DCMedical News: Friday, March 18, 2022
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY Friday, March 18, 2022
When the Pandemic Is Over
InsideHealthPolicy reports (here) that "The Biden administration has yet to provide a concrete timeline for ending the COVID-19 public health emergency or name which HHS COVID-19-related flexibilities should be made permanent," according to 75 Republican Members of the House in a letter to the White House which also said that it’s time for the administration to release its PHE exit plan and identify which HHS emergency measures and regulatory flexibilities will be phased out or made permanent.
In a separate report (here), IHP noted "The Biden administration hopes to partner with private insurers to manage the “unwinding” of the public health emergency and the transition to private payment for COVID-19 vaccines and treatments, a White House domestic policy advisor said Tuesday (March 15). The official warned insurers the transition could come sooner than planned if Congress doesn’t quickly pass the stalled $15.6 billion COVID-19 relief bill.
See Medicaid below, for the end of Medicaid PHE expansion.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Education and Training for Nurses Measures in State Legislatures
Stateline reports (here) that, as nurses quit, states seek to train more. "Under pressure from short-staffed hospitals and burned-out nurses, lawmakers in several states recently passed bills designed to expand nursing schools . . . This legislative season, that sense of crisis has powered bipartisan efforts to increase nurse training and licensure."
The Stateline report notes that "The proposals have split somewhat along party lines, with Republican lawmakers in red states emphasizing reduced education regulations [substituting simulation for clinical work; part time for full time faculty, for example] and Democrats in blue states emphasizing funding increases. Still, leaders in both parties agree on the need to get more nurses educated and helping patients.
"The COVID-19 pandemic has put the health care system under such unusual strain that it's hard to say for sure how many new nurses the nation needs, academic experts say. Before the pandemic hit, Peter Buerhaus of the Center for Interdisciplinary Health Workforce Studies at Montana State University and his colleagues projected that the United States would gain a million new registered nurses between 2015 and 2030 . . . The pandemic scrambled forecasts by increasing demand for nurses in key roles, such as in intensive care units and emergency rooms, while simultaneously driving away nurses who were burned out, seeking higher pay, unable to find childcare or unwilling to get vaccinated."
"Hospital associations and nursing groups in many states say local shortages are pressing, however. And they’ve been pushing lawmakers to respond."
An Announcement From the Health Resources and Services Administration:
"Below are important updates about HRSA’s COVID-19 Uninsured Program and HRSA’s COVID-19 Coverage Assistance Fund.
At 11:59 p.m. ET on Tuesday, March 22, the Uninsured Program will stop accepting claims for testing and treatment due to a lack of sufficient funds.
At 11:59 p.m. ET on Tuesday, April 5, the Uninsured Program will also stop accepting vaccination claims due to a lack of sufficient funds.
At 11:59 p.m. ET on Tuesday, April 5, the Coverage Assistance Fund will stop accepting vaccination claims due to a lack of sufficient funds.
Claims that have been submitted by these deadlines will be paid subject to eligibility and availability of funds."
Imaging Costs Concern Radiologists, Patients
"Patients who are worried about the financial burden of advanced imaging are more likely to go into debt or forego exams altogether to cope with their medical expenses," says a study (here) in the Journal of the American College of Radiology.
“One in three Americans experience medical cost distress, and more fear the cost of a serious illness more than getting seriously ill,” Gelareh Sadigh, MD, with the Department of Radiology and Imaging Sciences at Emory University School of Medicine, and co-authors wrote. Concerningly, 15% of respondents said they did not adhere to their care plan in at least one instance. In this study, nonadherence was described as not filling appropriate prescriptions, taking fewer pills than prescribed to ration the supply and skipping imaging exams all together.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Phasing Down and Out
A report in the Commonwealth Fund blog (here) asks, "What Are the Economic and Employment Consequences of Phasing Down Medicaid Enrollment After the Public Health Emergency Ends?" The answer, "When the COVID-19 public health emergency ends . . . Without a change to current law, massive Medicaid disenrollment after the COVID-19 public health emergency ends will trigger a significant increase in unemployment and rock state economies."
The note explains, "The Families First Coronavirus Response Act of 2020 temporarily increased federal matching funds for state Medicaid programs during the COVID-19 Public Health Emergency (PHE) in exchange for a requirement that states suspend redeterminations of enrollees’ eligibility. This paused Medicaid disenrollment for the duration of the PHE . . . The redetermination process often results in loss of coverage because of paperwork barriers, not just income changes. The pandemic policy had the effect of stabilizing overall health insurance coverage despite massive job losses and increases in poverty. Unless current law is modified, Medicaid enrollment could decline rapidly when the PHE ends . . . The Urban Institute projected that if the PHE had expired at the end of 2021, Medicaid enrollment could fall by almost 15 million people within six months."
A report in the Washington Post echoes this concern. In a story (here) headlined "Millions of vulnerable Americans likely to fall off Medicaid once the federal public health emergency ends," the Post reports that "Every state accepted the bargain at a moment when few imagined that, two years later, the pandemic — and the public health emergency the Department of Health and Human Services has been renewing every 90 days since the coronavirus’s first winter — would still be present. In that time, Medicaid caseloads have jumped about 22 percent nationally as new people have joined and no one has cycled on and off the rolls. The nearly 78 million Americans on Medicaid as of September, the latest figure available because federal tallies run months behind, are the most since the program began as a shared federal-state responsibility in the 1960s as a pillar of President Lyndon B. Johnson’s War on Poverty."
DRUGS & DEVICES
Learning the Steps in Step Therapy
An essay in the New England Journal of Medicine (here) addresses "Step Therapy’s Balancing Act — Protecting Patients while Addressing High Drug Prices." The report notes that "Step therapy is a utilization management strategy whereby insurers implement tiered treatment pathways for various conditions. Patients (and their physicians) who seek approval for restricted therapies must document unsuccessful attempts at treatment with less expensive therapies in earlier 'steps.' Most employer-sponsored insurance plans incorporate requirements for step therapy into their drug formularies. By design, such utilization management strategies create administrative burdens aimed at steering patients and physicians to an insurer’s preferred treatments."
READINGS & REFERENCES
Select Coronavirus Public Health Resources and References may be found here.
2022 CQ Congressional Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
March 28, 29, 30, 31
April 1, 4, 5, 6, 7, 26, 27, 28, 29
May 10, 11, 12, 13, 16, 17, 18, 19
Notes to Fred Hyde, MD, JD, MBA, news@dcmedicalnews.org