DCMedical News: Wednesday, March 4, 2020
DCMedical News-DCMN
Washington, D.C.
Wednesday, March 4, 2020
DCMedical News is published every day both the House and the Senate are in session.
THE BIG STORY IN HEALTH CARE
Supreme Court Hears Arguments This Morning on Significant Abortion Case
The Wall Street Journal (here) reports that “The Supreme Court hears its first major abortion case Wednesday since two Trump nominees joined the bench . . . Most prominently, the case involves the Supreme Court’s approach to precedent, since it largely is a replay of an issue the court decided in 2016, when by a 5-3 vote it struck down a Texas law requiring that abortion providers obtain admitting privileges at a nearby hospital.”
Here, “the Louisiana Unsafe Abortion Protection Act, isn’t based on a state policy to protect potential life, an interest that the Supreme Court has recognized as valid justification for some abortion restrictions. Instead, it is based on the argument that abortion itself can be harmful to women, and that restricting access to the procedure therefore is beneficial to women. For that reason, the state’s brief contends that abortion providers shouldn’t be permitted to challenge the law on behalf of their patients, arguing that ‘a serious conflict of interest’ exists between them and Louisiana’s women.”
Coronavirus News
Tracking by Johns Hopkins shows on 3-4 at 8:00 a.m. EST worldwide 94,250 confirmed cases, 3,214 deaths, 51,026 patients recovered.
Public Health Resource Pages: AMA resource page for physicians here. CDC information page here. NIH information page here. National Library of Medicine Coronavirus page here, New England Journal of Medicine update page here.
CDC Report:
The Centers for Disease Control and Prevention reports (here) in the Morbidity and Mortality Weekly Report on “Active Monitoring of Persons Exposed to Patients with Confirmed COVID-19—United States, January-February 2020.” CDC writes, “In the United States, two instances of person-to-person transmission of SARS-CoV-2 have been documented from persons with travel-related COVID-19 to their household contacts. Since February 28, an increasing number of newly diagnosed confirmed and presumptive COVID-19 cases have been in patients with neither a relevant travel history nor clear epidemiologic links to other confirmed COVID-19 patients. However, despite intensive follow-up, no sustained person-to-person transmission of symptomatic SARS-CoV-2 was observed in the United States among the close contacts of the first 10 persons with diagnosed travel-related COVID-19.”
News Media: USA Today has an opinion (here) on national preparedness to cope with coronavirus outbreaks, namely “As state and local public health offices scramble to respond to the coronavirus outbreak, they do so against a backdrop of years-long budget cuts, leaving them without the trained employees or updated equipment to adequately address the virus' growing threat, former public health officials say.” CDC testing was flawed and controversial, according to an update (here) in the New York Times. The Washington Post worries (here) that “The race to curb the spread of the new coronavirus could be thwarted by Americans fearful of big medical bills if they get tested, low-income workers who lose pay if they take time off when sick, and similar dilemmas that leave the United States more vulnerable to the epidemic than countries with universal health coverage and sturdier safety nets.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
No Progress in Making Physician Services More Accessible, 1998-2017
Himmelstein, Woolhandler and colleagues study trends in the unmet need for access to physician services. In JAMA Internal Medicine (here) they examine the “proportion of persons unable to see a physician when needed owing to cost (in the past year), having no routine checkup for those in whom a routine checkup was likely indicated (within 2 years), or failing to receive clinically indicated preventive services (in the recommended timeframe).” Results? “Despite coverage gains since 1998, most measures of unmet need for physician services have shown no improvement, and financial access to physician services has decreased.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Measurement of Hospital Mortality: Do the Dark Arts of Reimbursement Coding Skew Mortality Measures?
A study in JAMA Internal Medicine (here) reports that “Prior studies have reported declines in mortality for patients admitted to Veterans Health Administration (VA) and non-VA hospitals using claims-based risk adjustment. These apparent mortality reductions may be influenced by changes in coding practices.”
Specifically, “In this observational time-trend study that included 146,924 hospitalizations for HF [Heart Failure] and 131,325 for pneumonia from 2009 to 2015, the estimated decline in 30-day mortality rates per quarter was substantially smaller when using clinical variables for risk adjustment (HF, −0.017%; pneumonia, −0.026%) than when using claims-based variables (HF, −0.051%; pneumonia, −0.084%).”
The meaning: “Compared with clinical risk adjustment, claims-based adjustment is likely to overestimate temporal declines in mortality for veterans hospitalized with HF and pneumonia.” Dr. Mark Chassin of The Joint Commission offers opinion (here) about this and similar studies concerning measurement of hospital mortality, noting “the increasing number of comorbid conditions coded by hospitals over time. Adding additional risk factors to claims-data–only risk-adjustment models may lead those models to estimate increasing risk of death when that may or may not be true. Silva et al showed that the claims data models showed increasing risk of death over time, but the severity models showed the opposite.”
The importance of these measurements, according to Dr. Chassin: “It is vital to look beyond the statistical robustness of a risk-adjustment model, particularly for outcome measures that are used for public comparisons of hospital performance. Such programs (eg, public reporting, pay for performance) are designed to provide information to consumers and to hold hospitals accountable to improve specific health outcomes.”
Probably related: this study from JAMA Cardiology, finding that “Hospitals that received awards for high-quality cardiovascular care from the AHA/ACC [American Heart Association, American College of Cardiology] were more likely to be penalized and less likely to be financially rewarded by federal value-based programs. These findings highlight the potential need to standardize measurement of cardiovascular care quality.”
READINGS AND REFERENCES
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
March 5, 9, 10, 11, 12, 23, 24, 25, 26, 27, 30, 31
April 1, 2, 3, 20, 21, 22, 27, 28, 29, 30
May 12, 13, 14, 15, 18, 19, 20, 21
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.