DCMedical News: Tuesday, May 19, 2020
DCMedical News-DCMN
Washington, D.C.
Tuesday, May 19, 2020
DCMedical News is published every day both the House and the Senate are in session and on pre-pandemic Regularly Scheduled Session days (see CQ calendar, below).
THE BIG STORY IN HEALTH CARE
Coronavirus News: (reference pages below under Reading & References)
Tracking by Johns Hopkins shows on 5-19 at 8:00 p.m. EST worldwide 4,889,287 confirmed cases; 322,821 deaths worldwide; 91,730 U.S. deaths (28%).
Science and COVID Society
NEJM Journal Watch Review (here): Pandemic in the summer (it may not go away), the critically ill in NYC hospitals (40% died), hospital admissions for myocardial infarction (down 48% in study period), reflections on Elmhurst.
Telemedicine Expansion May Have Other Positive Outcomes: Researchers told the Society for Cardiovascular Angiography & Interventions (Medscape Cardiology report here) that “A novel telemedicine approach to remotely guide ST-segment elevation myocardial infarction [MI] treatment in four Latin American countries screened more than 780,000 patients and resulted in a mortality rate of 5.2%, results from a 1-year, prospective, observational study showed . . . We have created a modality where the care of acute MI can be remotely guided."
Physical Distancing: A study in the Seattle area reported in NEJM Journal Watch (here) notes “The increase in SARS-CoV-2 positivity rates followed by the steady decline aligned with physical distancing measures taken in the region, where a “stay home, stay healthy” order was issued on March 23. The peak positivity rate occurred 5 to 6 days after the order, which mirrors the pathogen's incubation period.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Primary Care Growth Pales in Comparison to Health Cost Growth
A study (here) in JAMA Internal Medicine notes “Spending on inpatient services, specialty care, and prescriptions combined accounted for about two-thirds of the increase in total US health care expenditures from 2002 to 2016. In contrast, primary care accounted for 4.2% of the total increase in health care expenditures, while declining as a proportion of all expenditures.” The authors contend that “Insufficient investment in primary care is one reason that the US health care system continues to underperform relative to the health systems in other high-income countries. States and countries with greater access to primary care clinicians and more robust primary care services have better outcomes and lower costs.”
Hospital-Acquired COVID-19 in England
The Guardian (here) reports that “Up to a fifth of patients with Covid-19 in several hospitals contracted the disease over the course of the pandemic while already being treated there for another illness . . . The figures represent NHS England’s first estimate of the size of the problem of hospital-acquired Covid-19, which Boris Johnson last week said was causing an ‘epidemic’ of deaths.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Filipino Nurses Recognized in the Los Angeles Times
The promise and the challenge to Filipino nurses working in American hospitals is recognized (here) in the Los Angeles Times, building on a study of the history (here) of nursing immigration from the Philippines (1898 annexation, World War II, 1965 immigration limitations lifted, Ferdinand Marcos’ encouragement). “Filipino nurses — along with doctors, anesthesiologists and every other kind of medical worker — are an essential source of labor at public hospitals such as L.A. County-USC, Kaiser Permanente and Ronald Reagan UCLA. Filipinos also staff and own many long-term care and mental health facilities. And about 18% of registered nurses in California are of Philippine descent, according to a 2016 survey.” According to the author, “I think this history still matters today because hospitals hit with a flood of COVID-19 patients have nurses to care for them in large part because America opened its borders to Filipino nurses. It matters because Filipino nurses recruited generations of sons, daughters, sisters and brothers to the field, and now entire families are at risk.”
Maryland’s Global Budget Reimbursement System May Save Hospitals and Hospital Capacity
A report in Modern Healthcare (here) says that the global budget system, under development in Maryland since 1973, may provide the steady and predictable financing necessary to maintain hospital capacity, even in a pandemic. “An analogy might be made to holders of annuities during stock market slides: their decision to lock in a steady stream of income suddenly looks brilliant.”
Opioid Hospitalization
A study in JAMA Internal Medicine (here) finds that “Medicaid expansion appears to be associated with meaningful reductions in opioid-related hospital use [about 10%], possibly attributable to improved care for opioid use disorder in other settings.”
MEDICARE, MEDICAID, AND COMMERCIAL HEALTH INSURANCE
Proposed FY 2021 IPPS Rule
The FY 2021 proposed payment rule known as the Inpatient Prospective Payment System has its own “home page,” here. The proposal (to be published in the May 29 Federal Register) is here, CMS Fact Sheet here, HFM Executive Summary here.
In the rule, one hand gives (“CMS projects the rate increase, together with other proposed changes to IPPS payment policies, will increase IPPS operating payments by approximately 2.5 percent”) while the other taketh away (“Proposed changes in uncompensated care payments, new technology add-on payments, and capital payments will decrease IPPS payments by approximately 0.4 percent.”) “Therefore, CMS estimates a total increase in overall IPPS payments of approximately 1.6 percent.”
READINGS & REFERENCES
Coronavirus Public Health Resources and References:
AMA resource page for physicians here. AMA guide to medical education and COVID-19, here. American Public Health Association information here. Association of American Medical Colleges Clinical Guidance Repository, here. CDC information page here. CMS (Centers for Medicare & Medicaid Services) Current Emergencies website, here. Council of State Governments, here. JAMA Network’s COVID-19 resource center here. Library of Congress Coronavirus Research Guide, (here) from the In Custodia Legis blog of the Library of Congress (LoC), with links to Congressional Research Service (CRS) reports. NIH information page here. National Library of Medicine Coronavirus page here, New England Journal of Medicine update here, New England Journal of Medicine Journal Watch here. The Lancet COVID-19 Resource Centre here and real-time dashboard to monitor clinical trials, here. State actions, Kaiser Family Foundation, here. UC Hastings College of Law’s “The Source” (on health care prices and competition) COVID-19 page, here. The White House open research dataset (CORD-19) here. World Health Organization COVID-19 page here.
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
May 21
June 1, 2, 3, 4, 9, 10, 11, 12, 15, 16, 17, 18, 23, 24, 25, 26
July 21, 22, 23, 24, 27, 28, 29, 30, 31
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.