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Teaching Hospital Update – May 25–29, 2009

 
 

Email Alert

By Leah Voigt Romano*

May 29, 2009

Senator Kennedy Circulates Draft of Health Reform Legislation

Late this week, Senator Edward Kennedy (D-MA) circulated an outline of healthcare-overhaul legislation that includes a requirement that all individuals obtain coverage and requires employers to contribute. The legislation "closely resembles" the Massachusetts health insurance law enacted in 2006, The Washington Post reports. According to the draft summary, the bill calls for a public, government-sponsored health insurance option that would compete with private insurers. The measure also would expand Medicaid eligibility. Sen. Kennedy spokesperson Anthony Coley said that the outline is not yet finalized. He said, "We are still actively negotiating with members" of the Senate HELP Committee.

According to a top White House official, Kennedy is expected to introduce his measure on Monday. A timetable released by Sen. Kennedy's office calls for Senate HELP Committee Democrats to meet June 2, 2009. Meanwhile, President Barack Obama said on Thursday that the opportunity to enact healthcare reform legislation could be missed unless Congress passes it this year. In a call to members of his political organization, Organizing for America, President Obama said, "If we don't get it done this year, we're not going to get it done." He added, "I think the status quo is unacceptable and that we've got to get it done this year."

President Obama also said that any action on overhaul legislation could be delayed unless volunteers pressure lawmakers to support the administration's goals for healthcare reform. Obama told volunteers that it was time to "remobilize" after their successful campaign to get him elected, adding that "we have gotten a lot of things done during our first four months. But health care, that's a big push."

Kaiser Daily Health Policy Report, Sen. Kennedy Circulates Draft of Health Reform Legislation, Henry J. Kaiser Fam. Fdn. (May 29, 2009).

New York Times Reports Underlying Conditions in City's Population Could Aggravate Effects of Swine Flu

According to an article in The New York Times this week, chronic conditions that are common in New York City's population such as diabetes, heart disease, and asthma could aggravate the impact of swine flu. The City's health commissioner reported this week that the flu had been implicated in the deaths of two more New Yorkers, both of whom had "underlying conditions."

Since the beginning of the swine flu outbreak, the phrase "underlying medical condition" has been transformed from a snippet of medical jargon into a household phrase. Mayor Michael R. Bloomberg (R) had fully absorbed the new vocabulary lesson by the City's second swine flu death on Sunday, that of a woman in her fifties. In an expression of empathy, he said his father had also died in his fifties "because of an underlying health condition."

The commissioner intended his warning, which he has applied to all four New York deaths so far linked to the H1N1 virus, to be at once helpful to those who might be more at risk for the disease and reassuring to those who are not. But, it may apply to so many households that efforts to control public fears by using the term may be having something of an adverse effect. Even accounting for people who have more than one condition, statistics suggest that the city's long list of red flags may encompass as many as one in three people.

About 400,000 New Yorkers have asthma, the city's most common chronic childhood illness; about 700,000 or 12.5% of adults have diabetes; about 100,000 have HIV; about 17,000 women are pregnant at any time, a conservative estimate; and about 900 people have tuberculosis, another risk factor, according to 2008 city statistics.

Anemonia Hartocollis, 'Underlying Conditions' May Add to Flu Worries,
N.Y. TIMES (May 27, 2009).

Study Shows Aspirin May Have No Clear Value in Primary Cardioprevention

According to a study published in the May 30, 2009, issue of The Lancet, long-term, low-dose aspirin provides no clear net value for primary prevention of cardiovascular events in apparently healthy adults, according to a meta-analysis of patient-level data. In people not known to have cardiovascular disease, aspirin reduced composite heart attack, stroke, and vascular death rates to 0.51% per year, compared with 0.57% among controls for a relative 12% reduction, according to researchers.

But the major gastrointestinal and extracranial bleeding rate rose from 0.07% per year among controls to 0.10% among those receiving aspirin for primary prevention, the study revealed. Importantly, the bleeding risk rose right along with cardiovascular risk level.

Guidelines from the U.S. Preventive Services Task Force and the American Heart Association largely ignore any differences in bleeding risk, and recommend wide use of aspirin for primary prevention in patients at moderately elevated heart disease risk, the researchers noted. However, there was no threshold cardiovascular risk level that appeared to have a sufficient benefit-to-bleeding risk ratio among the 95,000 participants in the six long-term primary prevention trials included in the meta-analysis.

The researchers recommended that the current guidelines may need to be reviewed. For primary prevention, "the main strategies ought to be really stopping smoking—if people smoke—then if further measures are needed, lowering blood pressure, lowering cholesterol," the lead author of the study said. "The benefits of adding aspirin to all that does not clearly outweigh the hazards."

Antithrombotic Trialists' Collaboration, Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials, 373 LANCET 1849-60 (2009).

Crystal Phend, No Clear Value for Aspirin in Primary Cardioprevention, MedPage Today (May 28, 2009).

Report Finds Many U.S. Hospitals Fail to Report Physician Disciplinary Cases to National Databank

According to a report entitled "Hospitals Drop the Ball on Physician Oversight" released on Wednesday by the group Public Citizen, many U.S. hospitals do not take sufficient disciplinary action against physicians for poor conduct or medical incompetence and fail to report such cases to the National Practitioner Data Bank. Congress established the databank in 1990 as a central repository for information about physicians whose hospital privileges had been withdrawn or limited for more than thirty days. The bank is closed to the public.

For the report, Public Citizen's Health Research Group analyzed studies by the Department of Health and Human Services (HHS), Office of Inspector General and the Citizen Advocacy Center, as well as medical journal articles and recommendations made during an October 1996 meeting on under-reporting by hospitals. According to the report, nearly half of U.S. hospitals did not submit one physician's name in seventeen years to the databank. One purpose of the databank is to provide hospitals with background information about physicians that they were considering hiring at their facilities. Under the initial expectations of the databank, federal officials estimated that at least 5,000 disciplinary cases would be reported annually. However, on average, about 650 reports have been made annually since the databank was created, the report found.

The group on Wednesday sent a letter to HHS Secretary Kathleen Sebelius that included recommendations to improve the databank's efficacy. The letter said that the reporting numbers are "unreasonably low, compared with what would be expected if hospitals pursued disciplinary actions aggressively and reported all such actions." The letter urged Secretary Sebelius to ensure that hospitals are conducting necessary peer reviews and oversight of physicians, taking proper disciplinary actions and reporting them to the databank so that physicians' track records are available to all hospital administrators. Penalties also should be established for hospitals that fail to comply with the reporting requirements, the group said.

In a statement responding to the report, the American Hospital Association said, "The premise that the number of reports received by the National Practitioner Data Bank correlates to jeopardized patient care is inaccurate," adding, "Hospitals are actively involved in a wide variety of efforts to continuously improve care and talk publicly about the care we provide."

Kaiser Daily Health Policy Report, Many U.S. Hospitals Fail to Report Physician Disciplinary Cases to National Databank, Henry J. Kaiser Fam. Fdn. (May 28, 2009).

*We would like to thank Leah Voigt Romano, Esquire (Hall Render Killian Heath & Lyman PLLC, Troy, MI) for writing this email alert.

AHLA Teaching Hospital Updates are intended to provide quick summaries of cutting-edge issues of interest to teaching hospitals and their counsel. Additional information and more in-depth coverage on these topics may be available from AHLA Health Lawyers Weekly and appropriate AHLA Practice Groups.

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