Healthcare News from My In-Box and some Opinion
Much of the news from the last few weeks has been about Covid, the Delta version, the Delta versions impact on the unvaccinated, and the lack of resources to care for those with Covid. Medical resource capacity is very low in some states. Hospitals are shipping patients to other cities and or states for care at a great expense.
Practicing your individual rights in the United States is protected mostly for White Americans and complained about if others of a different ethnicity, color, gender, etc. practice similar. What many practicing those rights during this pandemic forget is the practice of such rights shall not infringe upon the rights of others. Those practicing such claims do not care.
Biden Plans to Tie Vaccines for Nursing Home Staff to Fed Funding (medscape.com)
President Joe Biden intends to use the financial clout of Medicare and Medicaid to require that the staff of US nursing homes get COVID-19 vaccines, with plans to release a formal plan for this mandate next month.
A press release issued Wednesday by the Centers for Medicare & Medicaid Services (CMS) didn’t offer specific details on how such a mandate would work, such as intended fines or penalties or potential thresholds for withholding federal payment.
As one critic said “Focusing only on nursing homes will cause vaccine-hesitant workers to flee to other healthcare providers and leave many centers without adequate staff to care for residents.” There is already a shortage
Lacking Beds, Hospitals Ship COVID-19 Patients to Other States (medscape.com)
Hospitals in several states are full of COVID-19 patients and no longer have beds available, so they’re sending patients to other states for treatment — sometimes hundreds of miles away on ambulances, helicopters and planes, according to The Associated Press.
More than 85,000 COVID-19 patients are hospitalized across the U.S., according to the latest data from The New York Times. Arkansas, Florida, Hawaii, Louisiana, Mississippi and Oregon hit record-high levels for COVID-19 hospitalizations during the past week, and Alabama ran out of intensive care unit beds on Wednesday, the newspaper reported.
Keeping people out of hospitals during a pandemic has been difficult until vaccines were put into play. Much of today’s issue is the result of too few being vaccinated and resisting vaccination.
Biden Administration Takes Further Action to End Barriers to Medicaid Coverage – Center For Children and Families (georgetown.edu)
Nearly six months ago, the Biden Administration initiated efforts to withdraw work reporting requirements in the eleven states with approved section 1115 Medicaid waivers. Now, the resolution many have been waiting for is almost entirely complete.
On August 10, Ohio, South Carolina, and Utah all received letters from CMS formally withdrawing their work requirement waivers. The recissions of the work requirement in South Carolina’s “Palmetto Pathways to Independence” and Utah’s “Primary Care Network” demonstration withdrew the specific waiver authorizing the states to impose the requirements. In the case of Ohio and South Carolina’s second 1115 demonstration “Healthy Connections Works” though, CMS withdrew the states’ demonstrations in their entirety since the demonstrations only included the authority to impose work requirements.
We still need to end the Medicaid requirement of paying for the care received from Medicaid. Most people do not have resource to do so which is why they use Medicaid in the first place. Medicaid grants access to healthcare and Long Term Care to those who have neither with the agreement to sign over all resources and assists for the care.
We do need a resource for Long Term Care which would have occurred if Ted Kennedy had not died.
No Physicians Disciplined for COVID Falsehoods | MedPage Today
Despite a national call to sanction doctors who spread COVID-19 misinformation, a MedPage Today investigation found not one of 20 physicians who’ve peddled such falsehoods has been disciplined by their state licensing agency for doing so.
In spite of complaints being filed, the investigations haven’t been launched. These elements are confidential in most states, including the 10 contacted by MedPage Today who license the physicians.
This means physicians who have advanced false COVID information — including Simone Gold, MD, JD; Scott Atlas, MD; Joseph Mercola, DO; Lee Merritt, MD; Sherri Tenpenny, DO; and Stella Immanuel, MD — are free to continue to misinform their patients and the public, even as the Delta variant surges.
Fraudulent claims and fallacies by medical personnel.
With no beds, hospitals ship patients to far-off cities | Modern Healthcare
MISSION, Kan. (AP) — Many overwhelmed hospitals, with no beds to offer, are putting critically ill COVID-19 patients on planes, helicopters and ambulances and sending them hundreds of miles to far-flung states for treatment.
The surge in the delta variant of the virus, combined with low vaccination rates, has pushed hospitals to the brink in many states and resulted in a desperate scramble to find beds for patients.
The issue is that large hospitals in urban areas already were running short of space and staff with non-COVID procedures like cancer biopsies and hip replacements when the summer surge started. That means they have very few free beds to offer to patients from small rural hospitals without ICUs or from medical centers in virus hotspots.
More of the same on the lack of resource to treat Covid in unvaccinated people.
Pharmacist Charged for Vax Card Sales; Moderna Recipe Fight; Drug Waste Report COIs | MedPage Today
A Chicago pharmacist was arrested for allegedly selling dozens of COVID-19 vaccination cards on eBay, according to the Department of Justice.
Tangtang Zhao, 34, sold 125 authentic CDC vaccination cards to 11 different buyers for about $10 per card in March and April of 2021, the DOJ said.
More Fraud and lies by people we trust and who should know better
Is the Hospital Price Transparency Rule Actually Lowering Costs? | MedPage Today
In 2019, the U.S. spent $3.8 trillion or $11,582 per capita on healthcare, about 18% of the gross domestic product. The affordability of hospital care, which accounts for the largest share of healthcare spending (31% or $1.2 trillion), has significant public interest implications. The lack of hospital price transparency has been considered to be an important factor that compromises hospital care price competition and care affordability.
Comparing Complication Rates After Elective Total Knee Arthroplasty Delivered Or Purchased By The VA | Health Affairs
Veterans frequently face decisions about which services should be delivered versus purchased by the VA. Comparisons of quality across settings are essential if veterans are to receive care that is consistently accessible, patient centered, effective, and safe. We compared risk-adjusted major postoperative complication rates for total knee arthroplasties that were delivered in VA facilities versus purchased from community providers. Overall, adjusted complication rates were significantly lower for arthroplasties delivered by the VA compared with those that were purchased. However, hospital-level comparisons revealed five locations where VA-purchased care outperformed VA-delivered care. As the amount of VA-purchased care continues to increase under the Veterans Access, Choice, and Accountability Act of 2014 and the VA Maintaining Internal Systems and Strengthening Integrated Outside Networks Act of 2018, these results support VA monitoring of overall and local comparative hospital performance to improve the quality of the care that the VA delivers while ensuring optimal outcomes in VA-purchased care.
In most cases, the VA still out performs commercial healthcare and does it at a lower cost. Yet, politicians cut funding to it and push more veterans to commercial healthcare. If Medicare used the VA formulary, it would be saving $billions. There was a move afoot to do so.
Vaccinations Against COVID-19 May Have Averted Up To 140,000 Deaths In The United States | Health Affairs
We assessed the association between US state-level vaccination rates and COVID-19 deaths during the first five months of vaccine availability. We estimated that by May 9, 2021, the US vaccination campaign was associated with a reduction of 139,393 COVID-19 deaths. The association varied in different states. In New York, for example, vaccinations led to an estimated 11.7 fewer COVID-19 deaths per 10,000, whereas Hawaii observed the smallest reduction, with an estimated 1.1 fewer deaths per 10,000. Overall, our analysis suggests that the early COVID-19 vaccination campaign was associated with reductions in COVID-19 deaths. As of May 9, 2021, reductions in COVID-19 deaths associated with vaccines had translated to value of statistical life benefit ranging between $625 billion and $1.4 trillion.
The plus side of early vaccinations.
Mississippi’s Hospital System Is Rapidly Approaching Statewide Failure | The New Yorker
On Wednesday, Alan Jones, a senior administrator at the University of Mississippi Medical Center, announced that the state’s hospital system is approaching the “nightmare” that officials have “feared the most . . . total failure.” He said,
“Within the next five to seven to ten days, I think we’re gonna see failure of the hospital system in Mississippi. I mean, hospitals are full from Memphis to Gulfport, Natchez to Meridian. Everything is full.”
Owing to a shortage of both beds and staff, hospitals will be unable to treat not just covid-19
More detail about the impact of the unvaccinated on medical resources.
Vaccine Effectiveness Against Infection May Wane, CDC Studies Find
NYT: Vaccine Effectiveness Against Infection May Wane
… Together, the new studies indicate overall that vaccines have an effectiveness of roughly 55 percent against all infections, 80 percent against symptomatic infection, and 90 percent or higher against hospitalization, noted Ellie Murray, an epidemiologist at Boston University.
“Those numbers are actually very good,” Dr. Murray said. “The only group that these data would suggest boosters for, to me, is the immunocompromised.” …
Before people can begin to receive boosters, the Food and Drug Administration must first authorize a third dose of the vaccines made by Pfizer-BioNTech and Moderna, and an advisory committee of the C.D.C. must review the evidence and make recommendations. …
One of the new C.D.C. studies analyzed the effectiveness of vaccines among residents of nearly 4,000 nursing homes from March 1 to May 9, before the Delta variant’s emergence, and nearly 15,000 nursing homes from June 21 to Aug. 1, when the variant dominated new infections in the country.
The vaccines’ effectiveness at preventing infections dropped from about 75 percent to 53 percent between those dates, the study found. It did not evaluate the vaccines’ protection against severe illness. …
A second study evaluated data from New York State from May 3 to July 25, when the Delta variant grew to represent more than 80 percent of new cases. The effectiveness of vaccines in preventing cases in adults declined from 91.7 percent to 79.8 percent during that time, the study found. But the vaccines remained just as effective at preventing hospitalizations. …
The third study from the C.D.C. found that the vaccines showed 90 percent effectiveness against hospitalizations in the country …
“Practicing your individual rights in the United States is protected mostly for White Americans and complained about if others of a different ethnicity, color, gender, etc. practice similar. What many practicing those rights during this pandemic forget is the practice of such rights shall not infringe upon the rights of others. Those practicing such claims do not care.”
The bolded sentence is meaningless unless you, we, can somehow become alert to when WE are claiming rights that infringe on the rights of others. There is ALWAYS a conflict of “rights.” The whole point of democracy is to try to find a way to balance your rights against my rights, and to decide which rights are more important than others. Since human beings are notoriously bad at this, we have an adversarial system of law and politics to at least try to protect ourselves from our own blindness and the blindness of an all powerful authority.
Possibly “those practicing such claims do not care,” but it is a little fatuous to set ourselves up to judge what others “care” about while we ourselves don’t care about them.
This gets especially dubious if we haul racism, sexism, and etc-ism as an all purpose explanation of why “other people are so mean”… to us or our favorite perennial victim group.
Or, as Anaximander said, “All things arise out of chaos through injustice, one against the other, and thither are they returned in retribution, according to the order of time.” But it’s especially insufferable when it is accompanied by holier than thou blather and perverse blindness .
Yawn . . . the practicing of your rights in society shall not infringe upon societies or other individual right’s to safety.
It is held, a person should be left as free as possible to pursue their own interests as long as the pursuit or practice of shall does not harm the interests of others. In such a situation where the pursuit of interests by an individual does cause harm, “society has the jurisdiction over [the person’s conduct]. The practice of such liberty is not simply for the purpose of allowing selfish indifference The practice of such a liberal system will bring people to the practice of good more effectively than physical or emotional coercion.
One can conclude a person may, without fear of just punishment, do harm to himself through vice. Governments, he claims, should only punish a person for neglecting to fulfill a duty to others (or causing harm to others), not the vice that brought about the neglect.
This is simple J.S. Mill.
That entire hospital pricing transparency thing? I have yet had it explained just how that would work. Even if it is elected procedures, patients go where their doc has rights in. If offered a choice because the doc has rights at 2 places, the decision is based on how the patient views the reputation of the hospital. At least that is how it happens around my state.
Using the “free market” model implies that the person was/is free to make a decision at the time the decision has to be made. Not really the case when it comes to your health.
Yes:
In most cases. With MA you are limited to where you can go. The same with commercial insurance “these” days. With traditional Medicare, you can go anywhere as it is mostly accepted.
Are you going to negotiate if you are very ill?
“Are you going to negotiate if you are very ill?”
Exactly my point and may other’s point. Yet, it does not seem to be a concern of those who have been building this system as if we’re building for the purchase of toys.
Daniel:
The hospital management and insurance company execs know what they are doing. They know when you show up, you will only be thinking of getting better or fixed. When I go there with a bout, I bring a suitcase. I know I am not going home and that I will be there a week or so. The treatment is the same no matter where I go. The infusions are the same with the same expensive-ass drug. And I know I will be stabbed daily to test my blood.
I am very vulnerable to disease and bleeding out then. Forty years of this malady. This time after my first infusion, I woke up confused as to why I was there. I called my wife and asked why I was there. It was strange as I am not disoriented to such a degree.
I am here!
Run
yes, it is simple…odd from a person who finds other people’s lack of ability to manage complexity to be a sign of dimished adulthood.
I am glad for J.S.Mill: he articulated a number of ideas that other people needed to think about. But I have never managed to take “great men” so seriously that I am obligated to believe that everything they say is the last word.
I am sorry for the yawn. That is a sign of disrespect, and if I don’t take it personally…I don’t… it is a sign of contempt..contempt for the possibility of learning, or at least thinking about something “new”.. to you. at least.
You may not have quite registered Mill’s words about “The practice of such a liberal system will bring people to the practice of good more effectively than physical or emotional coercion.” Mill does not seem to have considered the perils of “society shall have the jurisdiction..” As in the case of the Nazis, the Communists, or the good citizens of Salem. Society’s jurisdiction is inevitable… whether from good liberals or mindless “give Me absolute Freedom or die” conservatives. The American Constitution, as far as I know,was the first careful attempt to limit the dangers of “society.” By no means completely successful, and apparently getting less so by the hour.
The Nazis did tell the people that Jews were a public health threat. It may be that the unvaccinated are, but that still leaves the question of what we can or should do about it without fear of backlash or being hoist on our own petard.
Becker
the reptile hearted beings from outer space who design these things have been taught from an early age not to fear death. They believe what they were taught, and, to tell the truth they have never heard anyone they killed complain.
anyway, their lawyers handle the negotiations pre need.
surely, if you were a prudent adult, you would have thought of this beforehand.
Run, Yes they do know. We are experiencing just in time thinking applied to management of our healthcare system. And they have trained the keepers of their system, the doctors well. My father in law was suppose to get out on a Monday. Yet, because the “hospitallist” changed on Monday, he decided he need to “observe” the patient some more to make sure. If I wanted to be rude, I would have asked him if the problem was that he did not trust the assessment and decision of his colleague from the weekend shift. All dad wanted was to get home. He knew and we knew he was dying. Everything was set Saturday for getting him home with all that would be need for Monday. He came home Thursday and died Saturday.
Yes, they know. A-holes!
Coberly, I have a theory that as we have become less agricultural and more industrial and now certainly more virtual we have become less real about death as a part of life. That if when the doctor said “you could die if you don’t do X” we looked the doc in the eye and said So! We would be much better off.
Don’t get me wrong, I’m not saying give up. I’m saying we have lost the reality that death is a part of life.
Another way of looking at it, imagine if every product had the ability to scare you into making the purchase by using the phrase: If you don’t do this, you could die!
That simple phrase is what keeps the system going. That and advertising that in no way should one be inconvenienced so just take X or do Y and you will be like you are 20 when you’re 65.
Part of the problem we are having with this pandemic is that people have been sold health care as if they are buying jeans or crayons or home goods etc. You know, are you a Ford, Chevy or Dodge fan? Which side are you rooting for?
I’ll just end with one of my favorite books that I have mentioned before: 4 Arguments for the Elimination of Television.
We have a major problem in this nation. It is that 47% of the population could not understand the personality of Trump. But such a problem was shown when people used the movies as the standard for understanding the reality of the towers coming down. Totally backward.
Becker
yes. i think i understand that and agree. when i started out i just accepted doctors as part of reality. you got sick, you went to a doctor, you did what he said, you got better. but an accumulation of experiences turned me into the skeptical bastard i have become. fairly recently i have been told by a doctor “We will decide that.” in a tone that implied that I had no right to decide that myself. it took real effort to tell him “no.” since i survived without incident i have had to do it a few more times. i can’t say it really gets easier.
Run
I am truly sorry about your health problems. I have learned that sometimes the doctors are right. That’s what makes it not get easier to say “no.”
But it is amazing how many of them have become Senators. And not the best kind of Senators.
Coberly, Run, et al,
Just ask your doctors about sedation-free colonoscopy option. Both my PCP and my gastroenterologist treated my like I was nuts when I asked. So I am having a sedated outpatient procedure tomorrow at the local hospital. Subsequent I have learned from the dreaded (doctors dread Google in the hands of patients) Internet that both the Mayo Clinic and the NEJM have recommended sedation free procedure for over a decade and it is the only way used in most of the ROW. NEJM made it clear that this was the choice of the butt-hole docs rather than patients. Higher cost for facility and people, but the gastroenterologist spends less time per patient thereby booking more procedures and payments.
https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/benefits-of-sedation-free-colonoscopy
Benefits of sedation-free colonoscopy
Few people look forward to having a screening colonoscopy. Some people even put off having the procedure done because they hear horror stories that are unfounded. Millions of people each year have a colonoscopy and do well, even without sedation.
A colonoscopy is the gold standard for colon cancer screening. During the procedure, a doctor can view your entire colon and rectum, and remove potentially premalignant growths called polyps. Major medical societies recommend screening for colorectal cancer beginning between the ages of 45 to 50.
For most patients, a sedative is given in intravenous form to help relax and minimize any discomfort during the procedure. But did you know that using a sedative is optional? In many countries, sedation-free colonoscopies are the norm. Patients are alert and engaged during the procedure.
Here are the most common questions that I answer when discussing a sedation-free option with patients:
What are the benefits of a sedation-free colonoscopy?
Saving time is the greatest benefit of a sedation-free colonoscopy. If you are sedated for your colonoscopy, you will have restrictions after the procedure until the next day, such as not being able to drive or return to work. You will require a ride home after your procedure, which also may cause your driver to take time off from work. After a sedation-free colonoscopy, you can resume normal activities right away — you can drive, run errands and generally get on with your day.
The second benefit is increased safety. Overall, the sedatives used for colonoscopies are very safe, but there is a small risk of side effects, such as drops in blood pressure, breathing problems, vomiting and prolonged sedation. These are avoided by having a sedation-free colonoscopy…
February 18th, 2009
Sedation-Free Colonoscopy: Why Isn’t It the Standard?
This Saturday’s Wall Street Journal featured an intriguing article on sedation-free colonoscopy, which is standard in Europe and Asia but rarely done in the U.S. One could argue that Americans are just “weenies,” but I think the blame rests solely with us doctors.
Sedation-free colonoscopy is successful in most who try it (I did!), but it does require a more careful exam to ensure that patients are comfortable. Over-distension, looping, and other problems that can cause pain must be avoided, and that means the doctor must spend more time and perform more maneuvers during each procedure. And therein lies the rub. Even though sedation-free colonoscopy is safer and cheaper for patients, most gastroenterologists already feel rushed when they see patients and don’t want to take the time to even broach the subject of sedation-free colonoscopy, let alone actually perform it.
What’s my recommendation? Discuss the availability and benefits of sedation-free colonoscopy with all your patients, and let’s let Americans know to ask for it. It’s a better way to get the exam — and you can even drive yourself home that day!