Appropriations decisions wait on the election
Shortly before leaving for the October recess and campaign trail, Congress overwhelmingly passed a continuing resolution to fund the government through December 20 and avoid a government shutdown on October 1. This keeps funding level from FY24 into the first three months of FY25. The details of what a final funding bill look like are all on hold until after the election, and the outcomes could influence whether we see another, longer term CR. At this stage, the two chambers are wide apart on health funding priorities. For example, while the Senate calls for a 2 percent increase in AHRQ funding, the House proposes eliminating the Agency altogether. At this stage, we expect an omnibus in December that looks far more like the bipartisan Senate proposals than the partisan House proposals.
Additionally, the debt limit was suspended until January 2 by the Fiscal Responsibility Act of 2023, which also included devastating budget caps for FY24 and FY25. Congress will likely have at least a few months into 2025 to deal with the debt limit, although it is possible that it could be included in the December omnibus. AcademyHealth has called on Congress to raise or suspend the limit without resorting to crude and ineffective discretionary budget caps.
FDA Commissioner: AI will play a crucial role in medical supply chain management
FDA Commissioner Robert Califf wrote in JAMA about how the FDA is thinking about AI. He says that AI advancements must be matched by efforts to better understand and evaluate how AI performs across health care and biomedicine as well as develop appropriate regulatory frameworks. The FDA has authorized approximately 1,000 AI-enabled medical devices, starting with PAPNET in 1995. He discusses the future role of FDA oversight into ensuring that AI tools improve the lives of patients and clinicians. Separately, Califf noted at the HLTH conference that he is worried that health systems are using AI to worsen health disparities by segregating patients based on profitability. He also talked about how health systems are unable to continuously validate AI models, and improving data interoperability is an important step in letting that happen.
ARPA-H announced $110 million in grants for women’s health conditions
The Advanced Research Projects Agency for Health (ARPA-H), an agency within the U.S. Department of Health and Human Services (HHS), announced 23 awardees for the Sprint for Women’s Health, totaling $110 million in research grants. Of the 23 awardees, 30 percent have never received government funding, 39 percent have fewer than 50 employees, and over 70 percent are led by women. Awards represent early-stage research and later-stage development. If successful, launchpad efforts will move to commercialization in two years after funding, bringing health solutions directly to women in record time.
Infant mortality spiked after Dobbs, research understanding why continues
Hundreds more babies died than expected in the year and a half after the Supreme Court ended the constitutional right to abortion in June 2022, raising questions about the ripple effects of the ruling on maternal and child health. In some months, infant mortality jumped by as much as 7 percent, or 247 excess deaths, from the baseline before the Dobbs v. Jackson Women’s Health Organization ruling, which overturned Roe v. Wade. Researchers said it is unclear whether the trend will continue or whether it is a product of the confusion and turmoil in the months after Dobbs.
Senate reports insurers used algorithms to deny Medicare Advantage claims
The Senate Permanent Subcommittee on Investigations launched an inquiry into the barriers facing seniors enrolled in Medicare Advantage in accessing care. They found that Medicare Advantage insurers are intentionally using prior authorization to boost profits by targeting costly yet critical stays in post-acute care facilities. In light of the findings, the Senate subcommittee recommended the CMS conduct targeted audits of insurers’ prior authorization data. It also asked regulators to consider expanding regulations governing the issue of predictive technologies to ensure workers aren’t bound by the tools’ recommendations when making final claims decisions.
OMB updates stakeholders on collecting federal data on race and ethnicity
Chief Statistician of the United States Karin Orvis announced updates on implementing revisions to the Statistical Policy Directive No. 15: Standards for Maintaining, Collecting, and Presenting Federal Data on Race and Ethnicity. OMB and federal agencies have been updating all censuses, surveys, and forms that collect race and ethnicity data to begin using the updated question format and data presentation approaches, as required by the revised SPD 15.
VHA published a brief on the strength of evidence checklist
In response to the passage of the Foundations for Evidence-based Policymaking Act of 2018 (Evidence Act), the Veterans Health Administration (VHA) deployed several innovative solutions to formalize and incorporate evidence into its decision-making processes. One of these is the development of the strength of evidence (SOE) checklist used to assess legislative and budgetary proposals. The SOE checklist assesses the strength of a proposal’s evidence across five dimensions: need, feasibility, effectiveness, cost, and comparison to alternatives. There are 20 prompts within those dimensions, each scored on a scale of one (low) to five (high), resulting in a total score of up to 100.
ACF releases inaugural data strategy to improve services
The Administration for Children and Families (ACF) released an inaugural data strategy to better deliver care. It includes a dozen individual initiatives that fall into four categories: sustaining initiatives; one-stop shop initiatives; delivery initiatives; and technology initiatives. These include building foundational infrastructure such as hiring ACF’s first ever Chief Data Officer and establishing a Data Governance Council; supporting program offices such as by creating a Data Talent Center to provide expertise in hiring and retaining data talent; and sharing data regularly through community-centered data tools and stories.
What we are reading
The Government Accountability Office released a report estimating that the number of people in the US that live with limb loss will double from the current 2 million by 2050. This GAO report focused on health care services for individuals with limb loss, including those who are in Medicare and the VA. They also found significant racial disparities in limb loss, with 21 percent of Medicare and Medicaid beneficiaries who lost a limb being Black despite beneficiaries only being 8 percent of the pool. GAO also reported on stakeholder identified challenges beneficiaries face, including their ability to access care, care coordination among health care providers, and affordability of prosthetics.
The Wall Street Journal reported on the growing challenges facing local oncologists in caring for cancer patients. The increasing complexity of cancer care means that oncologists at magnet cancer centers can develop expertise in just a few cancer subtypes, but most patients get treated locally where oncologists struggle to keep up with changing information. The National Comprehensive Cancer Network updated its nearly 90 guidelines across cancer types more than 200 times in the past year. The American Society of Clinical Oncology maintains a "living guideline" to track how to use the dozens of new drugs to treat lung cancer. "The guideline is almost impossible to read," said Dr. Julie Gralow, the group's chief medical officer.
AcademyHealth is happy to announce two new Reproductive Health Senior Scholars in Residence in partnership with the Society of Family Planning and the Commonwealth Fund. Tiffany Green, Ph.D., Reproductive Equity Action Lab Director at the University of Wisconsin School of Medicine and Public Health, and Maria I Rodriguez, M.D., M.P.H., Professor in the Department of Obstetrics and Gynecology at Oregon Health & Science University (OHSU) and Director of OHSU’s Center for Reproductive Health Equity, as the Senior Scholars in Residence for AcademyHealth will also provide expert guidance for the Research Community on the Equity Impacts of Dobbs.