DCMedical News: Wednesday, June 3, 2020
DCMedical News-DCMN
Washington, D.C.
Wednesday, June 3, 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 6-2 at 8:00 p.m. EST worldwide 6,372,447 confirmed cases; 379,709 deaths worldwide; 106,180 U.S. deaths (28%). Deaths by State, from The Guardian here.
Update: A YouTube coronavirus update with Dr. Anthony Fauci interviewed by the editor-in-chief of the Journal of the American Medical Association can be found here.
Surgery Will be Critically Important in Hospital Financial Recovery: A study of hospital financial distress due to COVID-19 lockdowns published in JAMA (here) finds that “Hospitals in the 25th percentile of surgical volume performed 19.7 surgical procedures per 100 hospital discharges, and those in the 75th percentile performed 55.8 procedures per 100 discharges. These differences suggest that some hospitals will sustain much larger losses due to recommended or mandated cessation of outpatient and surgical services,” that “financial challenges may make it difficult for hospitals to maintain appropriate staffing levels at a time when more hospital capacity is needed,” and that “The initial $50 billion disbursed under the CARES Act . . . was allocated to health care facilities in proportion to their 2018 net patient revenue from all payers, an approach that is unlikely to ensure the most vulnerable hospitals receive adequate support because this does not reflect the variable nature of COVID-19–related utilization.”
Treatment, Clinical Course: The New England Journal of Medicine has published (here) and (here) summaries of current approaches to treatment of COVID-19 disease. The first is a discussion of the clinical picture, diagnosis, and management of mild-to-moderate disease. The second focuses on severe disease, intensive care, respiratory support and interventions for refractory hypoxemia.
Nursing Home Coronavirus Deaths Counted, Continued: The Centers for Medicare and Medicaid Services on Monday unveiled data by State (here) showing that low-rated one-star facilities were more likely to have outbreaks than five-star facilities. In total, the 80 percent of facilities that responded recorded more than 60,000 coronavirus cases and nearly 26,000 deaths.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
New Data on Physician Training from AAMC and ACGME
The Association of American Medical Colleges has published their 2019 findings on residency choices (summary here) and the Accreditation Council for Graduate Medical Education their review of 2018-2019 residency programs (here).
The AAMC found that “Over the course of medical school, most medical students change their preferred residency specialty . . . Specialty preference continuity in Orthopaedic Surgery has decreased from 50.2% in the 2018 Report on Residents to 44.8% in 2019 . . . While the overall number of residents has increased in the 2019 Report on Residents, the percentage of residents who are International Medical School Graduates has decreased each year from 25.9% in the 2015 Report on Residents to 23.3% in the 2019 Report on Residents . . . Overall, 23.3% of the individuals who completed residency from 2009 through 2018 are practicing in Medically Underserved Areas . . . More than half (54.6%) of the individuals who completed residency training from 2009 through 2018 are practicing in the state where they did their residency training.” California had the highest retention rate, 77.5%.
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
tPA Door-to-Needle Time Turns Out to be Important in Recovery
A study in JAMA (here) finds that “Among patients aged 65 years or older with acute ischemic stroke who were treated with tissue plasminogen activator [tPA], shorter door-to-needle times were associated with lower all-cause mortality and lower all-cause readmission at 1 year. These findings support efforts to shorten time to thrombolytic therapy.”
Amputation Epidemic Among African American Diabetes Patients
ProPublica reports (here) on a month-long investigation in Mississippi. The rate of amputations nationally has grown 50% from 2009 to 2015, but “Black patients lose limbs at a rate triple that of others.” The article notes that “It is the cardinal sin of the American health system in a single surgery: save on preventive care, pay big on the backend [$54,000 per year for an amputee, according to Medicare, here]” The article shows map overlap between enslaved populations in 1860 and the average rate of annual amputations. It chronicles the relationship of federal medical student loan policies, screening guidelines of professional societies, hospital policies and procedures and this result.
Rural Hospitals: High Occupancy and Charge Markup Signal Success, Low Occupancy and Lower Charges Failure
Bai, Anderson and colleagues study rural hospital financial stability, 2011-2017, in Health Affairs, here.
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 (published in the May 29 Federal Register) is here, CMS Fact Sheet here, HFM Executive Summary here. The Medicare Learning Network publishes (here) an overview of the IPPS system.
READINGS & REFERENCES
Coronavirus Public Health Resources and References (alphabetical):
Association of American Medical Colleges Clinical Guidance Repository, here.
AMA resource page for physicians here. AMA guide to medical education and COVID-19, here.
American Public Health Association information 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.
The New York Times Coronavirus coverage, 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
June 4, 9, 10, 11, 12, 15, 16, 17, 18, 23, 24, 25, 26
July 21, 22, 23, 24, 27, 28, 29, 30, 31
August, none
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.