found “It is less common for women of reproductive age in the U.S., Sweden, Canada, and Australia to have a regular doctor or place of care”; “Women of reproductive age in the U.S. are the most likely to skip or delay needed care because of costs,” (49% in the U.S., highest of the 13 high income countries, versus, for example, 12% in the Netherlands); “U.S. women have the highest rate of avoidable deaths,” (198 deaths per 100,000 women, versus, for example, 99 in France); and “The maternal mortality rate is highest in the U.S.,” (55.3 per 100,000 live births among Black American women, 19.1 among White American women; 3.2 in Germany; and 0.0 in Norway).
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Inexplicable
Research published in JAMA Surgery (here) reports that “Black Medicare patients had lower odds of receiving a surgical consultation after being admitted from the emergency department with an emergency general surgery condition when compared with similar White Medicare patients. These disparities in consultation rates cannot be fully attributed to medical comorbidities, insurance status, socioeconomic factors, or individual hospital-level effects.”
Bias in Algorithms
California’s Attorney General has begun an investigation of racial bias in “artificial intelligence” algorithms. A report from attorneys with Covington and Burling in an AHLA newsletter (here) says “California Attorney General Rob Bonta recently sent letters to 30 hospital CEOs across the state requesting information about how healthcare facilities and other providers are identifying and addressing racial and ethnic disparities in software they use to help make decisions about patient care or hospital administration . . . the AG’s letter seeks information such as a list of all decision-making tools or algorithms the hospitals use for clinical decision support, health management, operational optimization, or payment management; the purposes for which these tools are currently used and how they inform decisions; and the names of the persons responsible for ensuring they do not have a disparate impact based on race.”
REFERENCES
McKinsey publishes a four-article series on the future of health care (here).
The first article is on the “uncertain future” of American health care (here), in which the authors report “The combination of accelerating affordability challenges, access issues exacerbated by clinical staff shortages and COVID-19, and limited population-wide progress on outcomes is ominous.”
The second article (here) discusses the “transformative impact” of inflation on health care, noting “The impact of inflation on the broader economy has driven up input costs in healthcare significantly. Moreover, the likelihood of continued labor shortages in healthcare—even as demand for services continues to rise—means that higher inflation could persist. Our latest analysis estimates that the annual US national health expenditure is likely to be $370 billion higher by 2027 due to the impact of inflation compared with prepandemic projections.”
The third article (here), on affordability challenges posed by endemic COVID-19, contends that “It is well understood that COVID-19 is here to stay as an endemic disease due to the combination of rapidly waning immunity after infection or vaccination and the mutating nature of the SARS-CoV-2 virus. As societies move past the public-health measures of the acute pandemic phase, the prevalence of disease has the potential to remain high—potentially more than 100 million annual cases in the United States. Given the lack of cross-immunity with other diseases, this caseload represents a step-change increase in morbidity with which our health system must grapple.
The final article (here) promises “This gathering storm has the potential to reorder the healthcare industry and put nearly half of the profit pools at risk. Those who thrive will tap into the $1 trillion of known improvement opportunities by redesigning their organizations for speed, accelerating productivity improvements, reshaping their portfolio, innovating new business models to refashion care, and reallocating constrained resources.”
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
October 14, 17, 18, 19, 20, 21
November 14, 15, 16, 17, 18, 29, 30
December 1, 2, 5, 6, 7, 8, 12, 13, 14, 15
Notes to Fred Hyde, MD, JD, MBA, news@dcmedicalnews.org