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| Axios Vitals |
| By Tina Reed · Jan 23, 2023 |
| Welcome back to the work week, Vitals readers. Today's newsletter is 993 words or a 3½-minute read. 💻 Tune in tomorrow: Join Axios' Adriel Bettelheim and me tomorrow at 12:30pm ET for a virtual event exploring how policies and social determinants influence health outcomes and care options for seniors. Register here. - Guests include Rep. Raul Ruiz (D-Calif.) and National Hispanic Medical Association CEO Elena Rios.
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| 1 big thing: New rural hospital payment model a lifeline for some, a risky gamble for others |
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| Illustration: Aïda Amer/Axios |
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| The Biden administration is offering struggling rural hospitals a new financial lifeline starting this month, but with an unusual twist: Facilities that opt-in have to agree to close their non-emergency inpatient services, Axios' Arielle Dreher reports. The big picture: Becoming a "rural emergency hospital" brings enhanced Medicare payments and upward of $3 million in subsidies each year. But patients typically have to leave within 24 hours, meaning those who can't go home have to be discharged to a full-service hospital, possibly in another state. - The thinking is many small hospitals have so few patients that inpatient services invariably run in the red.
- Critical access hospitals or rural facilities with less than 50 beds are primary candidates for conversion under the program, which Congress authorized in 2020.
Go deeper: Critics say the designation is built around the mistaken belief that inpatient services for small patient populations are draining rural facilities and that eliminating that will solve most problems. - It's a myth, said Harold Miller, CEO of the Center for Healthcare Quality and Payment Reform, especially for facilities with swing beds for either acute or skilled nursing care, or long-term care beds.
- Miller studied cost drivers in Washington state and Alaska, concluding facilities would lose more money by eliminating inpatient care. "Costs would go down but revenue would go down even more from inpatient services and ancillary services," he said.
Yes, but: For some rural facilities on the brink, converting will bring an infusion of cash and the ability to triage patients as well as continue outpatient services. - The new designation amounts to "an alternative to those areas that want to maintain access in their community," Carrie Cochran-McClain, chief policy officer at the National Rural Health Association, told Axios.
Read the rest. |
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| 2. America's caregiver crisis |
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| Illustration: Sarah Grillo/Axios |
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| America is not only coping with a shortage of home care workers, but with turnover and churn among that workforce that's making it harder to line up care for loved ones, the Wall Street Journal reports. Why it matters: With an ever-growing number of aging baby boomers who need elder care, as well as the COVID-fueled reluctance to seek care in nursing homes, demand for home care is surging. Driving the news: The median caregiver turnover rate was about 65% in 2021, the WSJ reported, citing data from Home Care Pulse, a company that provides training to home care agencies. The big picture: Home health providers will avoid significant Medicare pay cuts next year, after the Biden administration announced a net 0.7% increase in fees last year, Axios' Maya Goldman wrote. - Yes but: But the industry is still dealing with staffing woes, scheduling gaps and waiting lists for services. And it's trying to persuade Congress to delay future rate cuts. A planned $180 million in reductions will be phased in over two years, spreading out the pain for the sector.
Our thought bubble: While tech innovations, such as those highlighted at the recent CES in Las Vegas, are enabling more home care than ever, the staffing crunch highlights how critical it still is to have human help involved in this kind of patient care. |
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| 3. Zoom in on the omnibus "health" law |
| The year-end spending package Congress cleared in December could also be thought of as an omnibus health bill for all the changes it's setting off through the medical system, argues the New York Times' Margot Sanger-Katz. The details: Lawmakers included everything from pandemic-readiness spending to an extension of telehealth for seniors on Medicare. - The bill, signed by President Biden on Dec. 29, also extended Children's Health Insurance Program funding and set up policies to discourage states from dropping adult Medicaid enrollees from their rolls when the public health emergency ends. It also included lower profile issues like a requirement for Medicare to cover the cost of compression garments for patients with lymphedema, per the Times.
Between the lines: In recent days, advocacy groups like the American Medical Association also lauded health care provisions in the law such as an alternative payment model bonus for clinicians and the extension of the Medicare Acute Hospital Care at Home waiver. - The American Psychiatric Association said the package included a delay an in-person mental health requirement for telehealth, as well as the new graduate medical education residency slots designated for mental health subspecialties.
Yes, but: As Axios' Peter Sullivan, Maya Goldman and Victoria Knight have previously reported, much was left on the cutting room floor, including money for next-gen vaccines and provisions favorable to medical device makers and hospice providers. |
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| A message from Axios |
| Business news worthy of your time |
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| Get a daily look at the news and trends dominating the business world. Delivered weekday mornings, afternoons and evenings. Subscribe for free |
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| 4. Pics du jour: Coast-to-coast rallies |
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| Over 1,000 people march in Los Angeles on Saturday during the annual OneLifeLA rally which opposes abortion rights. Photo: Keith Birmingham/MediaNews Group/Pasadena Star-News via Getty Images |
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| Thousands gathered over the weekend at rallies and marches to mark the 50th anniversary of Roe v. Wade. Why it matters: Both sides in the abortion fight sought to take the high ground on first anniversary since the Supreme Court overturned Roe last year. - Anti-abortion advocates celebrated the culmination of their decades-long effort to overturn the federal right to the procedure while abortion rights advocates pressed to maintain access in states where it remains legal, Axios' Oriana Gonzalez writes.
Demonstrators take part in the annual National Women's March in Washington, D.C., on Sunday. Where things stand: In its Dobbs opinion overturning Roe v. Wade, the Supreme Court ruled that elected officials — both on the state and federal levels — have "the authority to regulate abortion." - Some conservative-led states have quickly enacted restrictions while progressive legislatures and governors adopted protections guaranteeing access to the procedure. Another raft of bills is emerging as state legislatures gavel in their 2023 sessions.
- But the focus increasingly is on the judicial system. At least 14 states have ongoing litigation in which providers, clinics and other groups are challenging state bans and restrictions, according to a new brief from the Kaiser Family Foundation.
Related: The post-Roe fight dividing anti-abortion activists |
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| 5. While you were weekending |
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| Former pharmaceutical executive Martin Shkreli points as he exits the courthouse in 2017. Photo: Drew Angerer/Getty Images |
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| 🏛 The Federal Trade Commission asked a judge to hold "pharma bro" Martin Shkreli in contempt of court for forming new drug firm. (CNBC) ✈️ Disgraced Theranos CEO Elizabeth Holmes made an "attempt to flee the country" after her conviction, prosecutors say. (CNN) 👉 Former White House COVID-19 leader Jeff Zients will be named the new White House chief of staff. (Axios) |
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| A message from Axios |
| Business news worthy of your time |
| |
| |
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| Get a daily look at the news and trends dominating the business world. Delivered weekday mornings, afternoons and evenings. Subscribe for free |
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| Thanks for reading, and thanks to senior editor Adriel Bettelheim and senior copy editor Bryan McBournie for the edits. |
 | | Your personal policy analyst is here. | | |
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