DCMedical News: Wednesday, June 15, 2022
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY Wednesday, June 15, 2022
Better Nurse Staffing May Be Key in Addressing Maternal Morbidity and Mortality
The Joint Commission’s Journal on Quality and Patient Safety (here) reports that “Issues with task overload, tools, and technology inhibit nurses’ abilities to respond appropriately to women in labor who experience clinical deterioration.”
“Health care administrators should improve staffing, decrease nurse task load, and include bedside nurses in the redesign of tools and technology to mitigate the harms of performance obstacles.”
Background: “Maternal morbidity and mortality are at their highest recorded levels in the United States, with more than 50% of maternal deaths deemed preventable. Women in labor often experience gradual morbidity, but signs of worsening condition may not be noticed by clinicians. Nurses are well-positioned to notice these signs, but performance obstacles inhibit nurses’ work.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Travel Nurses and Other Clinical Gig Work Expose Employers to Liability
Bloomberg Health Law & Business (here) reports that “as hospitals turn to outside companies to fill staffing gaps . . . the practice carries legal and regulatory risks for both sides. The gig model that relies on independent contractors is more complicated in the highly regulated health-care industry than for rideshare and food delivery. The trend could leave facilities and the companies serving them vulnerable to misclassification accusations, joint-employer disputes, and complicated wage and hour laws, attorneys and others in the industry say.”
“As pandemic-era flexibilities that allowed travel nurses to easily move from state to state expire, staffing companies will have an even harder time navigating the regulations . . . The Covid-19 pandemic exacerbated the burgeoning shortage of health-care workers of all kinds. Job openings in the industry are more than double what they were a decade ago, according to the Bureau of Labor Statistics” [see diagram in Bloomberg article showing vacancy percentage in health care and social assistance 4.5% in 2020, 9% in 2022].
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
STAT+ Reports, “The FTC says it’s getting tougher on hospital consolidation. Antitrust experts aren’t buying it.”
The report (here) said “After the Federal Trade Commission’s flashy announcements last week that it was suing to block not one, but two hospital mergers, it’s tempting to think the agency — with its new Democratic majority — is living up to pledges from its leaders and President Biden to get tougher on health care consolidation. Antitrust experts see it differently.”
Some of the experts: “The complaints themselves are more smoke than fire.” And “Antitrust attorneys and academics describe the hospital mergers being challenged in Utah and New Jersey as low-hanging fruit.” And: “Truly ramping up scrutiny, by contrast, would mean going after vertical mergers, like when hospitals or insurers buy physician groups, or cross-market mergers, where hospitals unite across state lines.”
Which Country Is This?
Health Policy (here) reports on a country which “entered the COVID-19 crisis with common problems, including workforce shortages and underdeveloped and underutilized preventive and primary care” but “acted swiftly to the first wave of the COVID-19 pandemic, declaring a state of emergency in March 2020 and setting up new governance mechanisms. The initial response benefited from a centralized approach and high levels of public trust but proved to be only a short-term solution. Over time, governance became dominated by political and economic considerations, communication to the public became contradictory, and levels of public trust declined dramatically.”
There was “additional bed capacity for the treatment of COVID-19 patients in the first wave, but a greater challenge was to ensure a sufficient supply of qualified health workers. New digital and remote tools for the provision of non-COVID-19 health services were introduced or used more widely, with an increase in telephone or online consultations and a simplification of administrative procedures. However, the provision and uptake of non-COVID-19 health services was still affected negatively by the pandemic. Overall, the COVID-19 pandemic has exposed pre-existing health system and governance challenges . . . leading to a large number of preventable deaths.”
The answer? Authors of this study described COVID measures and responses in Bulgaria, Croatia and Romania.
DRUGS & DEVICES
Hospitals’ Dependence on §340B Profit Outlined in Brief
A brief (here) by the American Hospital Association, 340B Health, America’s Essential Hospitals, the Association of American Medical Colleges and the Children’s Hospital Association shows the extraordinary dependence of the hospital industry on the profit from drug sales under § 340B.
What began as a modest program of support for safety net hospitals in 1992 has grown to involve more than 2500 hospitals nationwide. Under the program, pharmaceutical companies are compelled to sell their products to hospitals at a significant discount, and the hospitals that received those drugs are entitled to bill for them at much higher amounts than they paid. The difference is nominally intended for the “safety net” activities of those hospitals, almost all of which are not safety net providers.
The drug companies, contending that the charitable purpose of the 1992 statute has been lost, contend that “while the use of contract pharmacies has grown exponentially, the overall level of charitable care provided by hospitals has not.” The hospital brief counters that “340B hospitals provide substantial community benefit, and charity care tells just one piece of the story.” Customarily, hospitals use Schedule H of form 990 to display the amount of “underpayment” of services for Medicare and Medicaid beneficiaries, and claim those underpayments as part of their community benefit.
Protesting the limitations on the program imposed by manufacturers, who have essentially created their own program rules, the hospitals say “More than three quarters of 340B hospitals reported that they will need to cut or adjust programs if the drug manufacturers’ restrictions become permanent. These include cuts to patient care services (80 percent), services in underserved areas (74 percent), and targeted programs to serve low-income patients that live in rural areas or are otherwise vulnerable (72 percent). A third of critical access hospitals report that the restrictions put their hospitals at risk of closure.”
READINGS & REFERENCES
Select Coronavirus Public Health Resources and References may be found here.
Oral anti-viral medications for COVID-19, JAMA Patient Page, here.
Monkeypox resources, CDC (here), JAMA Patient Page (here).
2022 CQ Congressional Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
June 16, 21, 22, 23, 24
July 12, 13, 14, 15, 18, 19, 20, 21, 26, 27, 28, 29
August, Congress adjourned, no editions of DCMN
Notes to Fred Hyde, MD, JD, MBA, news@dcmedicalnews.org