DCMedical News: Thursday, January 28, 2021
DCMedical News-DCMN
Washington, D.C.
Thursday, January 28, 2021
DCMedical News is published every day both the House and the Senate are scheduled to be in session this year. Publication will resume February 8. Subscription information and archives here.
THE BIG STORY IN HEALTH CARE
Coronavirus
Tracking: Johns Hopkins (here) shows at 8:00 p.m. on 1-27-21 worldwide 100,739,720 COVID-19 cases, 25,580,995 U.S. cases. Deaths worldwide are 2,170,237, of which 428,654 are in the U.S., 20%.
Vaccination: NEJM publishes a vaccination information page, here. Different models of vaccine distribution have a new addition, with California’s decision (Los Angeles Times, here) to enlist Blue Shield to manage that state’s vaccination program. The report notes that “Following a shaky rollout of the state’s COVID-19 vaccination efforts, advisors to Gov. Gavin Newsom have struck a far-reaching agreement with Blue Shield of California for the health insurance company to oversee the distribution of vaccine doses to counties, pharmacies and private healthcare providers. The decision marks a sharp turn away from a more decentralized process that has been criticized for inconsistency across regions of the state and sluggishness in its effort to vaccinate Californians. It will also mean the outsourcing of tasks that, until now, have been overseen by state and local government officials.”
Treatment and Testing: Long haulers and heart damage: a report in JAMA Cardiology (here) found that “In this study of a cohort of German patients recently recovered from COVID-19 infection, CMR [cardiac magnetic resonance imaging] revealed cardiac involvement in 78 patients (78%) and ongoing myocardial inflammation in 60 patients (60%), independent of preexisting conditions, severity and overall course of the acute illness, and time from the original diagnosis.”
Policy: The federal agency charged with pandemic preparation was used as a “slush” fund for unrelated expenditures, according to a letter (here) to the President, reported also (here) by The New York Times: “The Biomedical Advanced Research and Development Authority, which drew national attention last year when the Trump administration fired its director, has been used for the past 10 years as a ‘slush fund’ to cover expenses unrelated to its core mission of fighting health threats like Ebola, Zika and the coronavirus. The 223-page report, issued Wednesday by the Office of Special Counsel, found that the Department of Health and Human Services diverted millions of taxpayer dollars intended for BARDA to finance vaccine research and pandemic preparedness into other government activities, and failed to inform Congress — a potential violation of federal law.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Early Career Radiologists Decry Corporatization, Private Equity
A survey of 600 early career radiologist (reported here) in the Journal of the American College of Radiology found that “86% believe that corporate entities harm radiology as a specialty. And another 83% said they’d prefer to work for an independent practice, rather than one owned by a corporation.”
Admission to the Hospital for Patients With Chest Pain Shows Wide Variation, No Apparent Benefit
A study in Cardiovascular Quality and Outcomes (reported here) showed “Wide variation in individual physician admission rates were observed (unadjusted, 1.5%-68.9%) and persisted after case-mix adjustments (adjusted, 5.5%-27.8%). More clinical experience was associated with a higher likelihood of hospital care,” but also that “There was no associated benefit in 30-day death or acute myocardial infarction for patients evaluated by high-admitting physicians.” Also not helping: public reporting of PCI mortality by physician, in this study in JAMA Cardiology, which found that “public reporting of ssRAMR [site specific risk adjusted mortality rate] in NYS [New York State, which compels such reporting] does not adequately reflect the quality of care delivered by physicians performing PCI, may be misleading to patients, and should not be reported for physicians practicing at multiple sites.” But this may help: remote monitoring of post-discharge cardiac (acute MI) patients by allied health professionals, also in JAMA Cardiology.
Physician Practice Productivity Recovers, Reimbursement Still Lags
KaufmanHall reports (here) in their second “Flash Report” on physician practices that “Physician Work Relative Value Units (wRVUs) per FTE rose 4.6% from July to October. Even so, Physician wRVUs per FTE were 4.9% below 2019 levels, due to fewer patient visits and lower hospital diagnostic and procedural volumes compared to pre-pandemic levels. New patient visits—which are key to growing physician practices—also declined year-over-year due to negative economic trends, competitive telehealth offerings, and continued reluctance of some patients to visit physician offices.” One area of growth, the Medicare annual “wellness” visit, is followed by a “cascade” of low-value studies, according to this study in JAMA Open Network: “A minority of healthy Medicare beneficiaries received routine tests during their annual wellness visits, and low-value electrocardiograms and urinalyses were associated with cascades of care.” That minority of patients probably came from a minority of PCPs, according to a study in the Annals of Internal Medicine, report here: “Most primary care physicians performed, ordered and referred out a minority of their patients’ spending on low-value services.”
Understaffing of Nursing Found in COVID-19 Hospital Patient Care
As well as wide variability, according to a study in BMJ Quality and Safety (here): “Mean staffing in medical-surgical units varied from 3.3 to 9.7 patients per nurse, with the worst mean staffing in New York City.”
READINGS & REFERENCES
GAO on Lessons Learned Through September 2020
The GAO and recipients of its 500+ page report (here) release results of their examination of federal COVID-19 efforts.
Quality Measures and Professionalism
Harvard’s J. Michael McWilliams offers a contribution in the NEJM (here) to the debate over intrinsic (professional) and extrinsic (it’s all about tips, per the late Uwe Reinhardt) measures of patient quality.
Cancer Declines Over Times
This study in CA Cancer Clin J finds “After increasing for most of the 20th century, the cancer death rate has fallen continuously from its peak in 1991 through 2018, for a total decline of 31%, because of reductions in smoking and improvements in early detection and treatment. This translates to 3.2 million fewer cancer deaths than would have occurred if peak rates had persisted.”
Final Rules for 2021 Payment Under Medicare
The final rule for physician fees (and related outpatient payments) under Medicare from the Federal Register of December 28, 906 pages, is here; the final rule for hospital outpatient (and other Part B payments) from the Federal Register of December 29, 440 pages, is 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.
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.
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February 8, 9, 10, 11, 23, 24, 25, 26
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Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.