This week is the American Society of Clinical Oncology (ASCO) 2022 Meeting. Here is a link to the abstracts.
HHS withdraws controversial Trump-era sunset rule that required review of all regulations “The Department of Health and Human Services (HHS) has withdrawn a controversial Trump-era rule that would have required the agency to do a massive review of its existing regulations.
HHS issued a final rule Thursday that would get rid of the sunset rule passed at the tail end of the Trump administration. The agency said the rule’s requirements for reviewing existing agency regulations to keep them up to date created major burdens on staff and the industry.”
About Covid-19
CDC Plans to Stop Reporting Suspected Covid Cases to Ease Burden “The Centers for Disease Control and Prevention plans to simplify the Covid-19 hospital data it collects as the demands of the pandemic evolve and some assembled information has become outdated or redundant.
The agency is likely to stop collecting data from hospitals on suspected Covid cases that haven’t been confirmed by tests, for example, and may also wind down federal reporting from rehabilitation and mental health facilities that aren’t major intake points for virus cases, according to a draft of the plan that was viewed by Bloomberg News.”
On the other hand: CMS turning attention to hospitals with Covid outbreaks “The Centers for Medicare and Medicaid Services is probing hospitals where a high rate of patients have gotten Covid-19 infections after cases spiked to record highs this year.
Jon Blum, the agency’s principal deputy administrator and chief operating officer, told POLITICO on Wednesday that the regulator is focusing on facilities with Covid outbreaks, taking into account patient and health workers’ safety complaints, a change from the agency’s “less rigorous” process early in the pandemic.”
COVID-19 vaccine effectiveness in patients with cancer: remaining vulnerabilities and uncertainties “Vaccine effectiveness was compared between a cohort of patients with cancer and a control cohort of participants without cancer. Although initially similar between the cohorts, vaccine effectiveness waned more rapidly in the cancer cohort, falling to 47·0% (95% CI 46·3–47·6) at 3–6 months, than in the control cohort, in which it decreased to 61·4% (61·4–61·5). Waning of vaccine effectiveness was greatest in patients with leukaemia or lymphoma or a recent cancer diagnosis and in those who had received systemic anticancer therapy or radiotherapy within the preceding 12 months. A post-hoc analysis estimated that vaccine effectiveness was 74·6% (72·8–76·3) against COVID-19-related hospitalisation and 90·3% (89·3–91·2) against COVID-19-related death at 3–6 months after the second dose in the cancer cohort; other studies have reported a more severe disease course and higher mortality associated with SARS-CoV-2 breakthrough infections in patients with cancer versus those without.”
About health insurance
More in the news about the effects of termination of ACA plan subsidies. Today’s The Washington Post has a great summary of the issues and impact. The other side of the coin is this study: What Will Happen to Healthcare Spending if the American Rescue Plan Act Premium Tax Credits Expire? “Key Findings:
Hospital spending would decline by $3.8 billion.
Prescription drug spending would decline by $3.4 billion.
Spending on services provided outside of hospitals and physician offices would decline by $2.8 billion.
Spending on physician practice services would decline by $1.3 billion.
Florida, Georgia, North Carolina, South Carolina, and Texas would experience the largest decline in total healthcare spending, ranging from 1.3% to 1.9%.”
About hospitals and healthcare systems
UPMC's big losses in Q1: 6 things to know These issues are common to many hospitals. “The provider-payer cited the effect of COVID-19 and the most recent surge, along with labor conditions and supply markets as the reason for increased employment, staffing and operating expenses that have exceeded growth in revenue.” Also, the financial market dip had an effect: “The system lost $242 million in the first quarter from investing and financing activities. In the first quarter of 2021, the company made $326 million from investing and financing activities.”
Cleveland Clinic reports $282M quarterly loss “‘Operating revenues in the first quarter of 2022 were impacted by lower patients served, partially due to the postponement of nonessential surgeries and procedures during the month of January,’ the system said in an earnings release…
Cleveland Clinic reported expenses of $2.96 billion in the first quarter of this year, up from $2.56 billion in the same quarter of 2021. The system saw expenses rise across all categories, including supplies and salaries, wages and benefits.”
About the public’s health
Association of Inappropriate Outpatient Pediatric Antibiotic Prescriptions With Adverse Drug Events and Health Care Expenditures “The cohort included 2 804 245 eligible children… Overall, 31% to 36% received inappropriate antibiotics for bacterial infections and 4% to 70% for viral infections. Inappropriate antibiotics were associated with increased risk of several adverse drug events, including Clostridioides difficile infection and severe allergic reaction among children treated with a nonrecommended antibiotic agent for a bacterial infection… Thirty-day attributable health care expenditures were generally higher among children who received inappropriate antibiotics, ranging from $21 to $56 for bacterial infections and from −$96 to $97 for viral infections. National annual attributable expenditure estimates were highest for suppurative OM ($25.3 million), pharyngitis ($21.3 million), and viral URI ($19.1 million).”
Massachusetts General vaccinating employees against monkeypox “Boston-based Massachusetts General Hospital this week began vaccinating some employees against monkeypox who were in close contact with a patient diagnosed with the virus…
Previously, the Jynneos monkeypox vaccine had been used in the U.S. only in clinical trials, Brett Petersen, MD, deputy chief of the CDC's Poxvirus branch, confirmed to the newspaper.
The workers were in close contact with the male patient, who was hospitalized at Massachusetts General Hospital from May 12-20.”
And in a related article: FDA Approves IV Form of TPOXX for Smallpox “The FDA has approved SIGA Technologies’ intravenous formulation of TPOXX (tecovirimat) for the treatment of smallpox.
The agency previously approved TPOXX in oral form in July 2018 as the first drug indicated for treatment of smallpox. But the new approval gives an option for those who are unable to swallow oral capsules of the drug, the company said…
SIGA said the drug could also be used in the treatment of monkeypox…”
Associations of Clinical and Social Risk Factors With Racial Differences in Premature Cardiovascular Disease “Among 2785 Black and 2327 White participants followed for a median 33.9 years (25th–75th percentile, 33.7–34.0), Black (versus White) adults had a higher risk of incident premature CVD (Black women: HR, 2.44 [95% CI, 1.71–3.49], Black men: HR, 1.59 [1.20–2.10] adjusted for age and center). Racial differences were not statistically significant after full adjustment (Black women: HR, 0.91 [0.55–1.52], Black men: HR 1.02 [0.70–1.49]). In women, the largest magnitude percent reduction in the β estimate for race occurred with adjustment for clinical (87%), neighborhood (32%), and socioeconomic (23%) factors. In men, the largest magnitude percent reduction in the β estimate for race occurred with an adjustment for clinical (64%), socioeconomic (50%), and lifestyle (34%) factors.”
Black Patients Often Never Given a Chance to Join Breast Cancer Trials “Among more than 400 respondents surveyed, 40% of Black patients said they were not told about the possibility of enrolling in a clinical trial versus 33% of patients who identified as being of another race or ethnicity, reported Stephanie Walker, RN, of the Metastatic Breast Cancer Alliance in New York City.
But 92% of Black respondents said they were interested in learning about trials, and 83% said they were either "somewhat or very likely" to consider enrolling, she said during a press briefing ahead of the American Society of Clinical Oncology (ASCO) annual meeting.
Walker noted that roughly 15% of breast cancer patients in the U.S. are Black, and these patients carry the highest mortality rates, yet Black patients make up only 4-6% of trial participants.
The survey identified several barriers to trial participation that if addressed could bolster enrollment, said Walker, including concerns over treatments, trust issues, and worry over potential costs.”
Comparison of Cancer-Related Spending and Mortality Rates in the US vs 21 High-Income Countries “In this cross-sectional study of 22 countries, the median cancer mortality rate was 91.4 per 100 000 population… The US cancer mortality rate was higher than that of 6 other countries (86.3 per 100 000). Median per capita spending in USD for cancer care was $296 (IQR, $222-$348), with the US spending more than any other country ($584). After adjusting for smoking, 9 countries had lower cancer care expenditures and lower mortality rates than the US. Of the remaining 12 countries, the US additionally spent more than $5 million per averted death relative to 4 countries, and between $1 and $5 million per averted death relative to 8 countries. Cancer care expenditures were not associated with cancer mortality rates, with or without adjustment for smoking…”
About healthcare IT
CVS Health to launch new virtual primary care solution on single digital platform “The new offering, which is being sold to Aetna fully-insured, self-insured plan sponsors, and CVS Caremark clients now, will become effective for eligible Aetna members starting January 1, 2023, and for eligible CVS Caremark members during the second quarter of 2023. It complements Aetna’s virtual care strategy currently in market…
CVS Health Virtual Primary Care will give members access to primary care, on-demand care, chronic condition management, and mental health services virtually, with the option of being seen in-person when needed at an in-network provider, including MinuteClinic. The virtual primary care provider can also help members identify appropriate in-network specialists and other in-network health service providers, if necessary.”
About healthcare quality and safety
CMS Proposes to Suppress The Data on 25,000 Preventable Hospital Deaths Last Year. We Say No. From The Leapfrog Group: “The data targeted for suppression includes rates of serious complications from surgery like sepsis and kidney harm, along with preventable complications from medical care such as deep bed sores, lung collapse, and blood clots…
Just two months ago, leaders at CMS and the Centers for Disease Control and Prevention (CDC) reported that since 2020, federal data shows a significant increase in the number of common hospital infections and patient safety mistakes occurring during the pandemic. These federal officials have the data, but now want to suppress much of it from the American public.”