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Category: Health Policy

Doctors Urge Caution in Interpretation of Research in Times of COVID-19

September 9, 2020

To:      

American College of Cardiology

American College of Chest Physicians

American College of Physicians

American College of Radiology

American Heart Association

American Society of Echocardiography

American Thoracic Society

European Association of Cardiovascular Imaging

European Society of Cardiology

European Society of Radiology

Heart Rhythm Society

Infectious Disease Society of America

North American Society of Cardiovascular Imaging

Radiologic Society of North America

Society of Cardiovascular Magnetic Resonance

Society of Critical Care Medicine

Society of General Internal Medicine

Society of Hospital Medicine


Dear Society Leadership:

We are a group of clinicians, researchers and imaging specialists writing in response to recent publications and media coverage about myocarditis after COVID-19. We work in different areas such as public health, internal medicine, cardiology, and radiology, across the globe, but are similarly concerned about the presentation, interpretation and media coverage of the role of cardiac magnetic resonance imaging in the management of asymptomatic patients recovered from COVID-19.

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Hospitals Must Give Up Power to Save Healthcare

By KEN TERRY

(This is the sixth in a series of excerpts from Terry’s new book, Physician-Led Healthcare Reform: a New Approach to Medicare for All, published by the American Association for Physician Leadership.)

As hospital systems become larger and employ more physicians, healthcare prices will continue to rise and independent doctors will find it harder to remain independent. Hospitals will never fully embrace value-based care as long as it threatens their primary business model, which is to fill beds and generate outpatient revenues. To create a viable, sustainable healthcare system, the market power of hospitals must be eliminated.

Federal antitrust policy is not adequate to handle this task. Even if the Federal Trade Commission had more latitude to deal with mergers among not-for-profit entities, the industry is already so consolidated that the FTC would have to break up health systems involving thousands of hospitals. Such a gargantuan effort would be practically and legally unfeasible.

All-payer Systems

 The government could curtail health systems’ market power without breaking them up. For example, either states or the federal government could adopt “all-payer” models similar to those in Maryland and West Virginia. Under the Maryland model introduced 40 years ago, every insurer, including Medicare, Medicaid, and private health plans, pays uniform hospital rates negotiated between the state and the hospitals.

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Will COVID-19 Force The South To Finally Confront Structural Racism Within Their Medicaid Programs?

By MIKE MAGEE

If you would like to visit the meeting place of America’s two great contemporary pandemics –COVID-19 and structural racism – you need only visit America’s Nursing Homes.

This should come as no surprise to Medical Historians familiar with our Medicaid program. Prejudice and bias were baked in well before the signing of Medicaid and Medicare on July 30, 1965.

President Kennedy’s efforting on behalf of health coverage expansion met stiff resistance from the American Medical Association and Southern states in 1960. Part of their strategic pushback was the endorsement of a state-run and voluntary offering for the poor and disadvantaged called Kerr-Mills. Predictably, Southern states feigned support, and enrollment was largely non-existent. Only 3.3% of participants nationwide came from the 10-state Deep South “Black Belt.”

Based on this experience, when President Johnson resurrected health care as a “martyr’s cause” after the Kennedy assassination, he carefully built into Medicaid “comprehensive care and services to substantially all individuals who meet the plan’s eligibility standards” by 1977. But by 1972, after seven years of skirmishes, the provision disappeared.

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Patient Identity and Patient Record Matching

By ADRIAN GROPPER and DEBORAH C. PEEL

September 4, 2020

Thank you, ONC for the opportunity you gave me to speak in June. Also, thank you for the format of your August meeting where the Zoom chat feature offered a wonderful venue for an inclusive commentary and discussion as the talks were happening. Beats lining up at the microphone any day.

Here is a brief recap of my suggestions, in no particular order:

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THCB Gang Episode 24!

Episode 24 of “The THCB Gang” was live-streamed on Thursday, September 10th! Watch it below!

Joining Matthew Holt (@boltyboy) were some of our regulars: WTF Health Host Jessica DaMassa (@jessdamassa), patient & entrepreneur Robin Farmanfarmaian (@Robinff3), writer Kim Bellard (@kimbbellard), policy & tech expert Vince Kuraitis (@VinceKuraitis), and guest Mike Magee, a medical historian & health economist (@drmikemagee). The conversation was incredibly wide-ranging and one of the best we’ve had in a while–not the least because Mike Magee gave us a great base with how our non -health system somehow did actually act as a cohesive force in society before tech, then COVID19 broke it up!

If you’d rather listen to the episode, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels — Zoya Khan

#COVID19 Symptom Data Challenge

By FARZAD MOSTASHARI & INDU SUBAIYA

Applications for the #COVID19 Symptom Data Challenge close in three weeks! 

Amidst #COVID19, using analytic approaches to maximize available information and data is paramount. Hosted by Margolis Center, sponsored by Facebook Data for Good (@academics), and in partnership with the Joint Program in Survey Methodology, Carnegie Mellon University, and ResolveToSaveLives, the Challenge seeks to analytic approaches that utilize COVID-19 symptom data to develop insights into the trajectory of the novel coronavirus. 

Have a solution? Finalists can win up to $50k and the winning analytic approach will be featured on Facebook’s (@academics) Data For Good website!

Much, much more information is on the Challenge Website. Apply by 11:59:59 pm ET on September 29!

Much more about the Challenge Background in this interview or in this slack channel.

Official rules are here

Farzad Mostashari is CEO of Aledade, former National Coordinator for Health Information technology, and former Deputy Commissioner at the New York City Department of Health and Mental Hygiene. Indu Subaiya is the President at Catalyst @ Health 2.0

To Avoid Pay Cuts, Doctors Must Reduce Waste

By KEN TERRY

(This is the fifth in a series of excerpts from Terry’s new book, Physician-Led Healthcare Reform: a New Approach to Medicare for All, published by the American Association for Physician Leadership.)

Real healthcare reform depends on an effective plan to reduce cost growth. To achieve this goal, it makes a whole lot more sense to cut waste than to limit access to necessary services or slash provider payments to the bone, noted Donald Berwick, MD, a former acting CMS administrator, and Andrew D. Hackbarth, a RAND Corp. researcher, in a 2012 JAMA article. In their telling, a significant reduction in waste would allow us to bend the cost curve without hurting healthcare quality or access.

Berwick shared with me that he doesn’t know how much unnecessary care physicians or hospitals could safely eliminate. “Some of it is marbled into the daily activities of healthcare organizations,” he said. “There would have to be systemic changes to get it done. But it’s a matter of will. With enough will, a lot of it could be eliminated. And when you’re talking about $1 trillion [worth of waste], even if you get 10% of it, that’s a tremendous amount that could be applied to other activities.”

Risk-based contracts, whether shared savings or capitation, can incentivize physicians to reduce waste. From the viewpoint of long-suffering primary care physicians, value-based-care agreements that let them share in the savings they generate are a godsend. Of course, not all primary care doctors are willing to take financial risk or change their practice patterns. But if maintaining their current income depends on it, most physicians will embrace change.

Specialists, too, can benefit by embracing the new paradigm. If they’re mainly being paid fee for service, they’ll have to forgo a lot of lucrative tests and procedures. But they can still keep their incomes up by delivering more-appropriate procedures and tests to a larger patient population.

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A New Kind of Labor Day

By KIM BELLARD

This is probably the strangest Labor Day in decades, perhaps ever.   Tens of millions of workers remain unemployed due to the COVID-19 pandemic.  Many of those who are still working are adapting to working from home.  Those who are back at their workplace, or never left, are coping with an array of new safety protocols. 

Those who work in the right industries – like the NBA – may get tested regularly but most workers have to figure out for themselves when to quarantine and when to get tested.  For many workers, such as health care workers, people of color, and workers with underlying health issues, going to work is literally a life-or-death calculation. 

No wonder that experts, like Dr. David B. Agus, are calling for companies to have Chief Health Officers. 

Labor Day was originally intended to celebrate the labor movement, but these days labor unions don’t have much to celebrate.  Only around 10% of U.S. workers belong to a labor union; both the number and the percent of unionized workers has been in steady decline over the past few decades. 

Now Labor Day is mainly an extra day off for most, the unofficial end to summer, and, this year, possibly the springboard to a new surge in COVID-19 cases, due to holiday celebrations.  Dr. Anthony Fauci warned:

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Why Primary Care Should Run the Healthcare System

By KEN TERRY

(This is the fourth in a series of excerpts from Terry’s new book, Physician-Led Healthcare Reform: a New Approach to Medicare for All, published by the American Association for Physician Leadership.)

Many other countries’ healthcare systems outperform ours for one simple reason: They place a much greater emphasis on primary care, which occupies the central place in their systems. “The evidence is that where you have more primary care physicians, where you coordinate care, and where you pay to keep people healthy, you get better outcomes at lower cost,” says David Nash, MD, founding dean of the College of Population Health, part of Thomas Jefferson University in Philadelphia.

The evidence that Nash mentions includes studies by Barbara Starfield and her colleagues at Johns Hopkins University. In a 2005 Health Affairs paper, they showed that a higher ratio of primary care physicians to the population is associated with a lower mortality rate from all causes and from heart disease and cancer; in contrast, having more specialists in a particular area does not decrease the overall mortality rate or deaths from cancer and heart disease.

Another study of Medicare data found that states where a higher percentage of physicians were PCPs had higher quality care and lower cost per beneficiary. This factor alone accounted for nearly half of the variation in Medicare spending from one state to another. A separate study found that in the areas of the country that had the most primary care providers, the average Medicare cost per beneficiary was a third lower than in areas with the least PCPs.

One reason for this is that primary care doctors provide comprehensive, continuous care, including preventive and routine chronic care. Chronic illnesses drive 90% of health costs, and some studies show that intensive primary care can reduce ER visits and hospital admissions and improve the health of chronically ill people.

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The COVID-19 Symptom Data Challenge Webinar

By INDU SUBAIYA & FARZAD MOSTASHARI

Following the launch of the COVID-19 Symptom Data Challenge on September 1st, we are excited to host a dedicated webinar providing further insights into the Challenge directly from key leaders representing our partner organizations at Facebook Data for Good, the Delphi Group at Carnegie Mellon University (CMU), the Joint Program on Survey Methodology at the University of Maryland (UMD), the Duke-Margolis Center for Health Policy, and Resolve to Save Lives, an initiative of Vital Strategies.

A stellar line up of speakers includes a raft of former government officials Mark McClellan (FDA & CMA), Tom Frieden (CDC), Farzad Mostashari (ONC) and many more, including Johns Hopkins’ Professor Caitlin Rivers, Carnegie Mellon’s Alex Reinhart & Facebook’s Head of Health Kang-Xing Jin.

If you are applying to the Challenge or would like to hear more about experts’ responses to COVID-19 and the importance of data during the pandemic, you do not want to miss this conversation! 

  • We will be discussing the following
    • Shortcomings of the existing tools for COVID-19 surveillance in the US
    • The case for better situational awareness of COVID activity
    • Overview of Symptom Data survey methodology
    • Preliminary analyses relating symptom trends to COVID intensity
    • Goals and operation of the Symptom Data Challenge

Tune in on Tuesday, September 8th at 1-2pm ET!

Event Registration Link: https://register.gotowebinar.com/register/6102626394063911951

Indu Subaiya is President of Catalyst @ Health 2.0. Farzad Mostashari is CEO of Aledade and Chair of the COVID-19 Symptom Data Challenge

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