Todd Shyrock

 had a deadline of May 16 to notify the public that the Public Health Emergency would end in 60 days. Because the deadline has come and gone with no word, it is expected that the PHE will be extended past the current July 16 end date, but how far is unknown.

The American Medical Association in conjunction with the American Nurses Association and the American Hospital Association wrote Department of Health and Human Services Secretary Xavier Becerra 

Becerra told health care leaders after the first extension that he would give them a 60-day warning if it will not be renewed.

, allowing Medicare reimbursement and elimination of various site and security requirements, giving doctors and patients the ability to use whatever technology they had access to. While the Biden administration has pushed to make some of these changes permanent, congressional action is required.

While much of the country has moved on as if the pandemic was over, the CDC shows a rising number of cases in recent weeks, with a rise in hospitalizations, as well. These rising numbers concern the professional medical groups, who point out that new variants may emerge that strain hospital and health systems.

The end of the PHE will have far-reaching effects across the health system. For example, all states will need to reassess Medicaid eligibility resulting in a projected 13 million to 16 million people losing their coverage. Up to one-third of those may be eligible for a subsidized marketplace health plan, but getting them moved to the new program presents massive challenges to Medicaid officials because of the sheer volume of people. Planning is difficult, because there is uncertainty as to when the PHE will end. Officials will need to determine eligibility requirements and direct people to the appropriate program.

Fifteen million or more current Medicaid enrollees will potentially be ineligible for Medicaid at the end of the PHE, so states face a monumental task catching up on delayed renewals and redeterminations, according to a report from the 

. A lack of funding is expected to hamper this effort in many states, and those that have funding don’t want to hire staff until there is work to be done, but no one knows when that will start. Staff training is needed beforehand, but with no known start date for the end of PHE, timing is difficult for Medicaid officials.

Another challenge for state officials, according to the report, is to reduce the number of people who fall through the cracks and become uninsured. People will need targeted messaging to direct them to the right plan and program, and states aren’t always successful with their messaging. When confronted with an overwhelming volume of complicated plan choices, many consumers make no decision at all.

Another concern is that Marketplace plans have narrow provider networks that may be inadequate to meet the needs of the large influx of new enrollees. If a large share of people in a given service area gravitate to just one or two narrow-network plans in a short period of time, they may face delays or difficulties accessing timely appointments for needed services, according to the report.

Originally published on our sister brand, 

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The Department of Health and Human Services did not notify the public by the May 16 deadline that the Public Health Emergency will be ending.

Public Health Emergency expected to be extended

One in ten people from ethnic minority groups who refused a vaccine experienced racial discrimination in a medical setting since the start of the pandemic. They also experienced twice as many incidents of racial discrimination compared to those who were vaccinated, according to a study published in the 

The study authors said that this illustrates how the effects of racial discrimination creates low confidence in the health system to handle the pandemic, which led to vaccine refusal.

The study participants included 633 adults belonging to ethnic minority groups who were offered a COVID-19 vaccine between December 2020 and June 2021. 6.69% of participants who had refused the vaccine reported they had experienced poorer service or treatment than other people in a medical setting because of their race or ethnicity.

The researchers said that the findings underscore how government agencies must work to regain trust from ethnic minority groups to increase vaccination rates among these diverse groups. Public health campaigns to increase COVID-19 vaccination rates should not only focus on building trust in the vaccines, but also to prevent racial and ethnic discrimination and support people who have experienced it.

They also pointed out that failure to tackle racial discrimination would lead to a widening of systemic inequalities putting more ethnic minority lives at risk.

This article was originally published by sister publication Medical Economics.

Study shows that 10% of minorities refused COVID-19 vaccines because of past racial discrimination experiences

The relationship betweem racism in health care and vaccine hesitancy in minority groups

 and Cornell universities showed that Medicaid participation among physicians listed in provider networks may be overstated.

The study, published in the May issue of 

, looked at medical claims and Medicaid data from 2015-2017 in Kansas, Louisiana, Michigan, and Tennessee for more than 22,000 physicians.

The researchers found that 16% of adult primary care physicians listed in Medicaid managed care networks did not file any Medicaid claims in a year, and almost a third of outpatient primary care and specialist physicians contracted with Medicaid saw less than 10 Medicaid patients a year.

Medicaid covers more than 80 million Americans, but fewer office-based physicians participate in Medicaid than in Medicare and commercial plans. The researchers said they have concerns that insurers may be inflating their Medicaid managed care networks with physicians who may be unwilling to accept Medicaid patients.

The study authors said that while states set the standards for the number of physicians to ensure care 

, new methods are needed to account for patient preferences and physician willingness to accept Medicaid patients. The majority of Medicaid beneficiaries are enrolled in private managed care plans that contract with the states to provide care and manage the physician networks.

physicians provided 86% of the care, with similar numbers for specialists – 25% providing 75% of care for Medicaid patients. Study authors said this could be a result of patient preference due to cultural competence of the physician, or may reflect that some doctors do not want to see significant numbers of Medicaid patients.

In fact, 16% of doctors listed in directories saw zero Medicaid beneficiaries over a year. Another 17% saw 10 patients or less. The report also notes that prior studies have shown that provider directories are often inaccurate and that relying on them to measure access is not sufficient.

The authors proposed that states regularly evaluate Medicaid managed care networks using audit studies and claims-based assessments and possibly fine plans that do not meet standards.

About 16% of primary care physicians listed did not file any Medicaid claims

Medicaid provider networks overstate physician availability

 prescriptions are written for things like bronchitis, sore throats, common colds, and the flu, even though they are inappropriate for them. This is not only create a public health concern, but a new study shows that it also contributes to physician distress.

Clinician Distress and Inappropriate Antibiotic Prescribing for Acute Respiratory Tract Infections: A retrospective cohort study

 and looked at the association between clinician distress and the inappropriate prescribing in adult outpatients.

 and included outpatient visits in family medicine, general internal medicine, and emergency department visits where an acute respiratory tract infection for an otherwise healthy adult was listed as the primary diagnosis. The depression, anxiety, and burnout levels for the physicians were assessed using the National Institute of Health Patient Report Outcomes Measurement Information System and the Stanford Professional Fulfillment Index Burnout Composite scale obtained from clinician wellness survey data.

Overall, approximately 34% and 50% of clinicians in the study reported depression/anxiety and burnout symptoms, respectively. Findings showed each one standard deviation increase in a clinician’s composite depression and anxiety score was associated with a 28% increase in the odds of an inappropriate antibiotic prescription for an acute RTI. Clinician burnout had no significant association with inappropriate antibiotic prescribing.

“Although the current study was conducted in the pre-COVID-19 era, it is plausible that had this work been repeated during the height of the pandemic, the unique stressor imposed by the COVID-19 pandemic would have shown an even greater prevalence of depression and/or anxiety among clinicians,” Sara C. Keller, MD, MSHP and Pranita D. Tamma, MD, MHS, said in a statement. “We applaud … shedding light on an important and unrecognized area in need of intervention—the impact of provider mental health on inappropriate antibiotic prescribing.”

Handing out antibiotics for illnesses they weren’t meant for is adding to the distress doctors feel

Physician stress and inappropriate antibiotic prescribing: Is there a link?

 that tracks the use of medicines in the United States shows that spending on prescriptions rose 12% in 2021 primarily due to COVID-19 vaccines and therapies.

, found that despite an increase in overall spending, costs per prescription on average were flat or slightly declining.

 use reached 194 billion daily doses in 2021, a record compared to the slowdown that occurred in 2020. In addition, health services utilization rates returned to pre-pandemic levels, but have not made up for the backlog of missed patient visits, preventive screenings, and elective procedures.

 were the least affected during the pandemic and have increased to higher than pre-pandemic levels, but is 3% lower still than projected in prior years. Screening and diagnostic tests have mostly rebounded to pre-pandemic levels as well, but the cumulative deficit is 5% below baseline with a large portion (41%) of that occurring between March and May of 2020.

Despite lags in doctor visits, the use of medicines has grown 9.6% over the last five years, according to the study. Retail drugs make up 86% of that, with the other 14% of use in non-retail settings, which continues to decline since 2017. Drugs dispensed from retail pharmacies has continued to grow 2.3% annually.

Medicine cost continues to be a significant burden for some patients. Out-of-pocket costs rose $4 billion in 2021 to $79 billion. This growth was driven by retail out-of-pocket costs, which grew 4.8% in 2021 following two years of declines and lower growth. Non-retail out-of-pocket costs have remained relative stable over the last four years, but have grown 16% since 2016.

This article was originally written by sister publication Medical Economics.

COVID-19 vaccines and therapies were the main drivers

Spending on prescriptions rose by 12% in 2021

, an organization representing a spectrum of health plans, providers, vendors, and government entities, released new operating rules to improve day-to-day health care operations and how plans and providers exchange 

 related to benefits coverage and supplemental documentation. More than 88 percent of participating organizations approved adoption of these rules.

“The operating rules released today represent another step in improving the way plans and providers exchange information millions of times every day,” said Tim Kaja, MBA, Senior Vice President, Optum Care and 

 board chair, in a statement. “These rules will improve operations -- in administrative offices and at the point of care -- and will enhance the experience for all stakeholders.”

The rules cover three main areas: attachments, benefits verification, and infrastructure.

New rules for supplemental documentation attachments

The new prior authorization and health care claim attachments operating rules enable providers to send to health plans documentation to support a claim or prior authorization in a uniform, electronic format using industry standards. The exchange of attachments has been a longstanding industry challenge and these rules will lead to quicker coverage and payment decisions.

Updated rules for eligibility and benefits verification

CAQH CORE Eligibility and Benefits Operating Rules

 enhance the exchange of information related to telemedicine, prior authorization, remaining coverage benefits, procedure-level information, and tiered benefits when a provider confirms patient eligibility. This will enable providers to have better information regarding patient coverage prior to or at the time of service and will result in more timely patient care and accurate pricing and billing.

The updated infrastructure rules call for greater health plan system availability and less frequent periods of downtime. These rules will support care delivery, the patient experience and revenue cycle processing as providers will have more reliable access to data at the time of service.

“CAQH CORE participating organizations are taking on the most pressing and timely administrative issues in healthcare related to prior authorization, telemedicine and delivering better information to providers at the point of care,” said Linda Reed, RN, MBA, senior vice president and chief information officer, St. Joseph’s Health and CAQH CORE board vice chair, in a statement. “Health care stakeholders came together to develop, debate and adopt these important rules, and we expect the benefits to be significant and industry-wide.”

New rules for attachments, benefits verification, and infrastructure aim to improve communication