DCMedical News: Friday, November 20, 2020
DCMedical News-DCMN
Washington, D.C.
Friday, November 20, 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 11-19 worldwide 56,817,667 COVID-19 cases, 11,710,084 U.S. cases. Deaths worldwide are 1,358,489, 252,484 of them in the U.S., 19% of the world death total. Business Insider writes that “One map from the White House coronavirus task force [here] shows just how bad the U.S. outbreak is now.”
Staff Illness, Exploding Hospital Patient Volumes in Half of all States: STAT reports (here) on the pandemic in overrun hospitals. “Some hospitals are turning to local dentists and Red Cross volunteers, and people with basic health experience to help with tasks that require less training,” according to a spokesperson for the American Hospital Association.
Public Health: A meta-analysis in The Lancet (here) finds that COVID patients shed viral RNA for up to 83 days but are infectious for about 9. More: “Maximum shedding duration was 83 days in the upper respiratory tract, 59 days in the lower respiratory tract, 126 days in stools, and 60 days in serum. Pooled mean SARS-CoV-2 shedding duration was positively associated with age . . . No study detected live virus beyond day 9 of illness, despite persistently high viral loads.”
WHO’s In, Out: Bloomberg Law reports that “The World Health Organization recommended against using Gilead Sciences Inc.’s remdesivir to treat hospitalized Covid-19 patients, less than a month after U.S. regulators granted the drug a speedy approval.” The trial was reported October 15 and, according to Bloomberg, “The U.S. Food and Drug Administration approved the drug a week later, basing its decision on a trial run by the National Institutes of Health that showed remdesivir reduced hospitalized patients’ recovery time by five days,” but that “Despite the discordance with the WHO, the FDA said in its review of remdesivir that ‘there were no issues identified that would benefit from discussion’ by a panel of outside advisers. FDA typically convenes such a panel before deciding whether to approve a drug in situations where there are questions arising from clinical trial data.” Bloomberg adds, “The FDA was earlier criticized for hastily authorizing an antimalarial drug, hydroxychloroquine, to treat Covid-19. Trump repeatedly touted the drug early in the pandemic, though medical evidence was lacking to support his claims. The FDA then revoked its authorization after hydroxychloroquine was shown not to combat the virus and was linked to harmful side effects.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Hospitals Treating Black Patients Improved Over Two Decades
Chandra and colleagues (here) report in a paper published by the National Bureau of Economic Research. In a study of patients treated with heart attack diagnoses, they found “(1) Black patients receive care at lower-performing hospitals than white patients, even when they live in the same hospital market or ZIP code within a hospital market. (2) Over the past two decades, the gap in performance between hospitals treating Black and white patients shrank by over two-thirds. (3) This progress is due to more rapid performance improvement at hospitals that tended to treat Black patients, rather than faster reallocation of Black patients to better hospitals. (4) Hospital performance improvement is correlated with adoption of a high-return low-cost input, beta-blockers.”
Fitch Publishes (Here) Not-for-Profit Hospital and Health Systems Ratings Update
Measures in the Fitch (and other rating agency) publications are frequently cited in the literature, in consulting and internal hospital and health system analysis, notwithstanding that they are derived from the databases of the respective rating agencies, and therefore limited to the most credit-worthy hospitals.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Geographic Variation in Medicare Spending Narrowed 2007-2017
Two researchers at Weill Cornell Medical College report in Health Affairs (here) that “The gap in price- and risk-adjusted Medicare per capita spending between high and low-spending HRRs [hospital referral regions, Dartmouth] narrowed between 2007 and 2017 . . . The dollar difference in mean spending between high- and low-spending HRRs was $3,388 in 2007 compared with $2,916 in 2017, representing a reduction of $472, or 14 percent . . . These reductions were uneven across the study period: The dollar-amount difference between high- and low-spending HRRs actually widened somewhat from 2007 to 2009 [Great Recession], followed by a steady decline from 2009 to 2014, before stabilizing from 2014 to 2017 [full roll out January 1, 2014ff. of the Patient Protection and Affordable Care Act].”
The researchers offer possible explanations for the reduced variation, including “a greater supply of post acute care providers, especially hospice providers”; “areas with healthier beneficiaries had higher growth rates after 2009, which may at least partially be attributed to the fact that providers in those areas were financially rewarded for keeping patients healthy and spending low”; and “hospital capacity was positively related to spending growth after 2014 . . . regions with more hospital beds have large, consolidated health systems created by the rapid increase in vertical and horizontal consolidation in health care markets that took place after the ACA was implemented. Such consolidations largely accelerated after 2011 and were associated with increased spending or even higher spending growth rates.”
Healthcare.gov Sign-Ups Pass 8 Million
CMS weekly enrollment snapshots show 1.6 million sign-ups for 2021 as of the second week, compared to less than one million for 2020 at this point. Final sign-ups were 8.3 million for 2020 sign-ups, 8.4 million for 2019 and 8.7 million for 2018.
DRUGS & DEVICES
HIV Death Rates Down Nearly Half, 2010-2017, MMWR Reports
The CDC’s Morbidity and Mortality Weekly Report (here) says “Life expectancy for persons with human immunodeficiency virus (HIV) infection who receive recommended treatment can approach that of the general population,” but that there remain important variations. “During 2010–2017, HIV-related death rates decreased 48.4% (from 9.1 to 4.7) [per 1000 persons with diagnosed HIV infection], whereas non–HIV-related death rates decreased 8.6% (from 9.3 to 8.5). Rates of HIV-related deaths during 2017 were highest by race/ethnicity among persons of multiple races (7.0) and Black/African American persons (5.6), followed by White persons (3.9) and Hispanic/Latino persons (3.9). The HIV-related death rate was highest in the South (6.0) and lowest in the Northeast (3.2).”
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.
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
December 1, 2, 3, 4, 7, 8, 9, 10
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.