DCMedical News: Wednesday, June 16, 2021
DCMedical News-DCMN
Washington, D.C.
Wednesday, June 16, 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
Post-Covid 19 Study Based on (34 Billion) Health Insurance Claims Shows 23% of Patients With Continuing Symptoms
FAIR Health’s study (here), based not on clinical but on claims information, shows that “Many patients recover from COVID-19 within a few weeks, but some exhibit persistent or new symptoms more than four weeks after first being diagnosed. Patients with such post-COVID conditions are variously referred to as having long-haul COVID, long COVID or post-acute sequelae of COVID-19 (PASC). Using longitudinal data from a database of over 34 billion private healthcare claim records, FAIR Health studied a total of 1,959,982 COVID-19 patients for the prevalence of post-COVID conditions 30 days or more after their initial diagnosis with COVID-19. To FAIR Health’s knowledge, this is the largest population of COVID-19 patients so far studied for post-COVID conditions.”
“Among the key findings: Of patients who had COVID-19, 23.2 percent had at least one post-COVID condition. Post-COVID conditions were found to a greater extent in patients who had more severe cases of COVID-19, but also in a substantial share of patients whose cases lacked symptoms. Of patients who were hospitalized with COVID-19, the percentage that had a post-COVID condition was 50 percent; of patients who were symptomatic but not hospitalized, 27.5 percent; and of patients who were asymptomatic, 19 percent. The five most common post-COVID conditions across all ages, in order from most to least common, were pain, breathing difficulties, hyperlipidemia, malaise and fatigue, and hypertension.”
A report on the study in The New York Times (here) said that it “Analyzed records of people diagnosed with Covid-19 between February and December 2020, tracking them until February 2021. It found that 454,477 people consulted health providers for symptoms 30 days or more after their infection. FAIR Health said the analysis was evaluated by an independent academic reviewer but was not formally peer-reviewed.” The strength of this study is its size and its ability to look across the range of disease severity, according to Dr. Helen Chu, an associate professor of medicine and infectious diseases at the University of Washington School of Medicine. “The report ‘drives home the point that long Covid can affect nearly every organ system,’ said Dr. Ziyad Al-Aly, chief of the research and development service at the VA St. Louis Health Care System . . . Some of these manifestations are chronic conditions that will last a lifetime and will forever scar some individuals and families,’ added Dr. Al-Aly.”
The Times noted that “The database included only people with private health insurance or Medicare Advantage, not those uninsured or covered by Medicare Parts A, B and D, Medicaid or other government health programs. Dr. Chu said people without insurance or with incomes low enough to qualify for Medicaid are often more likely to have worse outcomes, so the findings may understate the prevalence of some post-Covid health problems or may not represent the full picture. In addition, diagnostic codes in electronic records are ‘only as good as what is documented by the provider who saw the patient,’ said Dr. Chu.”
On Monday the CDC published “interim guidance” (here) for the treatment of “long COVID” illness and symptoms.
DOCTORS, NURSES AND OTHER HEALTH CARE PROFESSIONALS
Pandemic Highlights Doctor Shortage in AAMC Survey, Exacerbated by Burnout
“According to new data published today (here) by the AAMC (Association of American Medical Colleges), the United States could see an estimated shortage of between 37,800 and 124,000 physicians by 2034, including shortfalls in both primary and specialty care. ‘The COVID-19 pandemic has highlighted many of the deepest disparities in health and access to health care services and exposed vulnerabilities in the health care system,’ said AAMC President and CEO David J. Skorton, MD.” Conducted in 2019, prior to the pandemic, the study is the 7th annual AAMC survey.
AAMC noted that “In his testimony (https://www.aamc.org/media/54376/download) during a recent congressional hearing on addressing the dire health care workforce shortage, Skorton noted that the issue of increasing clinician burnout, which has been intensified by the pandemic, could cause doctors and other health workers to cut back their hours or accelerate their plans for retirement.”
Demographics which drove the study findings included: “Population growth and aging — continue to be the primary driver of increasing demand from 2019 to 2034. During this time, the U.S. population is projected to grow by 10.6%, from about 328 million to 363 million, with a projected 42.4% increase in those aged 65 and above; A large portion of the physician workforce is nearing traditional retirement age . . . More than two of every five active physicians in the U.S. will be 65 or older within the next decade; Additionally, according to the AAMC’s 2019 National Sample Survey of Physicians, 40% of the country’s practicing physicians felt burned out at least once a week before the COVID-19 crisis began . . . If marginalized minority populations, people living in rural communities, and people without health insurance had the same health care use patterns as populations with fewer barriers to access, up to an additional 180,400 physicians would be needed now.”
Legislative relief for the pending shortage: The AAMC reports that “At the end of 2020, Congress took an important step to address the physician shortage by adding 1,000 new Medicare-supported graduate medical education (GME) positions—200 per year for 5 years—targeted at underserved rural and urban communities and other teaching hospitals nationwide, ending a nearly 25-year freeze on Medicare support for GME. Bipartisan legislation recently introduced in both the U.S. House of Representatives and the Senate, the Resident Physician Shortage Reduction Act of 2021 (https://www.aamc.org/news-insights/press-releases/aamc-endorses-resident-physician-shortage-reduction-act-2021), would build upon this historic investment and help expand the physician workforce by adding 2,000 federally-supported medical residency positions annually for seven years.”
Mom Wanted Me To Be a Provider
A plaintiff note in JAMA (here) discusses the use and misuse of the word “provider” in health care, a sobriquet originally applied to institutional providers, widely used in the managed care industry beginning in the mid-1980s, reportedly to diminish the authority of the word “physician.” The authors write, “The word provider comes from the world of commerce and delivery of commoditized services. It makes no reference to professionalism or to trusted therapeutic relationships. The personalized, important nature of health care depends on trust and professionalism, with the expectation that clinicians will place the needs of those they serve ahead of their own and those of their organizations. When used to designate those who care for patients, provider has the potential to suggest that patients are mere consumers, serviced without commitment to professionalism. This could foster distrust in the health care delivery system, which is an emerging problem. Most patients do not want to be seen as consumers.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
More on Price Transparency (Still Opaque)
A research report in JAMA Internal Medicine (here) on hospital price transparency, mandated by Congress but with minimal fines for noncompliance, found that “Of the 100 randomly sampled hospitals, 83 were noncompliant with at least 1 major requirement.” The report from big revenue hospitals: “Selective compliance was especially pronounced for the 100 highest revenue hospitals . . . Of the 100 highest-revenue hospitals, 75 were noncompliant with at least 1 requirement. Only 35 reported payer-specific negotiated rates . . . A total of 86 offered a price estimator tool, of which 34 posted payer specific negotiated rates in a machine-readable file.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
MedPAC, MACPAC Publish Reports to Congress
The Medicare Payment Advisory Commission (news release here, report here) and the Medicaid and CHIP Payment and Access Commission (news release here, report here) have published their June reports to Congress. More in tomorrow’s (June 17) DCMN.
READINGS & REFERENCES
Select Coronavirus Public Health Resources and References (alphabetical) may be found here.
2021 CQ Congressional Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
June 17, 22, 23, 24, 25
July 19, 20, 21, 22, 26, 27, 28, 29, 30
August - none
September 20, 21, 22, 23, 24, 27, 28, 29, 30
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.