DCMedical News: Thursday, June 24, 2021
DCMedical News-DCMN
Washington, D.C.
Thursday, June 24, 2021
DCMedical News is published every day both the House and the Senate are scheduled to be in session. Subscription information and archives from 2018 to the present at dcmedicalnews.org, here.
THE BIG STORY
Appropriations Deliberations Begin in the House, Budget Bills May Feature Drug Price Controls
The House Appropriations Committee will consider a total of 12 spending bills, based on the FY 2022 budget request from the Administration. The Appropriations Subcommittee on Agriculture, Rural Development and FDA takes up the FDA’s appropriation beginning tomorrow, with the full Committee taking up review on June 30th. The HHS Subcommittee will begin review of the Department’s appropriations on July 12th, with the full Committee looking at the discretionary spending bill July 15th. The House Appropriations Committee will complete its review of appropriations bills July 16th.
Simultaneously, work is proceeding on Budget bills which will also impact health care, especially focused on drug prices. CQ reports that “Senate Finance Chairman Ron Wyden would like to block a Trump-era ban on certain drug rebates, restructure Medicare Part D to cap out-of-pocket spending and ensure that critical drugs, such as insulin, are made affordable, according to a blueprint he outlined Tuesday (here) . . Some of Wyden's drug pricing proposals could be included in the upcoming reconciliation package. Lowering drug costs produces savings that could be used to offset the costs of other health care priorities, such as adding dental, vision and hearing benefits to Medicare.”
DOCTORS, NURSES AND OTHER HEALTH CARE PROFESSIONALS
Nurses “Underappreciated” in the NHS, High Vacancy Rate Only Partially Filled With “Imported” Nurses; Strikes Worldwide
The Financial Times (here) chronicles the causes and possible cures for a 10% nursing vacancy rate in hospitals of England’s National Health Service. “The country had entered the pandemic with around 40,000 unfilled posts, a vacancy rate approaching 10 per cent . . . Some hospitals have found a successful formula for maintaining staffing levels. Shelagh Meldrum, chief nurse and deputy chief executive at Yeovil District Hospital in Somerset, said it once sourced many nurses from Europe but had successfully pivoted to the Philippines and the United Arab Emirates.” An article in the New England Journal of Medicine (here) explores worldwide nursing strikes (“Health Care Worker Strikes and the Covid Pandemic”) contending that “Though these situations are distinct in multiple ways and health care workers have gone on strike (or protested) for myriad reasons, common demands underlying nearly all these actions relate to inadequate responses to Covid-19 and inadequate protections for frontline workers; every group taking action has explicitly demanded more PPE,” and that “It would be nice to say that it shouldn’t take a pandemic or a strike to force countries to confront these issues, but the past 12 months justify a certain skepticism.”
Physician Supply: Medicare Funded Residency Positions in Hospitals Fall Behind; Immigration Policy Doesn’t Help
A report from the General Accountability Office (here) says that 70% of hospitals that offer graduate medical education programs train more physician residents than the number Medicare pays for. A report in Modern Healthcare (here) says “Medicare is the single largest source for physician residency programs, paying $15 billion in 2018. But many contend the limits Medicare places on how many physician residency ‘slots’ it will pay for teaching hospitals to have are based on outdated formulas that limit efforts to increase the number of physicians.”
The GAO reported “Studies have shown the United States faces a shortage of physicians, making it increasingly difficult for people to access needed health care . . . Medicare offers payments to teaching hospitals to offset costs of training full-time equivalent residents, up to a capped number of resident slots for each hospital. For most hospitals, caps reflect the number of residents that Medicare funded in 1996.” In its report, GAO wrote “Research has shown that about half of physicians tend to practice in the same area where they completed their GME training, so the location of this training is important. However, physicians completing GME training . . . are unevenly distributed across the country, with most concentrated in certain urban centers and the Northeast,” and that “Primary care physician shortages affected about 83 million Americans, or approximately 25 percent of the population. About one-third (29 percent) of Americans affected by primary care shortages live in rural areas, though they account for approximately 18 percent of the total U.S. population.”
The American Health Law Association’s Academic Medical Centers and Teaching Hospitals practice group explores roadblocks to physician supply created by current immigration policy. An essay by Greg Siskind (here) notes that “Reform of immigration policy and programs has been difficult to achieve in the U.S. Congress. Legislation affecting health care and physician immigration has not occurred since 2004, despite legislation being introduced every year on the subject.” Country specific limits apply: “For example, nearly a quarter of IMGs are from India . . . these doctors face waits as long as 20 years to get permanent residency . . . Nearly 15,000 Indian physicians are waiting on green cards. By contrast, a doctor from neighboring Pakistan or Bangladesh can get a green card with no wait at all.” State options to sponsor up to 30 physicians a year to work in underserved areas have also not kept up: “The doctors are granted a waiver of the two-year home country residence requirement. That program has been in place for 27 years but is still a pilot program that Congress routinely extends every few months.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
New Medicare Imaging Requirements January 1, 2022 for “Clinical Decision Support”
AuntMinnie reports (here) that “On January 1, 2022, radiology practices and hospitals that perform certain imaging services for Medicare patients will be denied payment unless they submit documentation that the ordering physician has consulted a clinical decision-support (CDS) system . . . The regulation requires ordering physicians to consult appropriate use criteria (AUC) using a qualified clinical decision-support mechanism (qCDSM) that is approved by the U.S. Centers for Medicare and Medicaid Services (CMS) prior to ordering CT, MR, nuclear medicine, and PET exams for outpatients covered by Medicare Part B . . . The site where the imaging is performed, not the ordering site, determines the need to use CDS.” Not covered by the requirement: inpatient hospital imaging, critical access hospitals, Medicare Advantage plans (unless the plan has a requirement), technical glitches (internet access) and emergencies.
DRUGS & DEVICES
340B Program Now Involves Half of the Nation’s Pharmacies
Drug Channels reports (here) that “An astonishing 30,000 pharmacy locations—half of the entire U.S. pharmacy industry—now act as contract pharmacies for the hospitals and other healthcare providers that participate in the 340B program. Over the past 12 months, the number of pharmacies in the program has grown by more than 2,000 locations . . . multi-billion-dollar, for-profit, publicly traded pharmacy chains and PBMs—Walgreens, CVS Health, Express Scripts, OptumRx, and Walmart—dominate 340B contract pharmacy relationships with covered entities . . . You can keep your dogecoin and your stonks. The real money lies in the still-booming 340B contract pharmacy business.”
Cures 2.0 Emerges, New Federal Agency May Be Created on the Defense Model of DARPA
Politico’s AgencyIQ reports (here) that a “Draft update of the 21st Century Cures Act in the House [here] closely follows President Joe Biden’s vision for a $6.5 billion agency to pursue medical breakthroughs . . . The ‘Cures 2.0’ legislation would authorize the Advanced Research Projects Agency for Health and affect a wide range of areas from FDA regulation to Medicare payments to medical research clearance. ARPA-H would be modeled on research programs at the Defense and Energy departments, though Science magazine (here) commentary says the health agency “will need to pioneer new approaches.” Dr. Collins of the NIH has offered a list (here) of potential high priority projects for the new agency.
Drug Importing Hits (Another) Snag
The Lancet reports (here) that “President Joe Biden's administration said last week that it won't decide whether to allow states to import drugs from Canada anytime soon, if ever . . . Biden's declaration came in the administration's response to a lawsuit seeking to block an importation programme . . . ‘Although two proposals [to import Canadian drugs] have been submitted to the FDA, no timeline exists for the agency to make a decision’, lawyers for the administration argued. Opposition to the programme ‘rests upon contingent future events that may not occur as anticipated, or indeed may not occur at all’, they wrote.”
READINGS & REFERENCES
Select Coronavirus Public Health Resources and References (alphabetical) may be found here.
2021 CQ Congressional Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
June 25
July 19, 20, 21, 22, 26, 27, 28, 29, 30
August - none
September 20, 21, 22, 23, 24, 27, 28, 29, 30
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.