Local, state and national news of interest to the physician community

March 20, 2024

Match Day 2024: EM Rebounds, Pediatrics Dips

According to the National Resident Matching Program, a record number of medical school graduates were matched to residency programs on Match Day 2024, and perhaps the biggest winner of all was emergency medicine.

As reported a year ago, Match Day 2023 featured a worrisome 554 unclaimed positions in emergency medicine. But this year the specialty rebounded in spectacular fashion, with "95.5% of the 3,026 emergency medicine residency positions filled, reversing a two-year slide," Axios reports.

"Medical school graduates are continuing to choose higher-paying specialties like orthopedic surgery, ophthalmology, thoracic surgery and radiology," Axios notes. This has resulted in a fall in primary care and pediatrics residencies filled, says MedScape. "Nearly all of the obstetrics and gynecology residency slots were filled," Axios says, a fact which observers attribute to the fall of Roe v. Wade two years ago.

"At more than 50,000, the number of registered applicants again hit a new all-time high," AMA reports. For more data, visit NRMP's site here.

IN RELATED NEWS... A bill that would allow the Board of Medicine to issue temporary licensure to physicians licensed in a foreign country is awaiting Gov. Youngkin's signature. (MedPageToday)

As United Healthcare continues its scramble to get payment processing unit Change Healthcare up and running following last month's cyberattack, its woes continue to climb as lawsuits and a federal investigation pile on.

Last Wednesday, the HHS Office for Civil Rights announced an investigation into the cyberattack and United Healthcare's subsequent actions, to see "whether there was a breach of protected health data and if the company followed U.S. health privacy law," Reuters reports. The "unprecedented magnitude" of the attack warrants such, the agency says and AP reports.

UHC says it will cooperate with the investigation but is more focused on restoring its operations. Last Wednesday, Change reported its "pharmacy network was back online," with "all major pharmacy and payment systems up and more than 99% of pre-incident claim volume flowing," Reuters said.

UHC "has already been hit with at least six class action lawsuits accusing it of failing to protect millions of people's personal data...with more lawsuits likely to come," Reuters says. Meanwhile, it claims to have paid out $2 billion in advances to providers since the attack, NBC reports.

OTHER CHANGE HEALTHCARE CYBERATTACK UPDATES

• CMS allows and encourages "states to start making interim payments retroactively to the date when claims payment processing was disrupted." (Reuters)
• "CMS published FAQs related to the Change Healthcare/Optum payment disruption accelerated and advance payments. These go into detail about what services qualify for accelerated and advance payments, application criteria, terms of repayment, financial concerns, and other topics," AMA says.
• Insult to Injury: Ratings agency Fitch says small providers and pharmacies may take a hit to their credit reports in cyberattack aftermath. (Reuters)
• AHIP's statement regarding the cyberattacks was criticized as "tone-deaf" by the AMA.
• HHS Secretary Xavier Becerra was grilled on Capitol Hill last Thursday by Senators demanding his agency hold healthcare executives accountable. (Stat)
• What can the feds do to prevent a future similar attack? MedPageToday and Politico investigate.

An Inspector General's report into the longstanding, ongoing problems related to the U.S. Postal Service's Richmond Regional Processing and Distribution Center in Sandston is expected to be released soon, CBS 6 reports.

Lawmakers hope the investigation will reveal the causes of delayed and disappeared mail that have plagued the facility for years. It's already been chosen for a "consolidation" project designed to increase efficiency by "cutting out the number of trips it takes to get packages and letters from the processing centers to mailboxes."

A letter to the IG dated March 13 and signed by eight Virginia legislators recounts personal experiences, the Richmond Times-Dispatch says, including that of "a veteran who ordered medicine through the Department of Veterans Affairs and was told to expect a 7–10-day delivery time. He didn't receive his medicine," CBS says.

Meanwhile, CBS 6 also reports "four different U.S. Postal Service employees that worked in the Richmond area have now been charged with either obstruction of mail or stealing mail." One of them hoarded 18,225 pieces of mail in an apartment storage locker, while another "stole gift cards, checks and other items of value for her own use."

Sen. Tim Kaine held a roundtable at the Virginia Museum of History & Culture (VMHC) in early February to hear directly from the public. Following repeated requests, Virginia legislators will finally be granted a tour of the Sandston facility later this month.

March is not even over, and this year the United States has already recorded as many cases of measles (58) as it did all of last year, prompting health alerts from the CDC and WHO.

Nearly a quarter century after measles was declared eliminated in the U.S., the virus is resurging, thanks in large part to decreasing childhood vaccination rates. The CDC is urging healthcare providers to "ensure children are current on routine immunizations, including MMR."

So far, 17 states (including Virginia) have been affected. Outbreaks in 46 countries, including Austria, Malaysia, the Philippines, Romania, Russia, and the UK, pose threats to unvaccinated international travelers. "The agency noted in its advisory that the majority — 54 cases — have been linked to international travel," The Hill reports.

"Currently, CDC recommends Americans who plan to travel abroad to consult with their doctors at least six weeks before they go if they are unsure if they are up to date with their measles vaccinations. This is two weeks longer than the one-month recommendation the agency initially made in November," Advisory Board reports.

IN RELATED NEWS... Chicago Department of Public Health achieves 100% measles vaccination in "unprecedented operation" at homeless shelter. (CNN)

"The maternal mortality rate has more than doubled in the last two decades" in the U.S., skyrocketing us well beyond the rates of other developed nations and leaving observers baffled and concerned. However, a new study may have solved the mystery.

Two decades of flawed data being classified incorrectly skewed the numbers, the researchers claim. "In 2003, the National Center for Health Statistics (NCHS) recommended that 'pregnancy' be added to a checklist on a person’s death certificate as a way to track maternal deaths," The Hill reports. The result: Many egregious errors as hundreds of women above child-bearing age, even over 70, were checked as pregnant.

"When only death certificates mentioning pregnancy as a cause of death were counted — rather than those with the 'pregnancy' box checked but no mention of it as a cause of death — researchers found that maternal mortality rates lower and stabilize over time."

The study noted, however, that "large racial and ethnic disparities in maternal mortality persist." Maternal mortality rates were disproportionately high among Black women.

"Using the new method of tracking, researchers found that from 1999 to 2002, maternal mortality rates in the U.S. were 10.2 per 100,000 live births. From 2018-21, it was 10.4, a 2 percent increase."

IN RELATED NEWS... Teen moms were twice as likely to die before age 31, a large study found (NYT).

Barbie may be a beloved role model for many young girls, but one fateful day somewhere on I-95, a young EMT studying emergency medicine was the real hero. Due to several mental health diagnoses, Mia Soviero was considering abandoning her studies when she decided to attend the Barbie movie last July. In full Barbie garb, she left the theater with a PTSD-triggered panic attack and sorrowfully decided her pre-med career was over. But on the drive home, a car crash right in front of her spurred her to action, saving not only a life but also her dream. Read her inspiring story here.

RAM Events & News

RAM Family Day at the Metro Richmond Zoo

Saturday, April 13

10:00 a.m. - 2:00 p.m.

RAM Members & their immediate families are invited to join us at the Metro Richmond Zoo on Saturday, April 13, from 10 a.m. - 2 p.m.!

The family ticket price of $25 gets your immediate family all-day admission to the zoo and one zoo treat cup per family. We'll have pavilions 11, 12 and 13 reserved for our group to mingle and enjoy grab-and-go snacks and drinks! Pack a picnic lunch and sit at one of the tables under a pavilion or on the lawn near our reserved area.

Snack bar and rides are available but not included with your RAM admission.

RAM Member Social at Natalie's Taste of Lebanon

Wednesday, April 24

6:00 p.m. - 8:00 p.m.

Join us at Natalie's Taste of Lebanon on Wednesday, April 24th for our Spring RAM Member Social!

Come join us for a sampling of delicious Mediterranean cuisine while networking with your RAM friends and colleagues.

Free to RAM members and a guest - so invite a friend, colleague, or bring your spouse along and make it a date night!

Medi¢: The Business of Medicine

The New York Times (3/14, Stockton) cites AMA research and interviews with over 50 doctors and patients in a new video that seeks to answer one pressing question: "Should your insurance company be allowed to stop you from getting a treatment — even if your doctor says it's necessary?" They share their answers and the toll of prior authorization in 'What’s My Life Worth?' The Big Business of Denying Medical Care.

Other Medical Business News:

• AstraZeneca follows lead of rival Boehringer Ingelheim, caps asthma and COPD inhalers at $35. (The Hill)
• Newly approved life-saving gene therapy Lenmeldy (see FDA Approvals below) will be the world's most expensive medicine at $4.25 million. (CNN)
• Medicare Part D spending at in-house pharmacies increased fivefold in less than a decade. (Healio)
• Should telehealth consultations be cheaper than in-person visits? Lawmakers squabble over this in a House hearing. (MedPageToday)
• Regulatory safeguards needed: Sometimes Dr. Chatbot makes stuff up. But patients still believe it. (Politico)
• Zepbound surpasses Wegovy in new weekly prescriptions for first time. (Reuters)
• Kroger to sell specialty pharmacy business to Elevance Health's CarelonRx. (Reuters)

Are you aware of the latest recommendations, best practices, and clinical considerations for long COVID treatments? Test yourself with this quick quiz!

• COVID vaccination may cut down risk of post-infection blood clot and heart failure risks. (The Hill)
• Multisystem inflammatory syndrome (MIS-C) in children is still a concern as CDC continues to receive reports. (CIDRAP)
• Are testing and treatments for long COVID just around the corner? (Axios)
• FREE SPEECH CASE: U.S. Supreme Court to consider whether federal officials unlawfully pressured tech companies to suppress posts opposed to COVID-19 vaccines. (WSJ)

National News

• New EPA rule will force medical instrument sterilization plants to slash ethylene oxide emissions by 90%. (The Hill)
• Asbestos entirely banned by EPA. (Stat)
• Iowa lawmakers balk on fetal homicide bill due to concerns about impact on IVF. (AP)

Virginia Focus

• Funding for wastewater surveillance in Virginia may dry up by 2027. (Axios Richmond)

Drug & Tech News

• Noninvasive tests perform well at detecting colorectal cancer. (NPR; MedPageToday)
• Novel CAR T-cell therapy for glioblastoma resulted in rapid tumor regression. (NBC News; MedPageToday)
• Liraglutide (Victoza) could significantly slow peripheral artery disease progression. (MedPageToday)
• Antiviral drug obeldesivir may be effective in curing Ebola Sudan infections. (Stat)
• An experimental new drug could save lives and revolutionize liver surgery. (Reuters)
• Online sales for first OTC birth control pill in U.S., Opill, began Monday. (The Hill)

FDA Approvals

• Atidarsagene autotemcel (Lenmeldy), first FDA-approved gene therapy for children with metachromatic leukodystrophy. (FDA)
• Fluticasone propionate (Xhance) nasal spray for chronic rhinosinusitis to also include treatment of adults without nasal polyps. (MedPageToday)
• Lisocabtagene maraleucel (liso-cel, Breyanzi), for pretreated chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL). (MedPageToday)
• Maralixibat (Livmarli), for the treatment of cholestatic pruritus in patients 5 years and older with progressive familial intrahepatic cholestasis. (Reuters)
• Ponatinib (Iclusig) with chemotherapy, for newly diagnosed Philadelphia chromosome-positive acute lymphoblastic leukemia. (FDA)
• Resmetirom (Rezdiffra), the first treatment for adults with noncirrhotic non-alcoholic steatohepatitis (NASH) / metabolic dysfunction-associated steatohepatitis (MASH). (Reuters; MedPageToday)
• Rilpivirine (Edurant), for the treatment of HIV-1 in pediatric patients. (J&J)
• Spesolimab (Spevigo), expanded indication to treat generalized pustular psoriasis in pediatric patients. (Healio)
• Tislelizumab (Tevimbra), to treat unresectable or metastatic esophageal squamous cell carcinoma in adults. (Fierce Pharma; Reuters)
• twiist automated insulin delivery system, for people aged 6 years and older with type 1 diabetes. (Healio)

Medical Miscellany

• Metabolic syndrome increases the risk of all types of cancer. (MNT)
• Significant increase in breast cancer risk for Hodgkin lymphoma patients treated with doxorubicin. (MedPageToday)
• Diet and sugary drinks can raise atrial fibrillation risks by 20%. (CNN)
• No brain injury evident in Havana syndrome patients. (Reuters)

Pathogen & Vax Report

• Flu and norovirus headline the spring virus season. [Your editor can attest to the latter, unfortunately!] (USA Today)
• Second deadly amoeba type, Acanthamoeba, found to be transferrable to human brains through tap water nasal rinsing. (AP)
• Could a dramatic increase in Legionnaire's disease cases be caused by reduced air pollution? (CIDRAP)

(NOT-SO-) FUN FACT OF THE WEEK

Spring sojourns to Washington, D.C. this time of year are a tradition of many wishing to bask in the elegant beauty of the renowned cherry blossom trees lining the Potomac River. However, the splendid sight will be changed forever after this year: Over 150 of the trees, descendants of the original gifts of friendship sent to us from Japan in 1912, will be cut down as failing seawalls are repaired and raised, NPR reports. The sad but necessary action won't be done until after this year's National Cherry Blossom Festival, which began today and runs through April 14.

Thanks for reading The Leg.Up!



Sifting through the noise and bringing you the important medical news that matters to you is my goal each week. Keep up the great work that you do for your patients day in and day out: We at RAM are proud of every one of you!

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Click here for past editions of The Leg.Up.

Scott C. Matthew

RAM Director of Communications

Richmond Academy of Medicine

www.ramdocs.org

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