RESUMO
Rarely, if ever, does a national healthcare system experience such rapid and marked change as that seen with the COVID-19 pandemic. In March 2020, the president of the United States declared a national health emergency, enabling the Department of Health & Human Services authority to grant temporary regulatory waivers to facilitate efficient care delivery in a variety of healthcare settings. The statutory requirement that Medicare beneficiaries stay three consecutive inpatient midnights to qualify for post-acute skilled nursing facility coverage is one such waiver. This so-called Three Midnight Rule, dating back to the 1960s as part of the Social Security Act, is being scrutinized more than half a century later given the rise in observation hospital stays. Despite the tragic emergency circumstances prompting waivers, the Centers for Medicare & Medicaid Services and Congress now have a unique opportunity to evaluate potential improvements revealed by COVID-19 regulatory relief and should consider permanent reform of the Three Midnight Rule.
Assuntos
Centers for Medicare and Medicaid Services, U.S./organização & administração , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Instituições de Cuidados Especializados de Enfermagem/legislação & jurisprudência , Cuidados Semi-Intensivos/legislação & jurisprudência , Betacoronavirus , COVID-19 , Centers for Medicare and Medicaid Services, U.S./legislação & jurisprudência , Reforma dos Serviços de Saúde , Humanos , Medicare/legislação & jurisprudência , Pacientes Ambulatoriais , Pandemias , SARS-CoV-2 , Estados UnidosRESUMO
With the growing use of low-molecular-weight heparins (LMWH) for the treatment and prevention of venous thromboembolism (VTE), it is important to provide an evidence-based comparison with unfractionated heparin (UFH) concerning rates of heparin-induced thrombocytopenia (HIT). Such comparisons are essential in clinical decision-making and cost-modeling. In this paper we review data regarding non-surgical (medical) patients. We conclude that the lack of uniform evaluation and standardized testing for HIT in the current literature precludes making a reliable estimate of the relative risk of HIT in UFH vs. LMWH in either the treatment or prevention of VTE in non-surgical patients. However, current data suggest that the risk of thrombocytopenia and HIT is low and similar for non-surgical patients who receive either LMWH or UFH.