DCMedical News: Thursday, November 19, 2020
DCMedical News-DCMN
Washington, D.C.
Thursday, November 19, 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
Coronavirus
Tracking: By Johns Hopkins (here) shows at 8:00 p.m. on 11-18 worldwide 56,108,310 COVID-19 cases, 11,498,515 U.S. cases. Deaths worldwide are 1,346,741, 250,180 of them in the U.S., 19% of the world death total.
Medical Care: Biden COVID-19 panel member and director of the University of Minnesota's Center for Infectious Disease Research and Policy Michael Osterholm said during a seminar (here) that hospital care of coronavirus patients could be compromised due to a lack of staffing (see below, hospitals), personal protective equipment (the British also have challenges with PPE contracts given to insiders and startups, here) and drugs used to treat COVID patients.
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Staff Shortages in Hospitals Receiving Attention, Concern
The Atlantic’s “COVID Tracking Project” reports (here) that “HHS provided data on the number of hospitals experiencing staffing shortages. From November 4 to November 11, 958 hospitals—19 percent of American hospitals—faced a staffing shortage. This week, 1,109 hospitals reported that they expect to face a staffing shortage. That’s 22 percent of all American hospitals . . . More than 35 percent of hospitals in Arkansas, Missouri, North Dakota, New Mexico, Oklahoma, South Carolina, Virginia, and Wisconsin are anticipating a staffing shortage this week. COVID-19 puts pressure on hospitals in two ways. One, staff members get sick or are exposed to the coronavirus and have to stay home, reducing the labor supply. Two, more patients arrive at the hospital, increasing demand. A surge of cases makes both factors worse.” The full Atlantic COVID collection is here.
Study Cautions Against Patient Isolation
A study in the British Medical Journal (here) notes the trend toward isolation of patients in single bed rooms for infection control and ease of patient assignment, but with potential downsides of increases in adverse events (AE). Says the report, “AEs were significantly higher in isolated patients compared with non-isolated patients, more than half being preventable and with HAIs as the primary cause.”
Weekend Effect Variable
AHRQ’s Patient Safety Network reports a study in the Journal of Stroke and Cerebrovascular Diseases (here) showing “In-hospital mortality among hemorrhagic stroke patients was significantly greater among weekend compared to weekday admissions. No weekend effect was found among ischemic stroke patients.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
MedPAC Responds to Congressional Request on Beneficiary Access to Services in Rural Areas
The advisory group at its November 9-10 meeting received a report (here) requested by the House Ways and Means Committee. The report noted that while the number of “E&M” (Evaluation and Management coding) encounters per enrollee grew between 2010 and 2018 for both rural and urban areas, urban numbers remained higher (13.4 to 11). Differences in utilization across regions of the country were larger than differences between urban and rural beneficiaries within the same region. Both urban and rural beneficiaries increased their dependence on hospitals as the site of clinical care, but the increase was twice as fast for the rural group. Use of inpatient hospital services was similar in urban and rural groups, but, as also found with outpatient hospital services, variation in utilization was greater across states, with urban and rural utilization similar within individual states.
Rural hospital closure was preceded by large declines in inpatient admissions, two-thirds due to beneficiaries bypassing their local hospital, one-third reflecting the declining market for inpatient services. The presentation notes that Medicare’s policy response to rural hospital access was to increase payment rates, through in-patient add-on or cost-based payments with Critical Access Hospitals; over 95% of rural hospitals received higher than standard inpatient payment rates in 2018. The increased rates, however, have not prevented rural hospital closures. Alternative policies discussed at the November meeting included global budgets (e.g., an experiment underway with rural hospitals in Pennsylvania) and stand-alone emergency departments, with or without associated Federally Qualified Health Centers. A final report from the group is due June 2022.
DRUGS & DEVICES
LIS Plans Discussed by MedPAC, Additional Competition Among Plans Sought
The Medicare Payment Advisory Commission received a presentation (here) on Low Income Subsidy (LIS) Part D Drug Plans, which cover 13 million Part D enrollees. Members enrolled in benchmark or less expensive plans pay no premium; autoenrollment takes place for those who do not choose a plan (about 60%). Plans that “narrowly miss” the benchmark can waive the difference (known as “de minimus” exception plans). Eighty-eight per cent of LIS beneficiaries end up in zero premium plans. The plans have no incentive, however, to lower their premiums below the benchmark, hence the MedPAC discussion of increasing competition.
Financial Times Focuses on “Global Tsunami” of Anti-Biotic Resistance
The paper reports (here) that “Little more than half a century after the first antibiotics revolutionised medicine, overuse threatens existing treatments while the pipeline of replacements is thin” and “The UN fears 10m deaths a year from drug-resistant infections worldwide by 2050.” The article is part of a series of on this subject (here).
Select Coronavirus Public Health Resources and References (alphabetical):
AMA resource page for physicians here. AMA guide to medical education and COVID-19, 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.
HHS Protect Public Data Hub, https://protect-public.hhs.gov/datasets/state-representative-estimates-for-hospital-utilization/data?orderBy=state_name&page=4
JAMA Network’s COVID-19 resource center 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.
The COVID Tracking Project (The Atlantic Monthly), 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
November 20
December 1, 2, 3, 4, 7, 8, 9, 10
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.