DCMedical News: Monday, April 19, 2021
DCMedical News-DCMN
Washington, D.C.
Monday, April 19, 2021
DCMedical News is published every day both the House and the Senate are scheduled to be in session. Subscription information and archives from 2018 to the present at dcmedicalnews.org, here.
THE BIG STORY IN HEALTH CARE
Biden Program
Morning Consult reports that “The White House says it will release the second part of President Joe Biden's infrastructure plan, which is set to include health care, this month,” and that “Biden will put making recent changes to the Affordable Care Act permanent and filling the coverage gap in states that haven't expanded Medicaid as a higher priority over lowering the Medicare eligibility age or allowing Medicare to directly negotiate drug prices,” on grounds that “once you've made a deal, making that deal permanent is easier than making a new deal."
Sequestration Extension Signed
President Biden signed into law legislation (announcement here) to prevent Medicare payment cuts to health care providers from taking effect for the rest of the year. The sequestration program, begun in 2013, docks Medicare spending by automatic, across-the-board reductions in Medicare payments to health care providers by up to 2 percent, which would have been about $12.3 billion over the next nine months.
Junk Health Plans Targeted
Senators Casey, Baldwin and Stabenow introduced the Junk Plan Accountability and Disclosure Act which would beef up the Federal Trade Commission's authority to take enforcement action against misleading online health coverage ads; require junk plans to provide a plain language explanation of benefits before enrollment and a warning to inform consumers that the plan is not comprehensive; require junk plans to issue annual reports detailing their enrollment, the amount of claims that are submitted to them and the amount of claims that they deny; strengthen funding for federal ACA outreach and enrollment efforts and create a separate open enrollment outreach program for states with state-based marketplaces. News release here. See also “Patient Advocacy and Voluntary Health Groups Take Aim at Skinny Health Plans,” DCMN 4-16-21.
Doctors in the House (and in the Senate)
Seventeen physicians are members of the 117th Congress (list here), 6 surgeons, 3 emergency medicine physicians, 14 Republicans (3 Democrats), 4 Senators (13 Members of the House), 1 Woman.
Coronavirus
Half of the adult population in the U.S. has received at least one vaccination shot. Today begins “anyone over 16 is eligible” in most states. Value in Health publishes (introduction here) a series of articles on the health-economics of coronavirus.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Cardiologists Promote Their Skills for Thrombectomy
This month’s JACC: Cardiovascular Interventions (article here, Medscape coverage here) has a study of outcomes of acute stroke thrombectomy in a cardiology cath lab. The article notes that “Mechanical thrombectomy has proven to be the best treatment option for ischemic stroke patients, but this method is not widely available.” These researchers established an endovascular treatment program for ischemic strokes in the cardiac cath lab in the tertiary hospital in 2012. The decision to perform a thrombectomy would be made be a neurologist, based on stroke clinical symptoms and CT angiographic findings. The 333 patients treated over the course of seven years had a total of 19 intracerebral hemorrhages and six embolizations in new vascular territory. The researchers contend that the “outcomes were comparable to those of neuroradiology centers.” They further indicate that the “learning curve” was flat, that is, “The desired clinical results were achieved from the onset of the program, without any signs of a learning curve effect.” Cardiologists being much more readily available than neuro-interventionalists, the researchers conclude that “These findings support the potential role of interventional cardiac cath labs in the treatment of acute stroke.”
Highest Paid (Salary Only Survey) Physicians, by State
Medscape reports (here) that the highest paid salaried physicians were in New York? California? Well, no. The highest paid were in Alabama, Kentucky (both repeating these positions from last year’s survey) and Oklahoma, New York ranking next to last. Self employed physicians earned more, on average, than those employed. Paperwork hours per week ranged from a low of 10 (anesthesiology) to a high of 24 (infectious disease). Worst part of the job, rules and regulations.
Nurses at Greater Risk for Suicide, 2x for Female Nurses, Even Before the Pandemic
A major new study of health professions’ mental health stress (study here, commentary here) in JAMA Psychiatry found that, from 2007-2018, “suicide rates among nurses exceed those of people in the general population and that female nurses are at twice the risk for suicide compared with women in the general population.” The findings “predate the COVID-19 global pandemic and its exacerbation of 2 well-known risk factors for suicide among health care workers: work-related stressors and mental health problems . . . A 2020 systematic review of studies examining the prevalence of mental health problems in health care workers since the start of the COVID-19 pandemic demonstrates [high] prevalence of anxiety, depression, and stress among health care workers . . . The highest level of psychological distress identified in this systematic review was among nurses, women workers, frontline health care workers, younger medical staff, and workers in areas with higher infection rates . . . these findings suggest that the national trends in suicide among nurses are greater than the general population and are potentially increasing in the context of the COVID-19 global pandemic.”
HOSPITALS, NURSING HOMES AND OTHER HEALTN CARE FACILITIES
Post-Operative Risk for COVID-19 Patients
A study in JAMA Network Open (here) found that “Among all hospitals, there were more than double the number of deaths reported in the cohort of patients with COVID-19 (811 [14.8%]) compared with the cohort of patients without COVID-19 (388, [7.1%]).” Complications and length of stay did not differ, but HACs and patient safety events were both more common among the COVID-19 patients. Also, “Among surgical patients with COVID-19, there were no differences in mortality rates, complications listed in the Vizient Clinical Data Base, hospital-acquired conditions, or patient safety indicators among public, private, or nonprofit hospitals.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
“Bundled” Payments Don’t Save Money, in Fact Increased Expenditures, at Least in the Netherlands
A study in Health Policy (here) found that “Bundled payments for chronic diseases increased health care expenditure in the Netherlands, especially for multimorbid patients.” Background: “The Netherlands introduced bundled payments for chronic diseases in 2010. These were expected to improve integration of care and reduce healthcare expenditure. Their long-term effects were unknown. The bundled payments led to an increase in total healthcare expenditure. This increase was higher in patients with multimorbidity.”
Medicare Part E (The “Choose Medicare” Act)
A newly introduced bill (here) for Part E would require such plans to meet PPACA requirements at the gold level; require coverage for abortion; prohibit states from disallowing the plan; be available for individuals and groups; and require Medicare participating providers to also participate in Part E, but with negotiation “in a manner that results in payment rates that are not lower, in the aggregate, than rates under title XVIII [Medicare], and not higher, in the aggregate, than the average rates paid by other health insurance issuers offering health insurance coverage through an Exchange.”
READINGS & REFERENCES
Select Coronavirus Public Health Resources and References (alphabetical) may be found here.
2021 CQ Congressional Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
April 20, 21, 22
May 11, 12, 13, 14, 17, 18, 19, 20
June 14, 15, 16, 17, 22, 23, 24, 25
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.