DCMedical News: Monday, January 25, 2021
DCMedical News-DCMN
Washington, D.C.
Monday, January 25, 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 1-24-21 worldwide 99,131,815 COVID-19 cases, 25,111,828 U.S. cases. Deaths worldwide are 2,127,884, of which 419,043 are in the U.S., 20%.
Vaccination: Bloomberg reports that Israel has vaccinated about 30% of its population, the UAE about 20%. If sustained, these rates could enable those countries to reach the threshold for “herd immunity” by mid-year.
Hospitalization: How many hospital beds are enough? Statista (story here, chart here) displays international disparities, 13 beds per 1,000 population in Japan, 12 in South Korea, 2.9 in the U.S., 2.5 in the UK. Public service news in Los Angeles (here) reports that state coordination, a slight decline in the hospitalization rate and opening of closed hospitals enabled Los Angeles to avoid “critical” standards of care. Modern Healthcare reports (here) on continuing high demand for agency (travel and other) staff (RNs, therapists and technicians, locums physicians, per diems), together with a list of the largest staffing firms. The Washington Post (here) reports on the continuing challenge posed by patients, visitors and others being infected with COVID-19 in the hospital.
Policy: White House Chief of Staff Klain sends a memo (here) to federal agencies, freezing pending and recently proposed regulations. “With respect to rules that have been sent to the OFR [Office of the Federal Register] but not published in the Federal Register, immediately withdraw them from the OFR for review and approval . . . With respect to rules that have been published in the Federal Register, or rules that have been issued in any manner, but have not taken effect, consider postponing the rules’ effective dates for 60 days from the date of this memorandum.” The GAO corresponds with Senators concerning pending Stark law changes (here), safe harbors (here) and drug safe harbors (here).
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Physician Burnout & Suicide Report
Medscape publishes (here) its 2021 report, “Death By 1000 Cuts,” based on survey responses August 30-November 5, 2020 from more than 12,000 practicing U.S. physicians in 29 specialties, weighted to AMA data on the distribution of physicians by specialty and state. Most burned out were critical care physicians (51%), the least plastic surgeons (31%) and dermatologists (29%), with women consistently reporting higher percentages of burnout (51%) than men (36%). The pandemic? Not a major factor, with 80% reporting burnout symptoms beginning before the start of the COVID-19 pandemic; only 8% reporting stress from treating COVID-19 patients and 16% experiencing “stress from social distancing/societal issues related to COVID-19”; and the largest number (58%) reporting burnout from “too many bureaucratic tasks, lack of respect from administrators” (37%), lack of control and autonomy (28%) and increasing computerization of practice (28%). Thirteen percent reported having thoughts of suicide, 19% among obstetrician-gynecologists.
HOSPITALS, NURSING HOMES AND OTHER HEALTH FACILITIES
COVID-19 and the Economics of Health Facilities and Services
Miller and colleagues report in Health Affairs (here) on changes in health facility and service usage in the pandemic, so far, including interruption of the consistency of health spending, concluding that “These data suggest that 2020 will likely be the first year ever to show an annual decline in overall health spending since CMS began tracking spending in 1960.” Hospital spending growth declined, but prices increased; nursing home care declined, accompanied by an increase in home health care spending; professional services, following an abrupt decline with the pandemic, began to recover in October, except for pediatrics, with telehealth remaining a small part of such services; dental services declined dramatically and show no signs of full recovery; prescription drug spending was largely unaffected.
Rural Hospital Closure Leads to Patient Travel, Uncertainty, Limitations on Access
A Government Accountability Office report released January 21 (here) found that, with more than 100 rural hospitals closing between 2013 and 2020, residents of rural areas previously served by those hospitals had longer travel to health services, greater uncertainty and limitations on access in finding new hospitals. Median distance traveled increased from 3.3 miles in 2012 to 24.2 miles in 2018. For alcohol and drug abuse services, the median distance traveled increased from 5.5 miles in 2012 to 44.6 miles in 2018. With the hospital closed, an “organizing principle” for health services disappeared, leading to fewer physicians, PAs and APRNs per 100,000 residents, and, as measured by the burden of disease on Medicare beneficiaries, higher prevalence of all of the ten most common chronic conditions.
DRUGS & DEVICES
ICER Reports on “Unsupported” Price Increases
The Institute for Clinical and Economic Research released its second report (here) on what it regards as unsupported price increases. A report in MedCity News (here) says “seven drugs have prices that do not align with any newly discovered increase in clinical benefit, leading to over $1.2 billion in excess drug spending in 2019, alone.”
AI: Regulation in Conflict, and Will Add Cost
The FDA proposed a scheme for regulating artificial intelligence software, followed by publication in the Federal Register of a request for information which appears in conflict, according to a report in MedCity News. (News report here, Federal Register publication here, FDA slides here.) MedCity reports that the “about-face took many by surprise, and seemed to fly in the face of the plans the FDA had outlined just days before. The list of proposed exemptions included some common uses for AI in health care, such as software used to flag lesions suspected for cancer, and radiological computer-assisted triage and notification software.”
A British radiologist’s blog published through Radiology Business (here) notes the size of an AI “add-on” payment approved by CMS. “CMS (the Centres for Medicare & Medicaid Services) in the USA approved the first reimbursement for AI augmented medical care . . . a deep learning model which identifies signs of stroke on brain CT and automatically contacts the neuro interventionalist, bypassing the first read normally performed by a general radiologist . . . Viz.ai demonstrated to CMS a significant reduction in time to treatment and improved clinical outcomes in patients suffering a stroke . . [and] has been granted a New Technology Add on Payment of up to $1,040 per use in patients with suspected strokes.”
READINGS & REFERENCES
Healthcare Measurements, Reflections on a Decade of Numbers and Whether They Mean Anything to Patients
Kaplan and colleagues write in NEJM Catalyst, Innovations in Care Delivery (here) about assessment of the actual outcome of patient care, and the plethora of “quality” measures of patient care developed during the past decade, and whether the two come together, that is, does any, most, or all of the last decade of quality measurement enable the hospital to “follow every patient it treats, long enough to determine whether or not the treatment has been successful” (the admonition of Dr. Ernest Amory Codman).
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.
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.
2021 House Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
January 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.