DCMedical News: Wednesday, January 6, 2021
DCMedical News-DCMN
Washington, D.C.
Wednesday, January 6, 2021
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: Johns Hopkins (here) shows at 8:00 p.m. on 1-5-21 worldwide 86,230,870 COVID-19 cases, 21,007,694 U.S. cases. Deaths worldwide are 1,865,267, of which 356,540 are in the U.S., 19% of the world death total.
Vaccination: The World Health Organization says “No” to lengthening the interval between two coronavirus vaccine shots, while the FDA says “No” (FDA statement here, Bloomberg report here) to splitting the Moderna dose in two, both proposals raised to accelerate the slow pace of vaccination which appears, however, to be due to logistics (report here), not to an absence (so far) of vaccines. The vaccine market may come to resemble the PPE market, according to The Financial Times (here), which notes that “America’s PPE supply chain looks distinctly sick” and that “large parts of the distribution system for personal protective equipment remain worryingly disorganised, at best, and prone to fraud and wild price swings, at worst. Nearly a year after the crisis started, boxes of PPE are being traded on WhatsApp by small-time entrepreneurs — both reputable and shady — in a murky underworld. Unsurprisingly, fake deals are widespread and prices wildly volatile.”
Two articles and an editorial in the Annals of Internal Medicine Tuesday favored splitting the dose or lengthening the interval between doses. The first article (here) reported that “Prior work has shown that the success of a COVID-19 vaccination program will depend more on the speed and reach of its implementation than on the efficacy of the vaccine itself. The analysis presented here highlights the steep clinical and epidemiologic costs imposed by a 2-dose vaccination series in the context of ongoing pandemic response . . . [a] vaccine with 55% effectiveness may confer greater population benefit than a 95%-effective vaccine requiring 2 doses.” The second article (here) on flexible timing for a second dose, claims that “Under a steady vaccine supply of 6 million doses per week, the flexible strategy would result in an additional 23% to 29% of COVID-19 cases averted compared with the fixed strategy.”
Said the FDA, “We know that some of these discussions about changing the dosing schedule or dose are based on a belief that changing the dose or dosing schedule can help get more vaccine to the public faster. However, making such changes that are not supported by adequate scientific evidence may ultimately be counterproductive to public health.”
Hospitals: Hospitals are in the midst of “a human disaster” (Los Angeles Times, here), “dire” (New York Times, below), up to capacity and challenged for staffing (the Houston Chronicle reports that “Houston Methodist announces $500 bonuses for healthcare workers who get COVID vaccine”).
The Los Angeles Times reports that “Los Angeles County hit another disturbing milestone today, exceeding 11,000 COVID-19 deaths as officials warned of more grim weeks ahead as a new Christmas surge is expected to pressure already overwhelmed hospitals. The county has reported more than 1,000 new deaths since Dec. 30, according to health officials, including 224 today.” One County Supervisor reported that “It took 10 months for the county to accumulate 400,000 coronavirus cases, it took only about a month to record an additional 400,000.” The more highly communicable “variant” of coronavirus has been reported in 32 cases in San Diego, here. The New York Times reports that “The situation is perhaps most dire in Los Angeles County, where it’s estimated that one person becomes infected every six seconds, and one person dies every 10 minutes. The latest crisis has stretched the health care system there so thin that incoming patients at one hospital were told to wait in an outdoor tent. The region is running out of oxygen, and ambulance crews have been instructed to stop transporting people who have little chance of survival.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH FACILITIES
Hospitals Looking Better in 2021, Says B of A
In a commentary on hospitals, a Bank of America report in Seeking Alpha (here) is “bullish on healthcare facilities, expecting the potential for ‘some good political news in 1H’ to lift the stocks until utilization recovery that is ‘weighted towards 2H’ . . . however, according to the report, the margins will be a cause for concern with ‘lower acuity/ lower margin volumes’ returning amid pressure from higher labor costs and other expenses from a reopening economy. Citing the potential impact on smaller providers as government support wanes, the analysts expect the market share changes and acquisitions to continue in 2021 and beyond. Despite the persisting COVID-driven shift towards home-based care, [see DCMN 1-5-2021] the analysts argue that the return of deferred procedures [will] offset COVID patient declines.”
Hospital Expenses Up 6% 2019 v. 2018, 31% of $3.8 Trillion in National Health Expenditures
The CMS Office of the Actuary has reported on total national health expenditures for 2019 (CMS news release here). Modern Healthcare (here) charts the comparison of 2019 to 2018 expenditures by category. Hospitals at 31% were the largest component, increasing 6.2% in 2019. Physicians were 20% of the total. Health insurance, the only component to go down, was 6%.
READINGS & REFERENCES
It’s Not Only the Prices
A study in the American Journal of Public Health (Speer M et al. “Excess medical care spending: The categories, magnitude, and opportunity costs of wasteful spending in the United States,” Am J Public Health 2020 Dec; 110:1743) reports that as much as half of the nation’s $3.6 trillion annual health bill may be wasted. Abigail Zugar summarizes the study in NEJM, as follows: “Researchers identified six studies, published from 2008 to 2019, in which components of our national medical waste were analyzed, and estimated the costs associated with each. Each study identified specific problems that could be reassorted into six general categories. In order of cost, they were: (1) excessive prices (at a median estimated cost of US$169 billion annually), (2) fraud and abuse ($185 billion), (3) clinical inefficiency ($202 billion), (4) administrative waste ($281 billion), (5) missed prevention opportunities ($310 billion), and (6) overuse ($451 billion). Estimates of total waste ranged from $600 billion to almost $2 trillion annually, or 17% to 53% of the $3.6 trillion we now spend annually on healthcare.”
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.
2021 House Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
January 7, 8, 21, 22, 25,26, 27, 28
February 8, 9, 10, 11, 23, 24, 25, 26
March 16, 17, 18, 19, 22, 23, 24, 25
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.