Believe it or not, there was more going on in the healthcare universe in 2020 than the response to the coronavirus pandemic and we've compiled a list of stories to prove it.
Understandably, the coronavirus pandemic dominated the headlines this year, not just with HealthLeaders, but with pretty much every media outlet on the planet.
Still, our savvy pillar editors reported on scores of healthcare stories that were not centered around that dreaded virus.
So, we thought we'd share a collection of some of non-COVID-19 content in 2020, if nothing else than to remind us all that we will get through this scourge and life will continue.
Picture a revenue cycle where employees jockey to work on their colleagues' accounts, the turnover rate is less than 5%, and staff members ask their manager not to fill a vacant position so they can work on extra accounts.
That's what's happening at Sharp HealthCare in San Diego, which has "gamified" its revenue cycle management workflow to turn employees' everyday tasks into opportunities to earn points, badges, and compete with each other.
Here are some of our other top Revenue Cycle stories of 2020:
San Francisco–based PlushCare has been providing primary care telehealth services to patients since its founding five years ago. PlushCare, which has a nationwide patient population of more than 200,000, employs more than 100 physicians. The COVID-19 pandemic has boosted demand for PlushCare's services, with a 400% increase in telehealth visit volume.
Here are some of our other top Clinical Care stories of 2020.
The Ohio State University Wexner Medical Center created Anti-Racism Initiatives to "elevate, engage, equip, and empower" the community, students, faculty, and staff to focus on improving racial inequalities in healthcare. The medical center also states that "racism is a social determinant of health."
HealthLeaders' Melanie Blackman spoke to Dr. Harold Paz, CEO of The Ohio State University Wexner Medical Center, about the medical center and university's focus on addressing social determinants of health and racial inequities in their surrounding communities through an anti-racism action plan.
Steward Health Care in June reached an agreement to buy back control of the company from Cerberus Capital Management, L.P., a New York-based private equity firm. Cerberus sold control of the Dallas-based physician-owned company to a group of Steward physicians led by CEO Dr. Ralph de la Torre.
This June, HealthLeaders convened health system executive thought leaders to discuss the "Healthcare System of the Future." In his keynote address, John Halamka, MD, MS, president of the Mayo Clinic Platform, discussed the technology stepping stones that will pave the road forward.
Other top stories from the Innovation pillar in 2020:
Per capita excess mortality was highest among people aged 65 years and older, men, Blacks and Latinos, and those without a college degree.
California saw nearly 20,000 more deaths from March 1 through August 22 than what would be predicted by historical trends, new research shows.
The Golden State recorded 146,557 deaths over the seven-month span between March and August, which is 19,806 more deaths than historical models suggest, according to a research letter in JAMA Internal Medicine.
Per capita excess mortality was highest among people aged 65 years and older, men, Blacks and Latinos, and those without a college degree.
"Following the statewide shelter-in-place, Latino residents and those without a high school degree/GED had the greatest increase in excess per capita mortality, with rates more than tripling after reopening," the UC San Francisco-led researchers wrote.
"We hypothesize that this pattern reflects the risk of COVID-19 death faced by low-wage, essential workers and their social networks owing to occupational exposure, crowded housing, and inadequate access to testing or treatments," they said.
The projections in the research letter are consistent with state and national tracking of COVID-19 deaths. As of December 21, the pandemic had claimed 22,820 lives in California with about 1.9 million cases reported. Nationally, the virus has claimed more than 311,000 lives, with more than 18 million cases reported, according to data compiled by The New York Times.
The research also compared deaths in March through April against deaths in May through August and found that Latinos and those without a high school degree or the equivalent had the greatest increase in excess deaths.
Latino deaths tripled from 16 to 51 excess deaths per 1 million, and deaths in those without a high school degree grew by a factor of 3.4, from 21 to 72 excess deaths per 1 million.
Younger adults had the biggest increases in excess deaths, more than doubling the rate between shutdown and reopening. Ages 25-54 increased from 4 to 11 excess deaths per million, and ages 55-64 grew from 12 to 30 excess deaths per million.
Black people had higher per capita excess mortality than other racial/ethnic group throughout most of the pandemic. However, later in the shelter-in-place period, White, Asian, and Black residents had a decline in excess per capita deaths.
Latinos and those without a high school diploma saw a large and sustained increase in per capita deaths.
While noting that the research is not designed to determine the effect of policies undertaken during the pandemic, the researchers said their findings "suggest that the policies adopted to date have had disparate outcomes across population subgroups.":
"Our findings underscore the importance of examining the inequitable effects of policies during the pandemic, reexamining the effects over time, and investing in strategies to mitigate the excess mortality in affected communities," the said.
Methodology
Using California Department of Public Health, the researchers evaluated deaths for the entire state and for specific groups by age, sex, race/ethnicity, and educational level, ages 25 or older.
The researchers estimated excess deaths for each week by subtracting the number of forecast deaths from the number of observed deaths.
"For each time period, we obtained 95% prediction intervals by simulating the forecast 10,000 times, selecting the 97.5% and 2.5% quantiles and subtracting the total number of observed deaths," the research letter said.
"We obtained per capita estimates by dividing the excess deaths and corresponding 95% prediction intervals by population size, using estimates from the U.S. Census Bureau."
The latest annual List of Measures under Consideration is part of a broader "Meaningful Metrics" initiative launched in 2017 to reduce red tape for providers.
Most of the 2020 quality and efficiency metrics proposed by the federal government would be collected digitally, cutting the hassle for providers to retrieve the data manually, the Centers for Medicare & Medicaid Services said Tuesday.
CMS Administrator Seema Verma said theList of Measures under Consideration is part of a broader "Meaningful Metrics" initiative launched in 2017 to reduce red tape for providers.
"We launched Meaningful Measures because too many providers were wasting precious time and resources reporting on quality metrics, many of which were barely relevant to their specialty," Verma said.
"Over the last four years, this initiative has delivered better, less onerous metrics that are actually useful to those who use them. The measures we are announcing today represent more of the same," she said. "They prioritize health outcomes, reduce burden, and give providers more time to do the work they entered medicine to do: treat patients."
The proposed list of metrics will be sent for stakeholder review to the independent National Quality Forum's Measure Applications Partnership, which is expected to provide feedback by February 1, 2021.
The 2020 list – which includes new measures and updates – features:
Five outcome measures, such as the rate of health care-associated infections requiring hospitalization for residents of skilled nursing facilities;
Five process measures, such as conducting kidney health evaluations or implementing interventions for patients with pre-diabetes;
Three process measures for the coronavirus vaccine, including vaccination coverage among healthcare personnel, vaccination by clinicians, and vaccination coverage for patients in End-Stage Renal Disease venues;
Five cost/resource use measures – including episode-based costs associated with addressing diabetes or asthma/chronic obstructive pulmonary disease;
Three composite measures, which summarize overall quality of care across multiple measures using one piece of information;
Two patient reported outcomes measures.
Only three measures under consideration rely "pen-and-paper" data collection.
Of the non-digital measures, two assess COVID-19 vaccinations among healthcare workers and patients in ESRD facilities. The other acts on patient-reported health outcomes.
CMS says enrollment growth is driven largely by the Public Health Emergency and the Families First Coronavirus Response Act's continuous enrollment mandate.
Medicaid and Children's Health Insurance Program enrollment grew by a combined 5.8 million people, or 8.3%, from February to August, a data "snapshot" from the Centers for Medicare & Medicaid Services shows.
Following months of decline in applications early in the public health emergency, the new data released Monday show an increase in applications starting in June, with a big leap in applications between July and August.
A further breakdown of the data shows that Medicaid enrollment grew by more than 5.8 million people, or 9.1%, over the seven-month span, and that CHIP enrollment grew by 33,000 children, or 0.5%.
CMS Administrator Seema Verma said the enrollment growth is driven largely by the COVID-19 Public Health Emergency, and by the Families First Coronavirus Response Act's continuous enrollment mandate.
"In the midst of a pandemic of generational scope and fury, it has never been more important to understand the underlying drivers of enrollment trends and the impact of new congressional requirements," Verma said.
The mandate provides a temporary 6.2% increase in matching funds through Federal Medical Assistance Percentages for states but requires states to maintain Medicaid enrollment for beneficiaries except in a few circumstances.
However, CMS noted that -- while the data on applications suggest that new enrollment has affected the overall increases in Medicaid and CHIP enrollment during the PHE -- it has not been "the key driver," because enrollment growth is outpacing applications.
"This trend suggests that enrollment increases are likely attributed to existing enrollees remaining eligible due to the maintenance of effort requirements," CMS said, adding that it will "continue to monitor these trends."
The rate of growth in 2019 was down slightly from the 4.7% rate in 2018 and consistent with the average annual spending growth rate of 4.5% since 2016.
Healthcare spending in the United States grew 4.6% in 2019, hitting $3.8 trillion, or $11,582 per person, federal actuaries announced on Wednesday.
The rate of growth in 2019 was down slightly from the 4.7% rate in 2018 but consistent with the average annual spending growth rate of 4.5% since 2016, according to a new analysis from the Office of the Actuary at the Centers for Medicare and Medicaid Services.
The report, which was published online Wednesday afternoon in Health Affairs, notes that faster growth in personal healthcare spending was offset by a drop in the net cost of health insurance, mostly because of the suspension of the individual mandate.
The report covers 2019 and does not include the effects of the coronavirus pandemic on healthcare spending.
Healthcare spending grew somewhat faster than the 4% growth in the gross domestic product, and healthcare spending as a share of the overall economy nudged up slightly to 17.7% from 17.6% in 2018, the analysis shows.
"Healthcare spending in 2019 increased at about the same rate as it had in 2018 and was similar to the average annual growth since 2016," said study first author Anne Martin, an economist in the CMS Office of the Actuary.
"This relative stability in healthcare spending growth over the last four years preceded the COVID-19 pandemic in 2020," Martin said. "The full impact of the pandemic on the healthcare sector is still not known, but it will certainly have profound consequences on the provision and consumption of healthcare in 2020 and perhaps beyond."
Personal healthcare spending accounted for 84% of total healthcare spending in 2019 and grew 5.2 %—compared with 4.1% growth in 2018. Martin said the increase was driven mostly by accelerated spending growth for hospital care, retail prescription drugs, and physician services.
National health spending grew 4.1% per capita in 2019, similar to the 4.2% increase in 2018, reflecting faster growth in the residual use of healthcare goods and services and slower growth in medical prices.
Medical prices increased 1.1% in 2019, half the rate of 2.3% growth seen in 2018. However, residual use and intensity of services increased 2.5% in 2019, which is faster than the 1.4% growth seen in 2018.
The rate of growth linked with changing demographics held steady at 0.5% in 2019.
A detailed breakdown of major spending growth in 2019 found that:
Hospital spending grew 6.2% and reached $1.2 trillion in 2019, representing 31% of overall healthcare spending, compared with 4.2% in 2018. However, hospital prices rose 2% compared with 2.4% in 2018, while nonprice factors such as the use and intensity of goods and services grew 4.2%, compared with 1.8 % in 2018.
Physician and clinical services grew 4.6% and reached $772.1 billion, or 20% of total healthcare expenditures. Spending grew 4.6%, up from 4% in 2018. Nonprice factors, such as the use and intensity of services, were the largest contributor to the acceleration in expenditure growth, as price growth remained steady in 2019 at about 0.8%. The 5.8% pending growth for clinical services outpaced spending growth for physician services 4.2%.
Private health insurance grew 3.7% and reached $1.2 trillion and accounted for 31% of total national health spending. Private health insurance spending increased 3.7% in, which was slower than the 5.6% growth rate seen in 2018, and driven largely by the suspension of the Affordable Care Act's Individual Mandate.
Private health insurance enrollment grew 0.5%. Per enrollee spending increased 3.2%, half the 6.4% growth of 2018.
Medicare spending grew 6.7% and reached $799.4 billion in 2019, representing 21% of total national healthcare expenditures. Medicare's 6.7% spending growth was up slightly from the 6.3% growth in 2018.
Medicare enrollment grew 2.6% in 2018 and 2019. Per enrollee Medicare expenditures grew 4% in 2019 compared with 3.6% in 2018. Fee-for-service procedures accounted for 61% of Medicare spending in 2019, down from 67% in 2016, which Martin said reflects the shrinking FFS share of total Medicare enrollment over the past four years.
FFS Medicare spending grew 2.2%, down from 3% in 2018. Medicare Advantage spending accounted for 39% spending in 2019 and increased 14.5%, up from 12.6% growth in 2018.
Per capita enrollee spending in Medicare Advantage grew 6.3%% in 2019, almost three times the 2.4% per capita growth rate of Medicare FFS.
Medicaid spending grew 2.9% and reached $613.5 billion, accounting for 16% of national health spending, and down slightly from the 3.1% growth in 2018.
Martin said the steady growth in 2019 was owing to faster spending growth for most goods and services and an offsetting drop in the net cost of insurance, thanks largely to the suspension of penalties associated with the Affordable Care Act's individual mandate.
The pact looks to create "a joint undergraduate and graduate medical education program to educate and train the next generation of culturally competent health clinicians and researchers."
CommonSpirit Health and Morehouse School of Medicine on Wednesday announced a 10-year, $100 million partnership to train Black doctors.
The initiative is part of a broader plan by Chicago-based CommonSpirit and Atlanta-based Morehouse -- a historically Black medical school renowned for its primary care program -- to create "a joint undergraduate and graduate medical education program to educate and train the next generation of culturally competent health clinicians and researchers," the stakeholders said in a joint press release.
"We are laying the foundation for patients to have more access to Black clinicians and for Black medical students and graduates to gain community-based experience that they need to be successful in their work," said CommonSpirit President and CEO Lloyd H. Dean.
"Our initiative also will create a pathway for healthcare organizations across the nation to follow and share our learnings, a vital part of our work," he said.
MSM and CommonSpirit will contribute $21 million in seed money in the first two years, with a goal of spearheading a 10-year, $100 million initiative with the support of individual donors, industry partners and philanthropic organizations.
There are 155 accredited medical schools in the United States, but Morehouse and three other historically Black medical schools produce the majority of the nation's Black physicians.
"Of the 21,863 students entering medical school in 2019, only 1,626 were Black – and only 619 were Black males," said Morehouse School of Medicine President and Dean Valerie Montgomery Rice, MD.
"This statistic is alarming for many reasons, not the least of which is the impact on patient care," she said. "Studies show that Black patients have better outcomes when treated by Black doctors."
CommonSpirit, one of the nation's largest nonprofit health systems, with a footprint in 21 states, is also the largest provider of Medicaid services in the United States.
Rice called the partnership "the perfect combination of two healthcare organizations that are devoted to the creation and advancement of heath equity in underserved communities."
"Now, more than ever, we believe society needs a unique partnership like ours that can help show the way to reducing health disparities in vulnerable communities, and, in turn, make all communities stronger," she said.
The partnership will create at least 300 new residency training programs each year for Black and other underrepresented groups, recruited from communities that have a historical provider shortage.
Morehouse and CommonSpirit will also build five regional "medical 2 school" campuses and graduate medical education programs in at least 10 markets in partnership with CommonSpirit healthcare hospitals, to be announced in spring 2021.
The partnership will also address cultural competency and develop research programs to confront illnesses that disproportionately affect underserved populations.
"We're immediately leveraging our partnership to address health inequities magnified by the COVID-19 pandemic, as Black Americans are disproportionately impacted by COVID-19," Dean said.
"Together, we will foster a culturally competent system of care that includes testing, care delivery, and vaccine allocation, directed at the most vulnerable populations to reduce the impact of COVID-19 in racial and ethnic communities," he said.
Patients, not payments, are now the biggest barrier to telehealth adoption among healthcare executives responding to a survey in a new HealthLeaders Intelligence Report.
For years, providers have complained that inadequate reimbursements, particularly from Medicare and Medicaid, have given them little incentive to expand remote care.
But that paradigm shifted during the coronavirus public health emergency, when the Centers for Medicare & Medicaid Services this spring temporarily expanded reimbursements for more than 140 remote services provided by Medicare.
And earlier this month, CMS announced that it has made permanent nine telehealth services and will extend payments for another 59 services beyond the public health emergency in the ongoing effort to expand remote healthcare access in rural America.
Now, 63% of executives responding to our latest Intelligence Report,Telehealth's Road Ahead, identified, "patient ability to use technology" as the biggest barrier for telehealth adoption, compared with 44% of executives who put reimbursement at the top of their lists.
Deanna Larson, CEO of Avera eCARE, a South Dakota–based telehealth network, says technical proficiency should not be a barrier to care. She says health systems must create easy access points for patients, including telephone apps and patient portals.
"It has a lot to do with your selection of the platform being sent out to the general public," she says. "Some people say that it's the older people only, but we definitely have found that ease of use is important for all ages. Think about the apps on your phone. If they're not easy to use or frustrating, you just don't go back."
Even with the CMS action, Ethan Booker, MD, a MedStar Health emergency physician and the medical director of the MedStar Telehealth Innovation Center and MedStar eVisit, says he was surprised by the poll findings on technical barriers.
"It's not entirely our experience. We have had the good fortune of having some very usable platforms," he says. "Certainly, while there are some folks who have struggled, and we support them in all the ways that we can, I wouldn't suggest that patients' difficulty using technology is much of a barrier."
Telehealth resource allocation
Primary care (73%) and behavioral health (51%) are the two biggest areas where survey respondents are allocating resources. Beyond that, neurology (25%), cardiology (22%), and rehabilitation (22%) lead a half-dozen subspecialties vying for resources.
Larson says she's surprised that providers aren't making an even bigger investment in behavioral health.
"We know that telemedicine is very valuable in the behavioral health space," she says. "It reduces the need to come in for the visit, and sometimes just getting past the social stigma that's associated with meeting in a behavioral health setting that's still out there."
She also questions why survey respondents are allocating relatively few resources for subspecialties such as neurology, cardiology, and ophthalmology.
"It's surprising to me that there isn't more investment for an early identification of an intervention," she says, "bringing them into a higher level of care if identified, and also follow up in all those areas when appropriate for those. It's easy to do in neurology, cardiology, and dermatology."
Booker says primary care is the clear leader in resource allocation in telehealth because the specialty stresses physician-patient communication and "lends itself extremely well to that longitudinal relationship."
"Rather than coming into the office for a handful of visits a year, there's an opportunity to check in more frequently, and perhaps with less intensity to continue to be connected to each other," he says. "It's also true that with value-based payments, population health, ACOs, etc., primary care has moved more fully into that value-based model."
The movement of behavioral health to a telehealth model predates the coronavirus pandemic, Booker says, and includes "a regulatory and reimbursement framework that began to make sense."
"There is an abundance of academic research on quality, safety, and outcomes that demonstrated that behavioral health, psychiatry, cognitive behavioral therapy—many of the core therapies that are delivered by psychiatry—can be very effectively delivered via telehealth," he says.
"There is also a critical access issue in behavioral health that there are not enough professionals to meet the needs. Telehealth has ability to spread out experts to low-density areas and to be efficient in the delivery of care," he says.
As for specialty care, Booker says MedStar Health is developing an infrastructure and a framework for "all kinds of care delivery."
"Primary care and behavioral health are right at the top of our list," he says, "but we think that it's important to build for absolutely everybody in our health system who feels like they could use telehealth to connect with a patient, whether that's fee-for-service evaluation and management, a coded encounter, or some other connection between patient and physician. We have the tools to build for them."
To download the full December 2020 HealthLeaders Intelligence Report, click here.
House and Senate leaders announced that an agreement had been reached on the "No Surprises Act," which establishes a mediation framework for providers and payers to resolve payment disputes.
The American Hospital Association is offering qualified support for bipartisan, bicameral legislation in Congress that would protect patients from surprise medical bills.
House and Senate committee leaders announced that an agreement had been reached on the "No Surprises Act," which also establishes a mediation framework for providers and payers to resolve payment disputes.
"Under this agreement, the days of patients receiving devastating surprise out-of-network medical bills will be over," House and Senate leaders said in a joint media release.
"Patients should not be penalized with these outrageous bills simply because they were rushed to an out-of-network hospital or unknowingly treated by an out-of-network provider at an in-network facility. This is a win for patients and their families that will improve America's health care system," they said.
The deal was agreed to on Friday by House Ways and Means Committee Chairman Richard E. Neal (D-MA) and Ranking Member Kevin Brady (R-TX), House Energy and Commerce Committee Chairman Frank Pallone, Jr. (D-NJ) and Ranking Member Greg Walden (R-OR), House Education and Labor Committee Chairman Robert C. Scott (D-VA) and Ranking Member Virginia Foxx (R-NC), and Senate Health, Education, Labor, and Pensions Committee Chairman Lamar Alexander (R-TN) and Ranking Member Patty Murray (D-WA).
Rick Pollack, president and CEO of the American Hospital Association, said in a letter Sunday to lawmakers that the nation's hospitals "strongly support provisions to protect the patient from surprise medical bills."
"However, we have significant concerns with several of the provisions that would attempt to implement unworkable billing processes and transparency provisions that are duplicative and costly without clear added benefit for patients," Pollack said.
Among the concerns raised by the AHA:
Independent Dispute Resolution Process. If payers and providers use the IDR process, each would submit an offer to the independent arbiter. When choosing between the two offers the arbiter would consider factors such as the median in-network rate, information related to the training and experience of the provider.
Pollack said hospitals are "concerned that the IDR process may be skewed if the arbiter is able to consider public payer reimbursement rates, which are well known to be below the cost of providing care."
"We urge that the legislation include an explicit prohibition on considering Medicare, Medicaid, and other public payer rates, especially as these programs are not implicated by the surprise medical billing provisions," he said.
Pollack also asked that payers' initial payments for out-of-network bills be considered their offer for IDR, which he said would "incentivize them to pay a fair initial reimbursement."
Clarity on enforcement of surprise medical billing violations. "We are unclear as to the oversight of this provision and, in particular, the role of states in overseeing providers," Pollack said. "It appears optional for states to conduct oversight of provider compliance, and the federal government would act as an enforcement backstop in the event a state did not take up this responsibility."
"It also is unclear if states are limited to the civil monetary penalty limits outlined in the draft legislation. This approach could potentially result in uneven enforcement of the bill's protections," he said.
Government auditing of health plan compliance. Pollack said the bill limits audits to 25 plans of all types unless there is a complaint. "This seems to be small number of maximum audits," he said. He also raised concerns that the auditing process "is sufficient to ensure ERISA plans would be audited in the same manner as other health plans."
Notice and Consent for Out-of-Network Services. Pollack asked for clarity on how the bill deals with out-of-network providers. "It appears to put the onus on the out-of-network provider to give the notice and obtain consent, but then suggests that, in the case of out-of-network providers in facilities, it is the facility's responsibility to maintain the consent forms," Pollack said. "Therefore, it is unclear as to the role of the facility versus the individual clinician in providing notice and consent. It also is unclear how the out-of-network provider will know what the in-network provider options would be for a patient, as well as whether the patient's health plan applies prior authorization or other care management requirements on items or services."
Consolidation of Professional and Facility Claims. The bill holds hospitals responsible for physician claims, even if the physician is not employed at the hospital. Pollack said hospitals would not be privy to the proprietary billing rates of providers and payers.
He also complained that the bill would require hospitals to build a framework to solicit bills from providers and issue payments.
"This would result in an unprecedented change in the relationship between independent hospitals and physicians and would require significant technology and legal resources, as well as a revamping of the billing workflow, to operationalize," Pollack said.
"This would add considerable burden and cost to the health care system and has the potential to result in a number of downstream consequences, including reducing patient access to certain specialties within a hospital or health system. And yet, this provision is not essential to resolving the issue of surprise medical bills," he said.
"We strongly urge you to clarify that independent providers, including those working in facilities, are responsible for their own contracting with and billing on health plans."
Timeline for bills. Pollack urged lawmakers to remove timeline provisions after raising concerns that providers will not control how quickly payers respond to bills. He said the bill gives payers "a mechanism to stop their clock by claiming there is a dispute between them and the provider."
"It also is unclear in the legislative text as to whether the penalties occur if any 30-day window within the 90-day timeline is breached or only if the entire 90-day window is breached," he said. "Delayed responses from plans could subject providers to penalties and prevent them from billing patients if they cannot provide patients their cost-sharing information within the required 90-day window."
President Donald J. Trump is expected to sign the resolution, which delays a government shutdown that would have taken effect at midnight Friday.
The U.S. Senate extended a stopgap delay for $4 billion in disproportionate share payments on Friday when it passed a continuing resolution to keep the government funded for at least another week.
The House passed a companion resolution on Wednesday. President Donald J. Trump is expected to sign the resolution, which delays a government shutdown that would have taken effect at midnight Friday.
The Senate action was met with applause from Bruce Siegel, MD, president and CEO of America's Essential Hospitals.
"This $4 billion cut—a third of all program funding—would destabilize hospitals and threaten access to care as the nation confronts a rapidly escalating healthcare crisis," Siegel said. "We must support essential hospitals on the front lines of the pandemic and reject funding changes that would undermine their mission."
The cuts were supposed to take effect on October 1, the start of federal fiscal 2021, and the Senate continuing resolution extends the delay for another week.
A UCLA-led study found that 30-day mortality rates are 23% higher for patients 65 and older who are treated on a surgeon's birthday.
Older patients undergoing emergency procedures on a surgeon's birthday are more likely to die within a month than are patients who go through similar procedures on other days, according to a new peer-reviewed study inBMJ.
The UCLA-led study found that 30-day mortality rates are 23% higher for patients 65 and older who are treated on a surgeon's birthday. The researchers say the evidence is quite clear, but they don't know why, beyond speculating that surgeons may be distracted.
"Our study is the first to show the association between a surgeon's birthday and patient mortality, but further research is needed before we make a conclusion that birthdays indeed have a meaningful impact on surgeons' performance," said study author Yusuke Tsugawa, MD, an assistant professor of medicine at David Geffen School of Medicine at UCLA.
"At this point, given that evidence is still limited, I don't think patients need to avoid a surgical procedure on the surgeon’s birthday," Tsugawa said.
The researchers looked at 30-day mortality for Medicare beneficiaries ages 65 to 99 who underwent one of 17 emergency surgical procedures from 2011 to 2014, and 981,000 surgeries performed by 48,000 surgeons. Of those, 2,064 procedures (0.2 %) were performed on the surgeons' birthdays.
After adjusting for patient characteristics and the comparing surgeons' performance on their birthday with other days, the study found a 6.9% mortality rate among patients who underwent surgeries on surgeons' birthdays, compared with a 5.6% rate among those whose underwent procedures on other days.
The gap represents a 23% difference in mortality rates between the two groups.
The researchers added caveats to their findings, acknowledging that they were unable to understand precisely what led to higher mortality among the patients in question and could not evaluate the causal link.
In addition, it's not clear if the findings apply to younger patients or to elective procedures.
