DCMedical News: Thursday, December 10, 2020
DCMedical News-DCMN
Washington, D.C.
Thursday, December 10, 2020
DCMedical News is published every day both the House and the Senate are scheduled to be in session this year. This is the final edition for 2020; publication will resume January 4, 2021. Subscription information and archives here.
THE BIG STORY IN HEALTH CARE
Coronavirus
Tracking: By Johns Hopkins (here) shows at 8:00 p.m. on 12-9 worldwide 68,812,710 COVID-19 cases, 15,371,953 U.S. cases. Deaths worldwide are 1,567,056, of which 288,889 are in the U.S., 18% of the world death total. The New York Times roundup, here, reports that “Just one week after the United States broke a daily record for coronavirus deaths, it did so again on Wednesday, when officials across the country reported at least 3,011 new fatalities.”
Medical Care: The WHO commissioned groups to study four drugs for use in hospitalized COVID-19 patients, with results (here, NEJM) reporting “These remdesivir, hydroxychloroquine, lopinavir, and interferon regimens had little or no effect on hospitalized patients with Covid-19, as indicated by overall mortality, initiation of ventilation, and duration of hospital stay.”
Hospitals: The New York Times reports that “In New Mexico, where I.C.U.s are full across the state, Gov. Michelle Lujan Grisham is expected to announce that hospitals will be allowed to ration care based on who is most likely to survive. Some experts say that physicians are already rationing care, as evidenced by the declining rate at which Covid-19 patients have been hospitalized during the last several weeks.” See below, COVID-Credentialed Practitioners.
Health Policy: CQ publishes (here) a transcript of remarks by President-elect Biden, Vice President-elect Harris, HHS Secretary nominee Becerra, Surgeon General nominee Murthy, CDC Director nominee Walensky, COVID-19 equity task force chair Nunez-Smith, Dr. Fauci, COVID response coordinator Zients and COVID response deputy coordinator Quillian. Said Biden, “We have been living with this pandemic for so long we are at risk of becoming numb to its toll on all of us. You know we are resigned to feel that there is nothing we can do, and we can't trust one another, that we must accept death, pain, and sorrow.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
New Mexico Executive Order Proposes to Legally Immunize Practitioners Working Under Crisis Standards of Care
The story of New Mexico, the first state to embrace “Crisis Standards of Care,” is reported here and here in the Albuquerque Journal; the Governor’s Executive Order is here. The Governor’s Order says “Normally, providers have an ethical and legal obligation to do whatever is in the best interest of each of their patients; under crisis standards of care, providers instead have an ethical and legal obligation to do what is best for everyone in the state, not just what is best for their individual patients.”
The Order creates a class of “COVID-Credentialed Physicians” and “COVID-Credentialed Advanced Practice Clinicians” and says they “Shall be considered public employees for purposes of the Tort Claims Act when performing the COVID-19-related duties for which they received that credential.” A medical advisory group will activate the standards; state officials will undertake additional responsibilities, especially the Superintendent of Insurance who is instructed to assure professional liability coverage and that “patients are covered for treatment even if it is received in a hospital outside the patient's health plan's usual provider network.”
Medical Specialties Residency Match Sets Records
A news release (here) announced that “The National Resident Matching Program has released the results of the 2020 Medical Specialties Matching Program (MSMP). The MSMP encompasses nearly all Internal Medicine subspecialties, and the 2020 Match (for positions that will begin in 2021) surpassed the 2019 Match to become the largest in history. Specifically, the 2020 MSMP included 6,847 applicants submitting certified rank order lists (an 8.9% increase), 2,042 programs submitting certified rank order lists (a 4.3% increase), 5,734 positions (a 2.8% increase), and 5,208 positions filled (a 6.1% increase).”
As to specialty preference, the group reported that “The most competitive subspecialties among those that offered at least 30 positions were Allergy and Immunology, Cardiovascular Disease, Clinical Cardiac Electrophysiology, Gastroenterology, Hematology and Oncology, and Pulmonary/Critical Care. All filled at least 95 percent of the positions offered, and more than 50 percent of the positions were filled by U.S. MD graduates. The least competitive subspecialties among those that offered at least 30 positions were Geriatric Medicine and Nephrology. Both filled less than three-quarters of the positions offered, and less than 45 percent were filled by U.S. MD graduates.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH FACILITIES
Data, and Information
AHRQ announces the 2018 Nationwide Readmissions Database (here) and the National Ambulatory Surgery Sample (here), also through 2018.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
MA Patients and Traditional Medicare Patients Fare Equally in Readmissions; Costs Grow for MA Hospital Inpatients
A report in the American Journal of Managed Care (here) says “Although our focus was on a single measure of performance, the claims that managed care plans are spearheading changes in the delivery system are not supported by our finding that relative readmission rates were stable over the 2009-2014 period.” An AHRQ HCUP study reports (here) that the average cost per hospital inpatient stay for Medicare Advantage patients, $200 per stay lower than traditional Medicare in 2009, had grown to $200 higher than traditional Medicare inpatient stay costs by 2017.
READINGS & REFERENCES
Thomas Bodenheimer on “The Political Divide in Health Care: A Liberal Perspective”
“Is the red-blue divide so deep and wide that national paralysis will continue to prevent solutions to health care’s problems of access and cost? Is the United States doomed to muddle along for years to come? I am hopeful that current policies—promoting limited insurance products tailored to the majority of the population that is healthy—will be short-lived, as insurance costs skyrocket and health care access plummets for people who are sick and middle class or poor. At that time, the government may finally act on the popular belief that health care should be a right of all people and demand a universal social insurance program that elevates the primacy of ‘me’ into concern for ‘us.’” Here, in Health Affairs, from December 2005.
To the reader: At this point in time we celebrate the holidays. Following celebration, we take the holidays off, resuming early January. “In fine, here’s looking at you, friends, as this preposterous year ends . . . and Heaven send us a mild winter!” (Frank Sullivan, The New Yorker, December 24, 1973)
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.
STAT COVID-19 Tracker, 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
2021 House Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
Publication will resume January 4, 2021
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.