DCMedical News: Wednesday, January 15, 2020
DCMedical News-DCMN
Washington, D.C.
Wednesday, January 15, 2020
DCMedical News is published every day both the House and the Senate are in session.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Burnout a Matter of Values
A study of primary care practitioner burnout in JAMA Internal Medicine found (here) that “Participants described their workloads as excessively heavy, increasingly involving less ‘doctor’ work and more ‘office’ work, and reflecting unreasonable expectations. They felt demoralized by work conditions, undervalued by local institutions and the health care system, and conflicted in their daily work. Participants conveyed a sense of professional dissonance, or discomfort from working in a system that seems to hold values counter to their values as clinicians.”
Diversity in Medical Education
The Association of American Medical Colleges reports (here) that “persistent, structural racism and widespread implicit and explicit bias has created an exclusionary environment for many students and faculty. According to the 2018 AAMC Graduation Questionnaire, 42.1% of fourth-year medical students said that they personally experienced some form of mistreatment or harassment. This figure has changed little since 2014.”
AMA Reviews Advocacy Positions
The AMA has reviewed its advocacy challenges and goals for 2020 (here), in these areas: surprise medical bills; Medicare payment for physician services; regulatory relief, especially from prior authorization requirements (85% of physicians indicating that prior authorization interferes with continuity of care; the opioid epidemic; access to medical care; protecting immigrant health; drug pricing transparency; gun violence; promoting access to compounded pharmaceutical products; addressing health equity; and promoting public health.
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Two-Midnight Meets Short Stays, With Bad Results for Hospitals
A study in The Journal of Arthroplasty (here) describes changes in total joint arthroplasty procedures from 2012 to 2016. The study, of nearly 5 million operations, chronicled year-over-year volume increases from 853,154 in 2012 to 1,134,891 in 2016, a one-third increase. Mean length of stay decreased during this period from 3.1 days to 2.4 days, but the number of short stay inpatient hospitalizations that incurred the “one-midnight” stay rule increased from 3.9% to 21.2%. Alternative scenarios estimated hospital losses from $117 million to $1.7 billion, but no change to payments by patients.
Fastest Growing Health Expenses
Modern Healthcare graphs (here) results from the December report of the CMS Office of the Actuary. Want to grow 2x as fast as the GDP? Pick health insurance, “other professionals services” or government. Chernew and Heath report in NEJM Catalyst (here) on fee-for-service, episode-based payment and population-based payment, with a useful list of references.
ASCs Continue to Grow, and Grow
Becker’s lists 183 new ambulatory surgery centers announced or opened in 2019, by state, here.
REITs in the UK
The Globe reports (here) that “Medical Properties Trust has struck a deal to acquire the real estate of 30 acute care hospital facilities located throughout the United Kingdom for approximately $2 billion. The facilities are leased under long-term net leases to affiliates of BMI Healthcare, the largest private operator of acute hospitals in the UK. In a related transaction, affiliates of Circle Health will acquire BMI and assume operations of its 52 facilities in the UK. Circle, an operator of UK acute hospitals and MPT tenant, has committed to a multi-million pound program to invest in facility infrastructure, technology and people as part of the transaction.” MPT (of Birmingham, Alabama) has been instrumental in the growth of the Steward and Prime hospital chains in the U.S., purchasing hospital property, plant and equipment from the operating companies, with proceeds to the hospital operating companies (who lease back their land and buildings) for further expansion and acquisition.
DRUGS and DEVICES
FDA Reviews Have Changed Since 1983
A review in JAMA (here) notes that “Approvals of new generic drugs have increased over time, leading to greater competition. Technological advances have been reflected in increased approvals of biologics over time. The number of expedited development and approval programs has expanded greatly since 1983, reducing the amount of evidence available at the time of approval and increasing uncertainty about the existence or amount of clinical benefit. These regulatory innovations have not clearly led to an increase in new drug approvals or to reduced total development times.”
Rent or Buy?
The Wall Street Journal reports (here) that pharma companies are testing “new payment models” (but not lower prices) to sell their newest products.
READINGS AND REFERENCES
Eat Your Greens?
Well, only if you really like greens. “In this randomized clinical trial that included 478 patients, there was no significant difference in prostate cancer progression over 2 years among men who participated in a counseling program that encouraged consumption of leafy green, carotenoid, and cruciferous vegetables compared with controls.” From JAMA, here, by Dr. Parsons, and colleagues.
U.S. House of Representatives:
Members at https://www.house.gov/representatives
Committees and Members at https://www.house.gov/committees
U. S. Senate:
Committees and Members at https://www.senate.gov/committees
CQ 2020 Calendar of Regularly Scheduled Sessions, here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
January 16, 27, 28
February 4, 5, 6, 7, 10, 11, 12, 13, 25, 26, 27, 28
March 2, 3, 4, 5, 9, 10, 11, 12, 23, 24, 25, 26, 27, 30, 31
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.