FY24 Appropriations look rocky as Congress leaves without key agreements
The House and Senate remain intractably far apart on agreeing to the total discretionary funding levels for FY24. Due to the unusual decision to split federal funding deadlines into two deadlines of January 19 and February 1, Congress only has a few weeks to reconcile four spending bills or risk a partial government shutdown. The Fiscal Responsibility Act, which raised the debt limit in June, provided total funding levels for FY24 and FY25, however immediately after passage, many House Republicans rejected the agreement and demanded far deeper cuts. Without knowing what numbers to use, appropriators cannot write their bills or conference the steep differences between the partisan House bills and the bipartisan Senate ones. The process of drafting an appropriations bill can take weeks, adding constraints on the ability of Congress to pass funding in time. Speaker Johnson has vowed to not do any more short-term funding arrangements, called continuing resolutions.
Congressional investigation found that pharmacies hand over patient information without a warrant
The nation’s largest pharmacy chains have handed over Americans’ prescription records to police and government investigators without a warrant, a congressional investigation found, raising concerns about threats to medical privacy. Though some of the chains require their lawyers to review law enforcement requests, three of the largest — CVS Health, Kroger and Rite Aid, with a combined 60,000 locations nationwide — said they allow pharmacy staff members to hand over customers’ medical records in the store. The policy was revealed in a letter sent late Monday to Xavier Becerra, the secretary of the Department of Health and Human Services, by Sen. Ron Wyden (D-Ore.) and Reps. Pramila Jayapal (D-Wash.) and Sara Jacobs (D-Calif.). The revelation could shape the debate over Americans’ expectations of privacy as Texas and other states move to criminalize abortion and drugs related to reproductive health.
ONC finalized a rule on healthcare AI transparency
The HHS’ Office of the National Coordinator for Health Information Technology (ONC) finalized a sweeping rule aimed at boosting data interoperability and patient access, including a provision to establish transparency requirements for artificial intelligence in health software. Under the rule, developers of clinical decision support and predictive tools certified by the ONC should enable a limited set of identified users to access information like the value of the intervention, how it should be used, known risks or inappropriate uses, and how the tool is maintained and updated.
March of Dimes released annual report card on the state of maternal and infant health in America
The March of Dimes released the 2023 March of Dimes Report Card: The State of Maternal and Infant Health for American Families, providing a comprehensive analysis of the state of maternal and infant health across the United States. The U.S. maintains a D+ grade for maternal and infant health, with a 1% improvement in preterm birth rate, but persistent health equity gaps persist. The worst preterm birth rates are in the southeast U.S. with 24 states and Puerto Rico receiving the lowest grades, reflecting systemic issues such as equity gaps, access to care, and failure to adopt policies to improve maternal and infant health outcomes.
HHS launches data sharing initiative TEFCA
The HHS Office of the National Coordinator for Health Information Technology (ONC) announced that the nationwide health data exchange governed by the Trusted Exchange Framework and Common Agreement (TEFCA) is now operational. The first five organizations that have joined the TEFCA are eHealth Exchange, Epic Nexus, Health Gorilla, KONZA, and MedAllies. These organizations can immediately begin supporting the exchange of data under the Common Agreement’s policies and technical requirements.
CDC Director Mandy Cohen working on rebuilding trust with American public
Americans trust in the CDC and science more broadly was badly damaged by the coronavirus pandemic, and the loss of faith is particularly pronounced among Republicans. In a recent survey by the Pew Research Center, 38 percent of Republicans said they had little or no confidence in scientists to act in the public’s best interests, up from 14 percent in April 2020. At the same time, the C.D.C.’s winter vaccination campaign appears to be falling on deaf ears. The agency issued an alert warning that low vaccination rates for the flu, Covid and respiratory syncytial virus, known as R.S.V., could lead to “severe disease and increased health care capacity strain in the coming weeks.” And partisan divisions over vaccination persist: A KFF poll in September found that seven in 10 Democrats but just a quarter of Republicans planned to get the updated Covid shot. Dr. Mandy Cohen is responding with a nationwide media blitz, having traveled across the country and doing dozens of national interviews and social media campaigns.
Health costs grew slower in 2022
New data released found that health care spending in the US grew 4.1 percent to reach $4.5 trillion in 2022, which was still a faster rate of growth than the increase of 3.2 percent in 2021 but was much slower than the rate of 10.6 percent seen in 2020. The share of the economy accounted for by the health sector was 17.3 percent in 2022, which was down from a peak of 19.5 percent in 2020 but was more consistent with the average share of 17.5 percent during 2016–19.
HHS released its strategy to support healthcare cybersecurity
HHS released a working paper that outlines its strategy to support healthcare cybersecurity efforts, including upcoming proposals to tie new cybersecurity requirements for hospitals through Medicare and Medicaid and to begin an update to HIPAA to include new requirements. HHS also intends to create a one-stop shop for cybersecurity support in the Administration for Strategic Preparedness and Response (ASPR) to enhance coordination. HHS will also establish a voluntary cybersecurity performance standard for the healthcare sector.
What I’m reading
The Kaiser Family Foundation released a sweeping survey on racism and discrimination in health care, and while the whole thing is worth a read, I was especially taken aback by one of the results they reported. They found that a majority of Hispanic, Black, and American Indian and Alaskan Native people in the US say they have to be careful about their appearance or prepare for insults during health care visits, compared to only a third of white patients. It is outrageous that one of the concerns that these individuals face when seeking healthcare is that a doctor, provider, or their staff will only treat them fairly if they are careful about their appearances.
The New York Times has a report on the unconscious biases that medical providers have against pregnant Black women, and the implications they have for the far worse health outcomes these women face. These unconscious biases are impactful as it affects decisions the brain makes, especially when a person is uncertain, tired, or stressed – features throughout the healthcare workforce. While these biases lead to Black women not getting the care that they do need, it also leads to them being more likely to be tested for illicit drugs during labor than white women, more likely to be described as uncooperative, and are less likely to be believed by providers when reporting their symptoms.
Dr. Robison et al wrote in JAMA Health Forum about the racial and ethnic differences in hospice use among Medicaid and dual-eligible patients. They found that in both of these patient categories that Hispanic and Black individuals had the lowest odds of receiving hospice care, and that Hispanic patients had the shortest stay. This raises important questions about equity in timing and access to hospice care for those patients that need it.
I was interested in seeing the innovation of Mass General Brigham in Boston, which is using on-demand vans with nurses and language interpreters to visit older patients for monitoring, preventative care, and vaccinations. This is an example of a model of care focused on making health care more accessible beyond the physical premises of practices. The program engages with social determinants of health, partnering with food pantries, nonprofits, and even law enforcement to bring services directly to patients.
Trying to grapple with America’s unique gun problems, more states are turning to Medicaid dollars to fund community-based violence programs to stop shootings. An infusion of reliable funding, their advocates say, could allow these nonprofits to expand their reach to more residents most at risk of being shot — or of shooting someone. With gun-control legislation stalled in Congress, the Biden administration has opened up federal Medicaid dollars to violence prevention. President Biden announced the novel approach in April 2021, and now the money is starting to flow to interested states.
With the end of the COVID-19 public health emergency, a patchwork of rules have come in when it comes to how providers interact with patients. Many clinicians and staff at hospitals, clinics, and nursing homes around the country have stopped regularly wearing masks. A conflict might arise when patients who are immunocompromised seek health care and encounter an unmasked clinician. While it may seem obvious that providers should put on a mask if asked, many patients with disabilities have reported providers refusing to. Dorfman et al discussed this ethical dilemma that the medical profession is wrestling with in JAMA Health Forum.