DCMedical News: Thursday, February 11, 2021
DCMedical News-DCMN
Washington, D.C.
Thursday, February 11, 2021
DCMedical News is published every day both the House and the Senate are scheduled to be in session. Subscription information and archives here.
THE BIG STORY IN HEALTH CARE
Coronavirus
Tracking: Johns Hopkins (here) shows at 8:00 p.m. on 2-10-21 worldwide 107,297,808 COVID-19 cases, 27,279,523 U.S. cases, 25%. Deaths worldwide are 2,352,063, of which 471,184 are in the U.S., 20%. How many cases are there, really? Noh and Danuser publish in PLOS One (here) this assessment: “In 25 out of the 50 countries, actual cumulative cases were estimated to be 5–20 times greater than the confirmed cases. Our estimates of cumulative incidence were in line with the existing seroprevalence rates in 46 U.S. states . . . In the U.S. states like Louisiana, Georgia, and Florida, more than 4% of the population was estimated to be currently infected, as of September 3, 2020, while in New York this fraction is 0.12%. The estimation of . . . currently infected people . . . may have been misguided by the reliance on confirmed cases.”
Testing: PCR rapid testing, but not yet at home: “Visby Medical announced Wednesday [here] it has received FDA emergency use authorization for its single-use, rapid point-of-care COVID-19 polymerase chain reaction test. Visby's PCR test, which provides results in 30 minutes and is performed without the need for additional instruments or readers, is authorized for point-of-care use by organizations with a CLIA certificate of waiver.”
Policy: COVID relief legislation moves along, with the full House Committee on Energy and Commerce meeting virtually today at 11:00 a.m. to consider public health, Medicaid, CHIP and COVID-related provisions in the $1.9 trillion relief package, summarized here. The Committee has jurisdiction over $188.5 billion of the $1.9 trillion. The House Ways and Means Committee continued debate on its $941 billion share of the total, approving unemployment benefit add-on payments, taking up expansion of health insurance premium subsidies, tax breaks and $1,400 direct payments for millions of households based on income today (Thursday).
DOCTORS, NURSES AND OTHER HEALTH CARE PROFESSIONALS
Graduate Medical Education (GME) — Should Funds Continue to Support Residency Training Primarily In Teaching Hospitals, or Should GME Funds Be Used In Other Settings?
In the pages of JAMA (here) Chandra and colleagues argue that teaching hospitals make money from residents, with or without GME funds from Medicare. “Large cuts to the GME program, of the magnitude of $9 billion that occurred over the 5 years after the 1997 Balanced Budget Act, did not change the number of residents or their salaries, which challenges the views of teaching hospitals that resident education hinges on public support. Moreover, more than 15,000 residency positions have been created since 2003, despite no increase in funding for these positions.” They argue for “sending GME dollars to rural hospitals with training programs, large primary care physician groups, or the Indian Health Service or by reducing debt for physicians and nurses who work in underserved areas and increasing the wages of primary care physicians, nurses, and community health workers who work in underserved areas.” They contend that “GME policy is a microcosm of US health care policy, where professional associations, including the Association of American Medical Colleges, the American Hospital Association, and the Council of Teaching Hospitals, have lobbied Congress and state legislatures to use an outmoded formula to give $20 billion annually to their members, leveraging national catastrophes into an opportunity to ask for more GME funding and raising the specter of ‘unintended consequences’ to derail GME reform that would be in the public’s interest.”
Royce, another voice for reform (here), writes that growth in residency positions as shown in “The National GME Census demonstrates that this growth has disproportionately favored well-reimbursed specialty care . . . from 2003 to 2018, the number of residents increased 209% in plastic surgery, 190% in neurosurgery, 153% in dermatology, 152% in otolaryngology, and 148%in radiation oncology, outpacing the number of residents in less lucrative and more primary care–focused residencies. . . Moreover, a strong correlation (r = 0.87) between median specialty income and GME growth has been described, providing additional evidence of a relationship between GME growth favoring higher revenue–generating specialty training over primary care positions.”
HOSPITALS, SKILLED NURSING FACILITIES AND OTHER HEALTH CARE FACILITIES
Hospital-Acquired COVID-19 Infection: Inevitable, or Malpractice?
Researchers from the University of Genova, writing in the International Journal of Environmental Research and Public Health (here), find that “Hospital-acquired COVID-19 represents a serious public health issue, which is a problem that could create reluctance of patients to seek hospital treatment for fear of becoming infected . . . From a medical-legal point of view, multiple aspects must be considered in order to understand whether the infection is a result of ‘malpractice’ or
an inevitable condition.”
Hospital Management of Health Failure (HF) Examined, Faulted
Researchers from UCLA write in JAMA Cardiology (here) that “Crude rates of overall and unique patient hospitalizations declined from 2010 to 2014 followed by an increase from 2014 to 2017. Additionally, readmission visits after index HF hospitalizations followed a similar trend. Future studies are needed to verify these findings to improve policies for HF management.”
Nursing Home Death Toll in New York
A long and contentious fight over where nursing home patient deaths should be counted (only when they die in the nursing homes, or when they have been sent back to a hospital, etc.) appears to be coming to an end. The think tank Empire Center noted in a message Wednesday night that “Between last week’s court order and tonight’s formal response, the department posted new death totals for each facility, including hospital deaths that had previously been omitted. Those revelations increased the known death toll from about 9,000 to almost 15,000—making clear that the pandemic’s toll on long-term care residents was much worse than the Cuomo administration previously portrayed it to be.” Another potential long-term care controversy: The City reported (here) that “The state, which licenses and inspects all 613 nursing homes in New York, allowed the facilities to administer hydroxychloroquine to patients exposed to the virus, even after public health experts cautioned against its use in non-hospital settings or for elderly and vulnerable patients.”
British Plan to Ditch Hospital Competition, Restore Central Controls
A report in the British Medical Journal (here) indicates that “Key elements of the Health and Social Care Act 2012 are to be reversed in the biggest legislative shake up of the English health service in a decade. A draft white paper, leaked to the website Health Policy Insight, outlines proposals to reverse major parts of former health secretary Andrew Lansley’s controversial reorganisation, including formally abolishing requirements to do with competition and competitive tendering in the NHS, and shifting control and decision making power back to Whitehall.” The Financial Times reports, here.
READINGS & REFERENCES
Cases Down, Revenue Up, Tenet’s CEO Gives Earnings Report for Q4, 2020 (Seeking Alpha, here).
DoJ Asks Supreme Court to Reverse Government Position on PPACA, here.
AHRQ Annual Chartbook on Patient Safety, 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 CQ Congressional Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
February 23, 24, 25, 26
March 16, 17, 18, 19, 22, 23, 24, 25
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.