DCMedical News: Wednesday, September 16, 2020
DCMedical News-DCMN
Washington, D.C.
Wednesday, September 16, 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
Congressional campaigns: The “Problem Solvers Caucus” proposed a coronavirus stimulus plan (“March to Common Ground,” here), a possible compromise between House (generous) and Senate (not so much) versions of a fourth pandemic-related bailout. The fifty members (evenly split between parties) of the Caucus supported $500 billion for state and local governments (cf. $915 billion in the Democratic proposal, $150 billion in the Republican); $450 per week in supplemental unemployment insurance for eight weeks, then capping benefits at 100% of previous wages or $600 per week, whichever is lower; another round of $1,200 direct stimulus payments and payments of $500 per child; and miscellaneous policy provisions favoring one or the other party, such as changes in liability law, food stamps, the postal service and election security. Actual outlays would be limited until March 2021, increasing money spent thereafter to $2 trillion if the pandemic worsens, reducing total outlays to $1.3 trillion if the pandemic is under control.
Coronavirus
Tracking: By Johns Hopkins (here) shows on 9-15 at 8:00 p.m. EST worldwide 29,425,572 confirmed COVID-19 cases; 931,272 deaths worldwide; 195,727 U.S. deaths (21%).
Testing: the FDA released results (here) on the performance of more than 55 COVID-19 tests. A report in Forbes (here) says that The Centers for Disease Control and Prevention effectively gave up trying to keep track of coronavirus, admitting it had failed to do so months ago, as chronicled in documents obtained by Forbes as part of an FOI request for contracts between the CDC and Mitre, a government contractor on data, defense, spy and scientific work. “When CDC was inking the deal with Mitre, a research and development firm to which the government farms out many of its most sci-fi projects, officials were claiming that their broad testing and data collection were responsible for the steep rise in cases numbers in parts of the US.” The news is certain to be seen in light of comments from HHS’ leading spokesperson on the pandemic, Michael Caputo, the subject of unfavorable news (Buffalo News, here; New York Times, here) and a hometown editorial (Buffalo News, here).
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Nursing Homes and Hospitals Scrutinized for Roles in COVID-19 Spread
A study in JAMA (here) notes that “In the US, approximately 27% of deaths due to coronavirus disease 2019 (COVID-19) have occurred among residents of nursing homes (NHs). However, why some facilities have been more successful at limiting the spread of infection than others is unclear.” The authors conclude that better staffing, not nursing home “quality” ratings or state inspections, were associated with lower mortality for patients: “Across 8 states, high-performing NHs for nurse staffing had fewer COVID -19 cases than low-performing NHs. In contrast, there was no significant difference in the burden of COVID-19 cases between high- vs low-performing NHs for health inspection or quality measure ratings.” A study in Health Affairs (here) of 355 nursing homes in New York concludes that unionization (with the prospect of more effective advocacy for PPE, stable employment, better staffing ratios) was associated with lower mortality for nursing home patients. “Health care worker unions were associated with a 1.29 percentage point mortality reduction, which represents a 30% relative decrease in the COVID-19 mortality rate compared to facilities without health care worker unions.”
Hospitals have also been subjected to scrutiny concerning infection control, PPE and staffing in the pandemic. A report (here) in The Wall Street Journal notes that “An average of 120 patients a day became infected with the new coronavirus inside U.S. hospitals as the pandemic ebbed from its spring peak and rebounded into the summer, according to previously unpublished federal data.”
“Scoop-and-Run” Model of Out-of-Hospital Cardiac Resuscitation Challenged
A study in JAMA (here) this week finds that “Among patients experiencing out-of-hospital cardiac arrest, intra-arrest transport to hospital compared with continued on-scene resuscitation was associated with lower probability of survival to hospital discharge.” An editorial on the research (here) states the challenge as follows: “Of the 347,322 cases of OHCA [out-of-hospital-cardiac-arrest] assessed by emergency medical services (EMS) in 2015, 52% underwent resuscitation efforts with 10.4% of these surviving to hospital discharge . . . Historically, management of OHCA in the US was guided by the model of rapidly transporting the patient to a hospital, in contrast to the model used in France and Germany of treating the patient at the scene. The promise of multiple potential in-hospital OHCA therapies and recent research into potential innovations in the out-of-hospital management have only fueled the debate between these 2 models, which in EMS parlance have been described, respectively, as ‘scoop and run’ and ‘stay and play.’” The editorial concludes that this study challenges scoop and run, but does not definitively argue against it, especially given great regional variation in practices within the U.S.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Census Bureau Reports on Health Insurance in the U.S. in 2019
In a report (here; Census Bureau web page for this and other reports here) the Census Bureau found that in 2019, 8.0 percent of people, or 26.1 million, did not have health insurance at any point during the year; that private health insurance coverage was more prevalent than public coverage, covering 68.0 and 34.1 percent of the population at some point during the year, respectively, with employment-based insurance the most common subtype; that in 2019, 9.2 percent of people, or 29.6 million, were not covered by health insurance at the time of interview, up from 8.9 percent and 28.6 million; that the percentage of people with Medicaid coverage at the time of interview decreased to 19.8 percent in 2019, down from 20.5 percent in 2018; that between 2018 and 2019, the percentage of people without health insurance coverage decreased in one state and increased in 19 states; and that all states and the District of Columbia had a lower uninsured rate in 2019 than in 2010.
MACPAC To Meet September 24-25
The Medicaid and CHIP Access and Payment Commission will meet virtually the 24th and 25th, here, details and registration information to come.
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 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.