DCMedical News: Tuesday, April 20, 2021
DCMedical News-DCMN
Washington, D.C.
Tuesday, April 20, 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
“Two Pillars of One Plan”
Politico Nightly reports that only half of the program to be proposed under the Biden Administration’s $2 trillion plan has been unveiled. “The second half is likely to emerge any day now as Biden prepares for his first address to Congress on April 28.” One pillar is the “American Jobs Plan,” broadband, clean water, transit and more. The second “pillar,” including health proposals, is dubbed the “American Families Plan,” including child care, education and other domestic priorities — and is yet to be unveiled.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
On the Internet, Your Patients Are Getting CABG and PCI Information, Doctor
A study in JAMA Internal Medicine (here) notes that “Coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are the most common interventions for coronary artery disease,” and that “patient involvement in the decision-making process is crucial and requires patient access to high-quality medical information. More than 80% of adults rely on the internet for such information.” The study “evaluated the readability, accuracy, content, quality, and suitability of online health information on CABG or PCI for patients,” and found that “Academic websites were more accurate and had more content than nonacademic websites. Public/nonprofit websites were more accurate and suitable than private websites,” but that all of them required at least college-level reading skills.
HOSPITALS, NURSING HOMES AND OTHER HEALTN CARE FACILITIES
SEPSIS-1 Bundle: Rigid Reporting, Focus on Process and a Waste of Time, Effort and Money?
The current issue of the Annals of Internal Medicine has bad news for government-mandated patient safety measures. A study (here) describes “Treatment Patterns and Clinical Outcomes After the Introduction of the Medicare Sepsis Performance Measure (SEP-1).” A companion editorial (here) reports that in “October 2015, the Centers for Medicare & Medicaid Services implemented the Medicare Sepsis Performance Measure (SEP-1), requiring U.S. hospitals to report adherence to a sepsis management bundle that includes obtaining blood cultures, checking serum lactate levels, administering broad-spectrum antibiotics, and if patients are hypotensive or have elevated lactate levels, infusing 30 mL/kg of body weight of intravenous crystalloids within 3 hours of sepsis time zero.”
Controversy followed: “Some believe it has brought welcome attention to sepsis and catalyzed hospitals to implement protocols that save lives. Others are concerned that the measure's rigid treatment requirements and aggressive timelines encourage excessive fluids and antibiotics, curtail clinicians' latitude to calibrate their management to their certainty of infection and patients' severity of illness, and unduly anchor providers' diagnostic focus on sepsis to the exclusion of other serious conditions. Critics have also questioned the evidence supporting SEP-1. Supporters point to observational studies that report lower mortality rates after implementing sepsis bundles. However, these studies are difficult to interpret because bundle implementations are inevitably accompanied by awareness campaigns [Hawthorne effect] that increase the detection of milder cases of sepsis.”
A new study was done with “detailed electronic health record data to determine the effect of SEP-1 on processes of care and risk-adjusted outcomes from 2013 to 2017 among 11 academic and community hospitals affiliated with the University of Pittsburgh.” The results: lots of process, no better results. “SEP1 was associated with a 50% increase in lactate checks . . . and a 30% increase in infusions of 30 mL/kg of intravenous fluid (13% vs. 10%) within 3 hours of culture orders. Despite these significant changes in processes, there were no significant changes in hospital mortality or the percentage of patients discharged to home.”
“Time to Rethink Nursing Homes”
So says long-time Brookings scholar Stuart Butler (here) in JAMA. Butler writes, “Hundreds of thousands of people who are older and disabled live in nursing homes not because they need specialized care or want to live in those facilities, but because Medicaid payment rules make that the only housing with daily living care they can afford.” Butler discusses low wages for caregivers, distorted incentives for owners, and possible alternatives.
FQHC Look-Alikes Receive Set-Aside for COVID-related Work
“Look-alike” community health centers, (similar in all aspects to Federally Qualified Health Centers but not receiving §330 grants), have received a $145 million set-aside, reports Modern Healthcare (here), to “slow the spread of the virus, strengthen vaccine efforts and improve healthcare services and related infrastructure. The new spending is part of the $7.6 billion that Congress gave HHS to help community health centers fight COVID-19 under the American Rescue Plan.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
More Post-Partum Coverage
CMS approved an extension of post-partum coverage in Medicaid programs for two states: from the current 60 days to six months for Georgia, and to one year for Missouri for beneficiaries diagnosed with a substance use disorder. These follow the approval by HHS Secretary Becerra of the Illinois extension of its Medicaid post-partum coverage to one year.
Urban Institute Gives Optimistic Estimate for Increases PPACA Coverage
The Urban Institute has projected that marketplace coverage for the uninsured would increase by more than five million people in 2022 if Congress made permanent the tax credits of the “American Rescue” plan. The Congressional Budget Office had previously estimated increased marketplace coverage of 1.7 million. Permanent expansion of the credits in the “infrastructure” package is expected to be an administration priority.
DRUGS & DEVICES
Here’s a $500 Debit Card to Get You Off Cosentyx
CIGNA has sent letters to users of Novartis’s expensive psoriasis drug Cosentyx, offering a $500 debit card for their use with alternatives to Cosentyx, sparking outrage (here) from patient advocacy (and rival) groups.
Ivermectin, the New Chloroquine
A study in JAMA (here) had as its objective “To determine whether ivermectin is an efficacious treatment for mild COVID-19.” The answer is: “No.” The drug, a common form of which is used to treat worms and parasites in horses, has become popular in some quarters (chloroquine users, mask avoiders, anti-vaxxers) as an alternative for COVID-19 treatment. Lack of results has not kept a judge in Western New York (reported here) from ordering at least two hospitals to provide the non-FDA approved medication to patients who believed it would help them. The FDA explains (here) why this is a bad idea.
The Expensive Few Drugs
The Kaiser Family Foundation (here) reports that “The top 50 drugs covered under Medicare Part B (8.5% of all Part B covered drugs) accounted for 80% of total Part B drug spending.”
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 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.