CMS is struggling to enforce regulations in hospitals

Presented by PhRMA: Delivered daily by 10 a.m., Pulse examines the latest news in health care politics and policy.

May 31, 2022 View in browser   By Krista Mahr and Sarah Owermohle Presented by With help from Megan Messerly and Daniel Lippman  Editor's Note: POLITICO Pulse is a free version of POLITICO Pro Health Care's morning newsletter, which is delivered to our subscribers each morning at 6 a.m. The POLITICO Pro platform combines the news you need with tools you can use to take action on the day's biggest stories.  Act on the news with POLITICO Pro. QUICK FIX — CMS is struggling to enforce its own regulations, putting patients at risk. — Low-income nations like Ghana won't be prepared for the next pandemic — or even continue to provide basic health care — at current international investment rates. — Austin is considering a resolution to skirt Texas' abortion trigger law, directing police to de-prioritize enforcement of the law. WELCOME TO TUESDAY PULSE — To belatedly mark Memorial Day, here's an interesting project by a writer who wants to pen an essay about the life of every U.S. service member killed in World War II. Send news and tips to kmahr@politico.com and sowermohle@politico.com.   A message from PhRMA: Nearly half of insured Americans who take prescription medicines encounter barriers that delay or limit their access to medicines. In a new report, learn more about the abusive insurance practices that can stand between patients and the care they need.   Driving the Day Early this year, Covid-19 infections in hospitals spiked. | Carlos Osorio/AP Photo WHY CMS CAN'T ENFORCE ITS OWN RULES — The Centers for Medicare and Medicaid Services is not well-equipped to enforce its own hospital regulations, particularly when it comes to infection control, reports POLITICO's Rachael Levy. That means CMS officials — who don't have the resources to follow up on every complaint or inspect every hospital — are sometimes unaware of the gap between what hospitals preach and what they practice regarding patient safety and especially Covid-19 protocols. Some hospitals allow nurses and doctors to go maskless as they treat immunocompromised patients. Testing requirements for health workers remain scarce. Other facilities still require patients to swap their N95 masks for surgical ones, despite CMS' crackdown on the practice after POLITICO wrote about the issue. A record number of people caught Covid-19 inside hospitals during January. The problem isn't new or limited to Covid-19. For years, the Government Accountability Office has found that hospitals struggle to control all kinds of infections. CMS and the Centers for Disease Control and Prevention have noted that hospital infections surged during the pandemic, reversing years of improvements. UNPREPARED FOR THE WORST — While the World Health Organization and the United Nations have tried to help low-income countries build up their health care systems over the last two decades, the investments haven't met the needs on the ground. Covid has exacerbated that gap, POLITICO's Erin Banco reports. In Ghana, often cited as one of the better-equipped health care sectors in sub-Saharan Africa, health care workers say the pandemic has depleted their resources and kept them from treating patients with dangerous chronic conditions. They worry their system is so worn down they'll be unable to continue providing basic care, let alone be prepared for the next virus. If new Covid-19 variants cause cases to spike or another large-scale infectious disease outbreak occurs, Ghana's entire health system could collapse, they warn. In 2021, the World Bank, in coordination with the U.S., created the Financial Intermediary Fund — a pot of money set up to help low-income countries build their health systems' capacity so they can more quickly contain outbreaks. So far, the fund has received only $962 million in pledges. Investing in health care systems in low-income countries will take tens of billions more. AUSTIN MOVES TO EFFECTIVELY DECRIMINALIZE ABORTION — Austin city council member Chito Vela is proposing a resolution that would direct the city's police department to make the criminal enforcement, arrest and investigation of abortions its lowest priority and restrict city funds and staff from being used to investigate, catalogue or report suspected abortions, Megan reports. The resolution — the first attempt by a major city in a red state to circumvent state abortion policy — aims to shield Austin residents from prosecution under a Texas law that would criminalize almost all abortions if Roe v. Wade is overturned. "In Texas, you're an adult at 17. We are looking at the prospect of a 17-year-old girl who has an unplanned pregnancy and is seeking an abortion; she would be subjected to first-degree felony charges, up to 99 years in jail," said Vela, who shared the resolution's details first with POLITICO. "That's just absolutely unacceptable." What's at stake? Texas lawmakers have enacted a so-called trigger law that would take effect 30 days after a Supreme Court ruling overturning Roe . The law would make performing, inducing or attempting an abortion where "an unborn child dies as a result of the offense" a first-degree felony, punishable by up to life in prison and up to a $10,000 fine — the harshest criminal penalties on the books in any state. It contains an exception only to save the life of the pregnant person. Will it have an impact? The Austin resolution is nonbinding in an effort to avoid conflict with the state law. But Austin city manager Spencer Cronk said in a statement that he is "prepared to take the steps necessary to faithfully implement this resolution upon passage by City Council." The council passed a similar measure in 2020 that effectively decriminalized marijuana by ending arrests and fines for low-level possession, which the police department has followed.   DON'T MISS DIGITAL FUTURE DAILY - OUR TECHNOLOGY NEWSLETTER, RE-IMAGINED:  Technology is always evolving, and our new tech-obsessed newsletter is too! Digital Future Daily unlocks the most important stories determining the future of technology, from Washington to Silicon Valley and innovation power centers around the world. Readers get an in-depth look at how the next wave of tech will reshape civic and political life, including activism, fundraising, lobbying and legislating. Go inside the minds of the biggest tech players, policymakers and regulators to learn how their decisions affect our lives. Don't miss out, subscribe today.     Mental Health BLACK AND HISPANIC COMMUNITIES UNDERDIAGNOSED FOR DEPRESSION — A report released today from Blue Cross Blue Shield found that depression is disproportionately undiagnosed and untreated in Black and Hispanic individuals compared with their white counterparts. Though the CDC reports that depression rates are equal or higher among Black and Hispanic people, the study found that diagnosis rates are 31 percent lower in Black communities and 39 percent lower in majority Hispanic communities than in white communities. That may be partly because of perceived stigma. The report included a survey that 54 percent of Black respondents and 47 percent of Hispanic respondents said people with mental health conditions were looked down on in their communities, compared with 38 percent of white respondents. But the care gap isn't just a result of who seeks treatment; it's happening at the provider level as well. The study found that drugs are prescribed to treat major depression at a 13 percent lower rate for Black communities and a 33 percent lower rate for Hispanic communities than for white communities. Around the Agencies CMS plans to lower premiums in 2023. | Getty Images CMS TO LOWER PREMIUMS IN 2023 — On Friday, CMS announced it will lower the premiums for doctor-administered drugs in 2023, POLITICO's Katherine Ellen Foley reports. The decision follows a review of Medicare Part B premium costs earlier this month by the CMS Office of the Actuary, which concluded the agency had overestimated costs for Aduhelm, a pricey and controversial Alzheimer's drug from Biogen, in its 2022 premiums. The backstory: In November 2021, CMS announced it would raise 2022 Part B premiums by more than 14 percent from $148.50 a month to $170.10. The increase, one of the steepest ever, was partly due to the estimated costs of Aduhelm, which was approved by the Food and Drug Administration in June 2021. Biogen has since slashed the drug's prices, and CMS has said it won't cover the drug unless patients are enrolled in a clinical trial.   A message from PhRMA:   Public Health HERE WE GO AGAIN — The World Health Organization urges wealthy countries stockpiling monkeypox and smallpox vaccines and devise a plan to audit and distribute them equitably to countries that need them, POLITICO Europe's Helen Collis reports. Last week, the European Union confirmed it's in talks to buy monkeypox vaccines and treatments for the bloc. The U.S. has also placed additional orders with the manufacturer of Jynneos, an FDA-approved vaccine for monkeypox, a CDC official said last week. On Friday, a WHO official said the organization didn't have a clear picture of how many vaccines countries currently had available. "That's why we encourage countries to come to WHO and tell us: What are their stockpiles? What are the quantities available? And have they done potency testing on those vaccines? So that we have a better understanding of what are the resources currently in hand." PEDIATRIC HEPATITIS CASES ARE GETTING WORSE — The WHO has now received reports of 650 probable cases of hepatitis of unknown cause in children from 33 countries and characterized the risk of the disease spreading globally as moderate, POLITICO's Carmen Paun writes. The cases it's examining appear to be more severe than those reported earlier, with more children developing acute liver failure. Adenovirus is still being investigated as a possible cause, but that doesn't explain why the cases are getting worse, officials say. The U.K. and the U.S. have reported the most cases of acute hepatitis: 222 and 216, respectively. Among the nearly 280 cases reported in Europe by May 20, three-quarters were in children under 5, the WHO said.   STEP INSIDE THE WEST WING: What's really happening in West Wing offices? Find out who's up, who's down, and who really has the president's ear in our West Wing Playbook newsletter, the insider's guide to the Biden White House and Cabinet. For buzzy nuggets and details that you won't find anywhere else, subscribe today.     Names in the News Chris Kuzmuk is joining Bristol Myers Squibb as executive director for intercontinental, Japan and Canada international policy and government affairs. He previously was associate VP for Asia at PhRMA. Lippi Doshi has joined the Gates Foundation as a senior program officer of program advocacy and communications in family planning and maternal, newborn and child health. She was previously a senior adviser in communications on the USAID Covid-19 task Force. What We're Reading The New York Times reports how Covid-19 positive travelers use the "backdoor" to enter the U.S. Covid-19 cases are five times higher this Memorial Day than last when Americans thought they were on the brink of a "hot vax summer," The Washington Post writes. The Wall Street Journal explores what the children of DNA donors have the right to know.   A message from PhRMA: According to data just released, insurance isn't working for too many patients. Despite paying premiums each month, Americans continue to face insurmountable affordability and access issues: Roughly half (49%) of insured patients who take prescription medicines report facing insurance barriers like prior authorization and "fail first" when trying to access their medicines. More than a third (35%) of insured Americans report spending more in out-of-pocket costs in the last 30 days than they could afford. Americans need better coverage that puts patients first. Read more in PhRMA's latest Patient Experience Survey.     Follow us on Twitter Tucker Doherty @tucker_doherty Dan Goldberg @dancgoldberg Erin Banco @ErinBanco Katherine Ellen Foley @katherineefoley Lauren Gardner @Gardner_LM Ben Leonard @_BenLeonard_ Rachael Levy @rachael_levy David Lim @davidalim Krista Mahr @kristamahr Megan Messerly @meganmesserly Alice Miranda Ollstein @aliceollstein Sarah Owermohle @owermohle Carmen Paun @carmenpaun Megan R. Wilson @misswilson   Follow us

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