DCMedical News: Monday, September 14, 2020
DCMedical News-DCMN
Washington, D.C.
Monday, September 14, 2020
DCMedical News is published every day both the House and the Senate are scheduled to be in session this year. Subscription information and archives here.
THE BIG STORY IN HEALTH CARE
The (Presidential and Other) Campaigns
KFF: The Kaiser Family Foundation (here) publishes an “Issue Brief” (with links to source documents, side-by-side comparison of positions) on the views and proposals of President Trump and former Vice President Biden on the coronavirus and COVID-19 disease.
Coronavirus
Tracking: By Johns Hopkins (here) shows on 9-13 at 8:00 p.m. EST worldwide 28,883,504 confirmed COVID-19 cases; 922,197 deaths worldwide; 194,033 U.S. deaths (21%).
Remdesivir: WION reports (here) that “Hospitals in the United States have turned down about a third of their allocated supplies of the Covid-19 drug remdesivir since July as need for the costly antiviral wanes . . . Between July 6 and September 8, state and territory public health systems reportedly accepted about 72% of the remdesivir they were offered. Hospitals in turn purchased only about two-thirds of what states and territories accepted. A surplus of remdesivir - which costs $3,120 for a 6-vial intravenous course - marks a turnaround from earlier in the pandemic, when supplies of the drug had fallen short of demand in some regions. Government-led distribution of remdesivir will expire at the end of September. Hospitals said they have little information on availability after that.”
PPE: The Minneapolis Star Tribune reports (here) that “Hospitals across Minnesota resumed elective medical procedures [in] May, but nurses say their employers still aren’t giving them enough N95 masks to protect them from COVID-19 . . . 49% of respondents felt unsafe with the N95 reuse policies in place where they work, which typically require wearing a single-use mask for five to seven days . . .Nationwide, 88% of 14,664 nurses surveyed by the ANA said reuse of single-use masks was either mandated or recommended” by hospital employers. The CDC’s MMWR (here) reports on a study of antibodies for the coronavirus in health workers: “9% of study participants in hospitals where PPE shortages were reported had detectable levels of antibodies, compared with 6% in hospitals that did not.” The Star-Tribune reports that health care workers represent 11% of Minnesota’s cases. The Centers for Disease Control and Prevention (CDC) issued guidelines (here) for “extended use and limited reuse” of single-use respirators during supply shortages in healthcare settings, and the FDA has issued emergency use authorization (here) for systems that can disinfect the masks, but manufacturer 3M doesn’t endorse reuse and makes no claim that doing so is safe.
Vaccines: BloombergLaw reports (here) that the FDA is close to issuing guidelines for Emergency Use Authorization for COVID-19 vaccine protection which the agency contends will have a higher-than-customary EUA standard, notwithstanding the agency’s June guidance that vaccines must only show 50% effectiveness.
Europe:
A study in Health Policy (here) on public perceptions and resulting public policy finds that “Citizens were overall satisfied with their government's response to the COVID-19 outbreak; A north-south pattern in public opinion was observed across the European states; Pandemic acted as a stressor, causing health and economic anxieties; Considerable differences in levels of trust were observed between and within countries; Containment policies offered lessons for the design of lockdown exit strategies.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
RVU Payment Conundrum: Medicare RVU Payments Increase for E&M, Drop in Other Areas to Achieve “Budget Neutrality,” May Be Costly for Hospital-Physician Contracts Denominated in RVUs
RACMonitor reports on an unanticipated consequence of changes in the Medicare Physician Fee Schedule for CY 2021. “The Centers for Medicare & Medicaid Services (CMS) will reimburse a greater number of relative value units (RVUs) associated with office-based evaluation and management (E&M) visits . . . In order to achieve budget neutrality, CMS will reduce the payment per RVU. With this change, CMS is allocating a larger proportion of its total spending to office-based physicians, at the expense of surgeons and hospital-based physicians. Here’s the rub: organizations that utilize RVUs in their physician compensation arrangements and continue to pay the same 2020 rates per RVU on the increased number of 2021 RVUs will experience a dramatic decline in operating income.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Hospital Nurse Understaffing Meets COVID-19
A study in the BMJ Quality and Safety (here) finds that “Hospital nurses were burned out and working in understaffed conditions in the weeks prior to the first wave of COVID-19 cases, posing risks to the public’s health.” The study examined nurse staffing in 135 New York and 119 Illinois hospitals. The conclusions: “Mean staffing in medical-surgical units varied from 3.3 to 9.7 patients per nurse, with the worst mean staffing in New York City . . . Half gave their hospitals unfavourable safety grades and two-thirds would not definitely recommend their hospitals.”
Patient Harms in Hospitals, Measurement and Assessment
A 71-expert panel in the Journal of Patient Safety (here) finds that “Thousands of patients each year experience health care–related adverse events . . . Twenty-five years after the seminal work of the Harvard Medical Practice Study, as health care has evolved, so have the numbers and types of patient harms being tracked and investigated . . . Each has advantages and disadvantages, and use of methods is not standardized across the health care industry. For example, voluntary reporting systems represent a confidential vehicle to capture adverse events, but only a small percentage, typically 5%–20%, of adverse events are reported . . . trigger tools . . . may yield many false positives requiring laborious chart review verification and is generally conducted retrospectively. Finally, despite the growing list of quality measures that hospitals are required to calculate for regulatory and payment purposes, it remains unclear whether these measures have improved patient safety or reduced adverse event rates in a meaningful way.” Earlier this year, the Agency for Healthcare Research and Quality published an analysis of the measurement of patient safety and harm, here.
READINGS & REFERENCES
Select Coronavirus Public Health Resources and References (alphabetical):
AMA resource page for physicians here. AMA guide to medical education and COVID-19, here.
American Public Health Association information here.
CDC information page for professionals here, Morbidity and Mortality Weekly Reports on Coronavirus, here.
CMS (Centers for Medicare & Medicaid Services) Current Emergencies website, here.
Council of State Governments, here.
The Guardian and Kaiser Health Network, report on health professionals dead from COVID-19, 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.
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.
Reproduction rate (rt), website https://rt.live/ tracks the highest and lowest COVID-19 reproduction.
State actions, Kaiser Family Foundation, here.
UC Hastings College of Law’s “The Source” (on health care prices and competition) 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
September 15, 16, 17, 22, 23, 24, 25, 30
October 1, 2
November 16, 17, 18, 19, 20
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.