DCMedical News: Wednesday, May 12, 2021
DCMedical News-DCMN
Washington, D.C.
Wednesday, May 12, 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
COVID-19, Health Care and the First Hundred Days
The Commonwealth Fund reports (here) on the first hundred days of the Biden administration. A dozen executive orders and proclamations in the fist ten days attempted to strengthen Medicaid and the Patient Protection and Affordable Care Act. Relevant department heads were directed to “review existing regulations and policies to ensure they are consistent with the goals of strengthening the ACA and Medicaid and to revise or rescind inconsistent actions.” This included review of “Trump rules and policies that involved turning over marketplace enrollment functions to private entities and using Medicaid Section 1115 waivers to implement work requirements and block grants” as well as “policies that make enrollment in Medicaid and ACA coverage more difficult.” A proclamation Tuesday by HHS Secretary Becerra (here) notes that one million additional persons have enrolled in PPACA exchange programs in the supplemental enrollment period which began February 15, and which is now extended to August 15.
Himmelstein and Woolhandler, co-chairs of The Lancet’s Commission on US Public Policy and Health, report (here) on “Recovering from Trump: Biden’s first 100 days.” They write, “Reluctance to confront market-imposed inequities, corporate privileges, and the outsized power of wealthy campaign donors and of conservative states in the US Senate obstructs further progress. More powerful mobilisation will be needed to impel the administration and Congress to reorient health-care, trade, and aid policies to prioritise health over profit and the military; compensate Black and Indigenous Americans for the land and labour stolen from them; and empower all poor and working-class Americans to share in the prosperity and health gains that the USA’s vast resources should enable.”
Adolescents and Vaccination
Seventeen million adolescents age 12-15 will become eligible for vaccination this week. The Kaiser Family Foundation (here) explores the demographic characteristics of this population, and issues involved in their protection.
More on the Leading Causes of Death in the U.S., and COVID-19 Deaths
Analysis of the National Vital Statistics System’s report on 2020 mortality (here) in JAMA note a 17.7% increase in the number of deaths in 2020 (the increase in the age adjusted rate was 15.9%) compared with 2019, with increases in many leading causes of death. “The provisional leading cause-of-death rankings for 2020 indicate that COVID-19 was the third leading cause of death in the US behind heart disease and cancer.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Truth and Reconciliation: AMA Publishes Plan to Address Inequities and Racism in Medicine and Health Care, Acknowledging Its Own History
The American Medical Association has published an extraordinary (here, 86 pgs.) three-year “strategic plan to embed racial justice and advance health equity.” Concerning its own history, the AMA’s exploration of its archives shows “AMA’s past and/or persistent practices that excluded, formally or informally, physicians based on race, ethnicity, gender, sexual orientation, ability and country of origin (i.e., International Medical Graduates), and caused long-standing harm to historically marginalized and minoritized communities. Historically, AMA policies have not always been well-aligned with an equity and justice imperative. We cannot deny that AMA’s past silence on certain health system and policy-related issues has contributed to and had a negative impact on historically marginalized and minoritized communities, and exclusion in medicine more broadly.”
STAT reports (here) that “The vile and painful episodes described in the report include the AMA publishing an 1849 state medical association policy that called for ‘irregular-bred pretenders,’ like ‘Indian Doctors,’ to be considered illegal practitioners; then-AMA president Alfred Stillé calling women inferior to men in all respects in 1871; AMA’s president from the late 1870s, J. Marion Sims, practicing vaginal surgeries on enslaved women without anesthesia; the AMA-supported Flexner Report leading to the closure of many Black and female-only medical schools; the Journal of the American Medical Association supporting the Chinese Exclusion Act” and anti-Semitic references in official AMA documents.
Survey Finds Final Year Residents Seeking Larger Employers, Big Cities; Joy in Short Demand
Merritt Hawkins survey of final year residents (here) finds “Geographic location is the most important factor residents consider when examining a job opportunity, followed by adequate personal time and lifestyle considerations,” and that “More medical residents (45%) would prefer hospital employment as their first practice setting than any other type of setting.” None of those surveyed (Merritt Hawkins cautions that returns were low for this year’s survey) would prefer living in a community with fewer than 10,000 residents, and only 3% in a community with fewer than 25,000.
A report in Health Policy (here) on “Burnout of intrinsically motivated GPs when exposed to external regulation.” Write the authors, “The well-being of general practitioners (GPs) is threatened by low job satisfaction and burnout. GPs’ well-being is important as it influences quality of care, GP prescription patterns, patients’ adherence to medical treatments and patient satisfaction. Moreover, well-being has proven central for the retention of GPs. Hence, in times of GP shortage well-being is key. One measure of well-being is burnout, which, among GPs, has been associated with increasing administrative burdens, greater workload, and longer working days . . . Sinsky et al. remarked in their paper on burnout in general practice that ‘joy is in short demand.’”
The AMA reports (here) on the impact of COVID-19 on physician practices.
Hall, Render attorneys provide an update (here) in an AHLA blog on new Stark and Anti-Kickback law requirements, effective January 19, 2021, noting “The Stark group practice rules are very complex and so are the proposed changes.” CMS issued a press release (here) and “fact sheet” (here), the latter hailing the clarifying and modernization of the rules.
The AMA published its survey (here) of physician practice arrangements, finding that “The magnitude of the changes since 2018 suggest that the shifts toward larger practices and away from physician-owned practices have accelerated. The Benchmark Survey data also make apparent the wide range of practices in which physicians work. No single practice type, ownership structure, or size can or should be considered the typical physician practice. 2020 was the first year in which less than half (49.1 percent) of patient care physicians worked in a private practice—a practice that was wholly owned by physicians.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Ouch, That Hurts!
Do management consultants make healthcare better or worse? A report in The Financial Times (here) on consultancy in England’s National Health Service finds “Hard evidence showing that consultants make a positive difference is elusive. In a 2018 study, Kirkpatrick, Sturdy and others examined 120 English hospital trusts over four years to discern the relationship between expenditure on consultants and efficiency, including levels of patient satisfaction . . . The more trusts spent on consultants during that period, the more inefficient they became.” They ask, “Is it a result of consultants providing the wrong advice, or managements not heeding the right advice, or because they were commissioned to work on a project that was never going to succeed in the first place? Perhaps a combination of all those things.”
DRUGS & DEVICES
New Technology Add-On in Proposed Rule for 2022 IPPS
Cardiovascular Business reports (here) that “CMS has ruled that coronary intravascular lithotripsy (IVL) cases performed in a hospital setting be eligible for an additional payment through a New Technology Add-On Payment(NTAP).”
READINGS & REFERENCES
Select Coronavirus Public Health Resources and References (alphabetical) may be found here.
2021 CQ Congressional Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
May 13, 14, 17, 18, 19, 20
June 14, 15, 16, 17, 22, 23, 24, 25
July 19, 20, 21, 22, 26, 27, 28, 29, 30
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.