DCMedical News: Monday, February 10, 2020
DCMedical News-DCMN
Washington, D.C.
Monday, February 10, 2020
DCMedical News is published every day both the House and the Senate are in session.
THE BIG STORY IN HEALTH CARE
Novel Coronavirus
Tracking at https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6 by Johns Hopkins. At 8:00. p.m. EST Sunday night 40,235 confirmed cases, 3,267 recovered, 907 deaths.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Immigration Limits May Impede Progress in Health Care Says AAMC
The Association of American Medical College publishes a list (here) of its position statements and studies on immigration limits through U.S. executive action. “The executive actions regarding immigration have created widespread concern about how the changes in processes will affect the ability of medical schools and teaching hospitals to deliver patient care, provide health education, and support medical research.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Medicare Advantage Enrollees More Likely to be Admitted to Hospitals with Average Quality Scores
Researchers from Brown reported in JAMA Open Network (here) in a “study of 12,190,280 hospitalizations in the United States in 2016, Medicare Advantage enrollees had a 2.8–percentage point lower probability of entering a highly rated hospital, a 5.5–percentage point higher probability of entering a hospital with an average ranking, and a 2.6–percentage point lower probability of entering a poor quality hospital compared with traditional Medicare enrollees.” In sum, “Medicare Advantage enrollees are less likely to enter the highest- or the lowest-quality hospitals.”
Commonwealth on Comparative Health Care Services
The Commonwealth Fund (slides here) reported on hospital and doctor services. In 2017, there were 4 physician visits per capita in the U.S. (compared to 6.8 OECD average). There were 2.6 practicing physicians per 1,000 population in 2017 (compared to 3.5 OECD average). Average acute care hospital stays were 5.5 days (compared to a 6.4 day OECD average, 7.4 days in Canada, 7.5 in Germany). In “mortality amenable to health care” measured in deaths per 100,000 population, the U.S. led in 2000 (with 149) and also led in 2016 (with 112).
Rural Health and Rural Hospitals
The Pew Foundation (here) reports on the faltering health care safety net in rural communities, noting that “Since 2005, at least 163 rural hospitals have closed, more than 60% of them since 2012. Nineteen rural hospitals closed in 2019, the most in a year.” A big challenge: “By most measures, the health of those living in rural areas is significantly worse than elsewhere. Mortality rates for the five leading causes of death--heart disease, cancer, unintentional injury, low respiratory disease and stroke — are all higher in rural areas, as is the overall mortality rate. And the gap is growing.” George Pink, PhD, a leader of the rural health research program, told Pew (here) "Not a day doesn't go by that I don't thank God I'm an academic and not the CEO of a rural hospital." The report also describes some innovative approaches at the state level to address the multiple problems.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Health Care Spending Report
The CMS Office of the Actuary reports in Health Affairs (here) on 2018 health spending in the U.S. Highlights: overall spending increased by 4.6% (compared to 4.2% in 2017 and 4.6% in 2016) to reach $3.6 trillion, “driven by faster growth in both private health insurance and Medicare, which were influenced by the reinstatement of the health insurance tax.” The number of uninsured increased by one million for the second year in a row, to reach 30.7 million in 2018. How about the “wasteful” component? Jha and colleagues ask in JAMA Cardiology (here) whether the U.S. is “simply spinning its wheels.”
DRUGS AND DEVICES
Rx-It: British Report on American Drug Trials
“Fewer than half of clinical trial sponsors reported their results to a U.S. government registry within a year of the trial’s completion, flouting U.S. law and risking fines, British researchers reported on Friday,” says Reuters (here). The article, in The Lancet (here), notes that “Failure to report the results of a clinical trial can distort the evidence base for clinical practice, breaches researchers’ ethical obligations to participants, and represents an important source of research waste. The Food and Drug Administration Amendments Act (FDAAA) of 2007 now requires sponsors of applicable trials to report their results directly onto ClinicalTrials.gov within 1 year of completion. The first trials covered by the Final Rule of this act became due to report results in January, 2018. In this cohort study, we set out to assess compliance.” The result: “Compliance with the FDAAA 2007 is poor, and not improving,” although compliance was better with industry than non-industry studies, and better with sponsors having a larger number of trials.
STAT+ Reports on Medical Societies as Data Sources for Pharma
Noting the increased emphasis (especially by the FDA) on “real world evidence,” STAT+ (here) notes that “Two years ago, Roche spent $1.9 billion to buy a startup, Flatiron Health, which uses data from patients’ electronic health records to better study cancer drugs. Now, many of the same investors are backing a new firm that will aim to do similar research in eye disease and neurology. The twist: The new company, Verana Health, is obtaining its data by partnering with medical societies, including the American Academy of Ophthalmology, the largest organization of ophthalmologists, and the American Academy of Neurology.”
READINGS AND REFERENCES
Research Methods Homework
JAMA Surgery publishes a series of short essays with examples and references on research methods. Today, patient-reported outcomes, here. “Patient-reported outcome measures (PROMs) are tools that translate patient-reported information into objective data, generally in the form of questionnaires.”
McKinsey Reports on the “Next Normal” in Healthcare
A report on health care in 2030, here.
Sprinting to New Stark Rules
A series of articles in publications of the American Health Lawyers Association describes the proposed changes in the “sprint to reform” Stark, Anti-Kickback and Fraud and Abused rules, here.
How Transparent in the Transparency Rule?
Crowe reports (here) on problems in reporting and accounting.
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
February 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.