“During the early stages of the COVID pandemic, the Drug Enforcement Administration (DEA) temporarily lifted restrictions on doctors’ ability to write prescriptions for controlled drugs via telehealth. However, the agency is poised to bring telehealth under regulation again, bringing back strict limits on how and when doctors can prescribe certain drugs.
DEA officials announced the proposed regulations on Friday. The rules would render most controlled drugs ineligible for prescription via telemedicine appointment—severely restricting patients’ ability to obtain drugs without an in-person examination.”
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“However, the proposal contains several carve-outs. Under the policy, Schedule III-V controlled medications can still be prescribed via telemedicine. But patients would be limited to a 30-day supply, after which the patient would be required to have an in-person visit in order to get a refill. The same exception applies to buprenorphine, a drug used to treat opioid substance abuse. Further, under the proposed rule, patients can get indefinite prescriptions for controlled substances via telehealth but only if they are referred to a telehealth physician after receiving an in-person examination by another doctor.”
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“Officials justified the regulations by citing concerns over the risk of overprescription of controlled drugs. While administration officials did mention the benefits that telehealth services bring to rural Americans, there is little consideration of how these services are equally important to many who rely on controlled drugs—and the increased risk that desperate patients will turn to significantly more dangerous drugs to alleviate their symptoms.
“As a health policy lawyer w. chronic pain & ADHD, I cannot overstate how unnecessary & cruel this policy is given what visits look like in person v. Telehealth,” wrote health policy lawyer Madeline T. Morcelle on Twitter. “Or how deadly this could be for those who struggle to get to [appointments] due to disability or transport/geographic barriers.””
“Perhaps the greatest success of the American health care system these last few benighted years is this surprising fact: The uninsured rate has reached a historic low of about 8 percent.
That’s thanks in part to the pandemic — or, more precisely, the slew of emergency provisions that the government enacted in response to the Covid crisis.
One policy was likely the single largest factor. Over the past three years, under an emergency pandemic measure, states have stopped double-checking if people who are enrolled in Medicaid are still eligible for its coverage. If you were enrolled in Medicaid in March 2020, or if you became eligible at any point during the pandemic, you have remained eligible the entire time no matter what, even if your income later went up.
But in April, that will end — states will be re-checking every Medicaid enrollee’s eligibility, an enormous administrative undertaking that will put health insurance coverage for millions of Americans at risk.
The Biden administration estimates upward of 15 million people — one-sixth of the roughly 90 million Americans currently receiving Medicaid benefits — could lose coverage, a finding that independent analysts pretty much agree with. Those are coverage losses tantamount to a major economic downturn: By comparison, from 2007 to 2009, amid the worst economic downturn of most Americans’ lifetimes, an estimated 9 million Americans lost their insurance.”
“The experts I’ve spoken with over the past few years generally agree that nurses are tremendously undervalued given the importance of their work in delivering quality health care. Research has found repeatedly that more nursing staff leads to patients reporting a better experience in the hospital and better health outcomes.
But the problem is, given the way health care in the US is typically paid for, hiring more nurses and making their work environment better doesn’t necessarily make good economic sense for these hospitals.”
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“Nurses point to exorbitant executive compensation (which soared nationwide during the pandemic) and multimillion-dollar real estate deals to explain their decision to strike. They have a point: Hospitals behaving on pure altruism would spend more on clinical staff without their nurses needing to go on strike to force their hand.”
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“Slashing executive pay (Montefiore’s CEO makes $6 million a year) can only pay for so many new nursing positions. Canceling a $38 million land deal in White Plains would make more money available, but when revenue depends on the number of services that a hospital system provides, buying land and building new facilities does make fiscal sense.”
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“Under the fee-for-service model that still dominates American health care, where every physician service can be billed by the hospital where they work, hospitals have every incentive to expand their services but little incentive to hire more nurses to support that work. From a hospital’s accounting perspective, nurses are entirely a cost. They do not generate any revenue directly, even though they are necessary to providing quality medical care.”
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““What we forget is when hospitals put profits over patients, they are operating well within the system of economic carrots and sticks that we created for them, and within the system we created, hospitals are acting completely rationally as any other economic agent would,” Olga Yakusheva, a health care economist at the University of Michigan, said. “There is no economic incentive, right now, for hospitals to invest in adequate nurse staffing, pay nurses well, or provide a good working environment for nurses.”
Until the US gives hospitals good financial reasons to invest in their nursing staffs, these labor disputes are going to occur again and again. As much as we want our health system to be focused on quality health care, in America, health care is a business.
Good health care and profitable health care are not always the same thing. The failure to value nursing in the way we pay for medical services, which laid the groundwork for NYC’s nurses strike, is a stark example of that.”
“According to a 2022 report from the National Academies of Sciences, Engineering, and Medicine, “on average, the number of ongoing drug shortages has been increasing and are lasting longer.” The root cause of that problem, per a report from the Food and Drug Administration, is the economics of the pharmaceutical market itself.
The reasons for shortages are generally consistent no matter the drug: either a shortage of raw materials or a problem at the plant where the drug is manufactured. Shortages for medicines that a patient can pick up at the pharmacy often draw the most headlines, but most of the medications that end up in short supply are generic, injectable drugs that are used in hospitals: usually, these drugs have only one or two suppliers. So if there is a problem at the factory of one company, there is not an easy way to scale up production to make up for a shortfall. And they are usually cheap, which means the companies that manufacture them do not have a strong economic incentive to produce any excess supply.”
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““It makes a lot of sense when you think about it from their perspective. But when you think about it from the hospital perspective, it’s very frustrating.”
Some of these shortages have led directly to patient deaths. An Associated Press report in 2011 linked at least 15 deaths over the prior 15 months to drug shortages. A more recent study, following the year-long shortage of a drug used to treat septic shock, found higher mortality rates for patients who relied on a substitute. Even short of death, drug shortages can meaningfully change the care patients get — if, for example, a pregnant person undergoes a cesarean delivery, with its higher risk of complications and longer recovery time, because the drug that could have induced labor earlier is out of stock.
Experts do have ideas about how to make the pharmaceutical supply chain more resilient. But they require action by the federal government. Until that happens, there is little reason to think the pace and duration of America’s drug shortages will slow down.”
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“These companies rely on razor-thin margins and massive scale to make their business work. They have a “just in time” production schedule, which means almost as soon as the product rolls out of the factory, it is delivered to health care providers. There aren’t warehouses with emergency stockpiles, because it wouldn’t really make financial sense for manufacturers to produce and store the excess supply.”
“about 900 Americans died in 2020 from complications related to childbirth. Another 50,000 or more women experienced severe pregnancy-related complications. Four of five of those deaths were from preventable causes. In terms of scale and rate, America’s maternal mortality dwarfs the issues of other wealthy countries, and these gaps in maternity care shoulder much of the blame.”
“The lesson here should not be that assisted suicide is bad, but heavy government involvement in health care decisions has an inescapable distorting influence. At the very least, how Canada manages health care access is a massive contributing factor. A survey from 2016 found that Canadians wait longer to access health care services than citizens in 11 other countries. The United States is one of the countries of comparison, but the survey also looks at other countries with government-managed health care systems like the United Kingdom and France. A 2020 study from the Canadian Family Physician journal notes that the country simply provides less freedom and opportunity for people seeking medical care than other countries, even when healthcare is centrally planned: ” What these countries do differently than Canada is they allow the private sector to provide core health care insurance and services, require patients to share in the cost of treatment, and fund hospitals based on activity (rather than the global budgets that are the norm in Canada).””
“the US was one of only two among 21 selected similar wealthy countries — along with Israel — in which life expectancy continued to decline last year. While most countries suffered hundreds of thousands of untimely deaths during the first year of Covid-19, once people began to get vaccinated, life expectancies for almost all the 21 countries either stayed the same or began to rise again, many up to their pre-pandemic levels.
The US started off with lower pre-Covid life expectancies than other rich countries like South Korea, France, and Australia. It has been the case for decades that the United States spends exorbitant amounts on health care, yet has worse health outcomes than comparable countries. Even before the pandemic, people in the US faced the opioid epidemic, gun violence, and higher chronic disease rates than people in other rich countries.”
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“Lack of health access and a robust public health care system exacerbated Covid-19’s effects, said Noreen Goldman, a professor of demography and public affairs at Princeton University. The lack of national coordination to address the pandemic, and lower vaccination rates, said Goldman, have also been a factor in outcomes being worse in the US than other comparable countries.
Young people were dying more from Covid-19 in 2021 than 2020, said Theresa Andrasfay, a demography researcher at the University of Southern California. While age remains the biggest risk factor, more middle-aged adults who are not vaccinated are dying. Additionally, she said, high rates of chronic disease, obesity, and diabetes had not yet affected mortality statistics, but when a disease — Covid-19 — came along that had these as risk factors, “it was like lighting a match.””
“When victims of rape or sexual violence seek emergency medical assistance following an attack, they may be saddled with hundreds or even thousands of dollars in medical bills, a new study published this week in the New England Journal of Medicine found.
These bills can further traumatize victims, the study authors warn, and deter others from seeking professional help. Only one-fifth of sexual violence victims are estimated to seek medical care following an attack.”
“the Department of Health and Human Services’ Office for Civil Rights, which is tasked with investigating breaches, helping health care organizations bolster their defenses, and fining them for lax security, is poorly positioned to help. That’s because it has a dual mission — both to enforce the federal health privacy law known as HIPAA and to help the organizations protect themselves — and Congress has given it few resources to do the job.
“They’re a fish out of water … They were given the role of enforcement under HIPAA but weren’t given the resources to support that role,” said Mac McMillan, CEO of CynergisTek, a Texas firm that helps health care organizations improve their cybersecurity.
Due to its shoestring budget, the Office for Civil Rights has fewer investigators than many local police departments, and its investigators have to deal with more than a hundred cases at a time. The office had a budget of $38 million in 2022 — the cost of about 20 MRI machines that can cost $1 million to $3 million a pop.
Another problem is that the office relies on the cooperation of the victims, the institutions that hackers have targeted, to provide evidence of the crimes. Those victims may sometimes be reluctant to report breaches, since HHS could then accuse them of violating HIPAA and levy fines that come on top of costs stemming from the breach and the ransoms often demanded by the hackers.
Depending on the circumstances, it can seem like blaming the victim, especially since the hackers are sometimes funded or directed by foreign governments. And it’s raised questions about whether the U.S. government should be doing more to protect health organizations.”