Excess Mortality by State, updated September 28, 2020

The CDC updated its count of excess deaths by state earlier today. For the weeks between the week ending February 1st through the week ending September 26th, the national excess death rate was 110% (same as last week). Thirteen states, the District of Columbia and New York City are reporting excess death rates higher than the national average (same as last week). Georgia has an excess mortality rate of 110%. California, Georgia and Nevada all had an excess mortality rates of 110%. New York City has the highest excess mortality rate (172% [down three percent]), followed by New Jersey (130% … Read More

Ideas About Resourcing Health Care in the United States: Can Economic Evaluation Achieve Meaningful Use?

“Managing health care spending is critical considering that the U.S. health care economy exceeds $3.5 trillion. Between $760 billion and $935 billion is wasted on low-value care that costs considerably more than its clinical benefits are worth. Giving Equal Weight to Valuation of Health Care Services and Technologies [..] payer reimbursements for health care providers and biomedical manufacturers could not be more different. Medicare and other payers that adhere to Medicare payment structures use prospective payments based on diagnosis-related group for hospital services, and fee schedules based on relative value units for physician services. Payments have created a fundamental divide … Read More

Sophisticated Purchasing of Pharmaceuticals: Learning From Other Countries

“The authors [Emanuel EJ et al. in a JAMA Internal Medicine Special Communication also published today] suggest that the United States should learn from its peers, from other developed nations that have created publicly accountable institutions for health technology assessment and drug price determination and that have reaped a return in the form of prices that are lower and better aligned with clinical value than drug prices in the United States. [..] Payers in the United States (governmental programs, self-insured employers, insurers, pharmacy benefit managers) conduct their own implicit health technology assessments but usually without the transparency or evidence focus … Read More

In The Era Of Hygiene, ‘Clean’ Author Makes The Case For Showering Less

“[physician and health reporter James] Hamblin’s new book, Clean: The New Science of Skin, is a documentary survey of this pre-dawn moment in our understanding of the skin microbiome. [Emily Vaughn] Your book sets out to challenge some cultural norms about hygiene. What types of cleansing do you think are overdue for reexamination, and which are critical? [James Hamblin] There’s a distinction between “hygiene” and “cleansing rituals” that’s especially important in this moment. “Hygiene” is the more scientific or public health term, where you’re really talking about disease avoidance or disease prevention behaviors. Removal of mucus, vomit, blood feces … … Read More

What Trump and Biden Should Debate at the Cleveland Clinic: Why the Hospital’s Private Police Mostly Arrest Black People

“Just as the Black Lives Matter movement has highlighted racial inequities in law enforcement, so the lopsided toll of Black victims in the pandemic has revealed them in health care. Hospital policing is where these two disparities collide. Cleveland’s prestigious hospitals, which mainly employ and treat whites, are surrounded by low-income Black neighborhoods with some of the worst health outcomes in Ohio, including lower life expectancy and high rates of asthma, diabetes and infant mortality. Hospitals have replaced the factories and plants of a faded industrial era as the most important economic engine in northeast Ohio. The clinic [Cleveland Clinic] … Read More

Republicans blasted Obama’s use of an obscure Medicare law. Now Trump’s using it on $200 drug coupons — and the GOP is silent

“Trump’s plan is to ship seniors $200 prescription drug coupons in the coming weeks, a massive, $6.6 billion initiative that he announced less than six weeks before Election Day. He is relying on the same authority that Obama used in 2010 to bolster a more expensive, albeit less outwardly political, plan to direct bonus payments to high-performing insurance companies ahead of his own reelection campaign. [..] Both the Obama and Trump controversies surround so-called demonstration authority, a power granted to the White House to test whether changes to Medicare to make the program run smoother or save money. Obama used … Read More

How to Keep the Coronavirus at Bay Indoors

Excerpt – Unless you are living with an infected person — in which case the Centers for Disease Control and Prevention offers specific guidelines to follow — protecting yourself at home does not require extraordinary measures, Dr. [Virginia Tech’s Linsey] Marr said. And when you venture elsewhere, wearing a face covering and washing your hands are still the best ways to protect yourself indoors. Health experts offered several tips for dodging the virus indoors: Open the windows, buy an air filter — and forget the ultraviolet lights. Fear of the risk of transmission indoors has fueled a market for expensive … Read More

Remote symptom monitoring integrated into electronic health records: A systematic review

“This systematic review identified and summarized EHR-integrated systems to remotely collect patient-reported symptoms and examined their anticipated and realized benefits in long-term conditions. [Results] We included 12 studies representing 10 systems. Seven were in oncology. Systems were technically and functionally heterogeneous, with the majority being fully integrated (data viewable in the EHR). Half of the systems enabled regular symptom tracking between visits. We identified 3 symptom report-guided clinical workflows: Consultation-only (data used during consultation, n = 5), alert-based (real-time alerts for providers, n = 4) and patient-initiated visits (n = 1). Few author-described anticipated benefits, primarily to improve communication and resultant health outcomes, were realized based … Read More

Mapping the Brain Effects of Hearing Loss: The Matter of White Matter

“Described as the “greatest global challenge for health and social care in the 21st century,” dementia is a debilitating disease that affects about 50 million individuals worldwide, a number projected to triple by 2050. Given the limited efficacy of current dementia treatments, society stands to benefit tremendously from public health prevention strategies. Hearing loss (HL) has been recently shown to be a treatable risk factor for dementia. [..] Clinicians may be tempted to use the known independent association between HL and cognition to justify HL treatment (eg, hearing aids) to prevent age-related cognitive deficits. While appropriate management of HL is … Read More