Quadrupling the price of COVID-19 vaccine would make it too expensive for millions of Americans, the Vermont Independent says.
Railing against "unacceptable corporate greed," U.S. Senate firebrand Bernie Sanders is warning the billionaire executives at Moderna to "reconsider and refrain" from rumored plans to quadruple the price of their COVID-19 vaccine.
In a letter this week to Moderna CEO Stéphane Bancel, Sanders, I-VT, the incoming chairman of the powerful Health, Education, Labor and Pensions (HELP) Committee, expresses alarm about media reports that the drug maker will raise the price of its COVID-19 vaccine by as much as $110 to $130 per dose, more than four times the $26.36 cost that the federal government paid.
Sanders says the price hike is "particularly offensive" because the federal government directly provided $1.7 billion to Moderna's COVID-19 vaccine research and development, and guaranteed the company billions more in sales.
"The huge increase in price that you have proposed will have a significantly negative impact on the budgets of Medicaid, Medicare and other government programs that will continue covering the vaccine without cost-sharing for patients. Your decision will cost taxpayers billions of dollars," Sanders says in his letter.
"Your outrageous price boost will also increase private health insurance premiums. Perhaps most significantly, the quadrupling of prices will make the vaccine unavailable for many millions of uninsured and underinsured Americans who will not be able to afford it. How many of these Americans will die from COVID-19 as a result of limited access to these lifesaving vaccines?"
Moderna did not respond Wednesday to HealthLeaders' request for comment.
Sanders cites estimates that the cost of producing the vaccine is about $2.85 per dose – 2.2% of what Moderna plans to charge. At the same time, he notes that Moderna has pocketed more than $19 billion in profits off of the COVID-19 vaccine.
Top executives at Moderna have become billionaires off vaccine profits, Sanders notes, citing a Forbes estimates that Bancel is worth $6.1 billion, Moderna Chairman / Co-founder Noubar Afeyan is worth $2.1 billion; Co-founder Robert Langer is worth $2.2 billion; and founding investor Timothy Springer is worth $2.6 billion.
"Further, my understanding is that Moderna approved a $926 million golden parachute for you once you leave the company along with $160 million for Stephen Hoge (Moderna's president) and $53 million for Juan Andres (Moderna's chief technical officer)," Sanders writes. "The purpose of the recent taxpayer investment in Moderna was to protect the health and lives of the American people, not to turn a handful of corporate executives and investors into multi-billionaires."
Sanders says the "profiteering has taken place in the midst of the worst public health crisis in America in 100 years," with COVID-19 claiming 1.1 million Americans over the past three years, and sickening more than 100 million others.
"Now, in the midst of a continuing public health crisis and a growing federal deficit, is not the time for Moderna to be quadrupling the price of this vaccine," he writes. "Now is not the time for unacceptable corporate greed."
In a conference call Wednesday morning with reporters, Health and Human Services Secretary Xavier Becerra says the Centers for Medicare & Medicaid Services will publish the first 10 high-cost Medicare Part D drugs picked for negotiations on Sept. 1. The "negotiated maximum fair prices" for the drugs to be announced on Sept. 1, 2024, and the prices will take effect on Jan. 1, 2026.
Following the outline laid out in the Inflation Reduction Act, CMS will pick another 15 Part D drugs for 2027, 15 more Part B or Part D drugs for 2028, and 20 more Part B or Part D drugs for each year after that.
Lowering the cost of prescription drugs is a key component of the Act, which President Joe Biden signed into law in August, 2022. It gives CMS, for the first time in history, the authority to set drug prices, which Becerra says will lower out-of-pocket costs for millions of Medicare enrollees.
"Thanks to the Inflation Reduction Act, we finally have the authority to get American families the lower prescription drug costs they deserve," Becerra says. "Today we are releasing our plan for how we will implement Medicare drug price negotiation under this landmark law — and we will be transparent and aggressive in implementation every step of the way."
The program is fiercely opposed by the pharmaceutical industry. Pharmaceutical Research and Manufacturers of America (PhRMA) President / CEO Stephen J. Ubl in August blasted HHS’s newly bestowed authority, calling it "a partisan set of policies that will lead to fewer new treatments and doesn’t do nearly enough to address the real affordability problems facing patients at the pharmacy."
"We will explore every opportunity to mitigate the harmful impacts from the unprecedented government price setting system being put in place by this law," Ubl said. "We will continue to advocate for policies that give patients better and more affordable access to lifesaving treatments and for a system that supports innovation."
CMS Administrator Chiquita Brooks-LaSure says the negotiations will not be done in a vacuum, and that her agency "will engage with the public early and often," including Medicare and consumer advocates, drug makers, providers, pharmacies, and Medicare Advantage and Part D plans.
"We are proactively seeking feedback and insights from a broad range of interested parties throughout implementation of this historic law," she says.
Meena Seshamani, MD, CMS deputy administrator and director of the Center for Medicare, says public feedback will play a critical role in the successful implementation of the new law.
"Through this detailed timeline, we offer stakeholders the predictability they need to contribute to our implementation efforts," Seshamani says. "We want the public to know when and how they can make their voices heard on forthcoming policies."
IRA Savings Touted
Becerra also notes that Medicare enrollees are already feeling the financial benefits from several provision of the Inflation Reduction Act, including: free preventive Tdap and shingles vaccines; and a $35 monthly cap on out-of-pocket costs insulin.
In addition, the IRA requires drug makers to provide rebates to Medicare for drug prices that outpace inflation. That mandate took effect on Oct. 1, 2022 for Part D drugs, and Jan. 1, 2023 for Part B.
The IRA also authorized health insurance subsidies during its ongoing Marketplace Open Enrollment that the Biden administration says will enable 13 million people to save an average of $800 a year on health insurance premiums, and which has allowed four-out-of-five Healthcare.gov enrollees to find a plan for $10 or less after subsidies.
In contrast, in-person services for common mental health disorders dropped by more than half after the PHE was declared in 2020.
Telehealth for common mental health issues grew up to 20 fold in the first year of the COVID-19 Pandemic, more than compensating for a concurrent drop in in-person care for a number of conditions, a RAND Corporation study shows.
The RAND study is the first to show that the magnitude of the increased use of telehealth more than made up for the decline in in-person treatment.
An examination of more than 5 million privately insured adults, the researchers found that in-person services for depression, anxiety, bipolar, adjustment, and posttraumatic stress disorders dropped by more than half after the public health emergency was declared in 2020.
In sharp contrast, telehealth use grew steadily during the first year of the pandemic. By December of 2020, tele-mental health treatments for some disorders was 10% to 20% higher than in January 2020, according to the study, which was published in JAMA Health Forum.
“Our findings highlight a remarkable transition in the U.S. mental health system from in-person to virtual care,” says RAND economist Christopher M. Whaley, senior author of the study.
Other studies have documented an elevated level of psychological distress and mental health disorders such as anxiety and depression over the course of the COVID-19 pandemic.
Meanwhile, concerns about the spread of the coronavirus have led many mental health providers to eliminate or reduce in-person services.
In response, many providers switched to providing telehealth mental health services, and both public and private insurance providers expanded coverage for telehealth services.
To examine trends in tele-mental health, researchers looked at claims from commercially insured adults from January to December 2020, as provided by Castlight Health, a health benefit manager for employer-sponsored health insurance plans for about 200 employers in all 50 states.
The study found that the increased use of telehealth was lowest for bipolar disorder and highest for anxiety disorders.
When combining in-person and telehealth service treatment rates, there was an overall increase in care for major depressive disorders, anxiety disorders, and adjustment disorders. The increase in use of mental health services for anxiety disorders during the pandemic was higher for women than for men.
People in rural areas were less likely to use telehealth services, and people over age 46 also had lower rates of services than younger adults.
“While this may be partly due to a lower prevalence of certain conditions among older Americans, the consistency of this trend across different diagnosis categories suggests that factors such as lower digital literacy and less comfort with using telehealth also may play a role,” said Ryan K. McBain, lead author of the study and a policy researcher at RAND.
Support for the study was provided by the National Institutes on Aging and the Robert Wood Johnson Foundation.
The declines varied by regions, with larger drops in the South, Midwest, and West.
After a summer of relative stability, Telehealth use fell 3.7% this past autumn, from 5.4% of medical claim lines in September to 5.2% in October, according to FAIR Health's Monthly Telehealth Regional Tracker.
The declines varied by regions, with larger dips in the South (6.8%), Midwest (4.9%) and West (4.1%), contrasting increased use in the Northeast (1.7%), according to the FAIR data, which includes privately insured population, including Medicare Advantage but excludes Medicare fee-for-service and Medicaid.
Also in the report:
COVID-19 continued to fall among the top five telehealth diagnoses nationally and in most regions in October, as it had in September. Nationally and in the Midwest, COVID-19 fell from third to fifth place in the rankings. In the Northeast, it fell from second to third place, and in the South, it fell from fifth place out of the rankings.
In the West, COVID-19 had already been out of the top five telehealth diagnoses since September.
Acute respiratory diseases and infections climbed in the rankings of the top five telehealth diagnoses in October, following a trend that began in September.
In the Northeast, from September to October, this diagnosis rose from third to second place; in the West, it rose from fourth to second place. Nationally and in the Midwest and South, it remained at second place but increased in percentage share of telehealth claim lines. Nationally, for example, it rose from 3.1% of telehealth claim lines to 4.1%.
The rankings of the top five telehealth specialties did not change nationally or regionally from September to October, as social worker remained the number one telehealth specialty.
From September to October, the rankings of the top five telehealth procedure codes did not change nationally or in any region when compared to the previous eight months. The number one telehealth procedure code nationally and in every region remained CPT®2 90837, one-hour psychotherapy.
The Telehealth Cost Corner spotlighted the cost of CPT 90833, psychotherapy with evaluation and management visit, 30 minutes in October. Nationally, the median charge amount for this service when rendered via telehealth was $126.20, and the median allowed amount was $77.70.
Without insurance coverage, out-of-pocket costs for the drug will average about $26,500 per patient per year.
With the Food and Drug Administration granting fast-track approval on Friday of Eisai/Biogen's new Alzheimer's drug Leqembi, stakeholders are now urging the Centers for Medicare & Medicaid Services to follow suit and cover the pricey treatment.
The Alzheimer's Association called the FDA approval of the new drug for patients with mild cognitive impairment or in the early stages of Alzheimer's disease "a milestone achievement" for patients and their families. However, they warn that the cost of the drug – about $26,500 annually -- will limit access for many of the 6.5 million people in the United States who suffer from the disease. The advocates are pressing CMS to cover the costs.
"What the FDA did today in granting accelerated approval to Leqembi was the right decision. But what CMS is doing by severely restricting coverage for approved treatments is unprecedented and wrong," Alzheimer's Association CEO/President Joanne Pike, DrPH says.
"The FDA carefully reviewed the evidence for Leqembi before granting approval. CMS, in sharp contrast, denied coverage for Leqembi months ago before it had even reviewed this drug's evidence."
"CMS has never done this before for any drug, and it is clearly harmful and unfair to those with Alzheimer's," Pike says. "Without access to and coverage of this treatment and others in its class, people are losing days, weeks, months — memories, skills, and independence. They're losing time."
CMS Administrator Chiquita Brooks-LaSure says the jury is still out on the efficacy of Leqembi, which has shown moderate success during clinical trials.
"We will continue to expeditiously review the data on these products as they become available and are committed to timely access to treatments, including drugs, that improve clinically meaningful outcomes," Brooks-LaSure says.
FDA Approval
The FDA used its Accelerated Approval pathway to approve Leqembi (lecanemab-irmb) saying the drug, which reduces the beta amyloid clumps linked to Alzheimer's, "represents an important advancement in the ongoing fight to effectively treat Alzheimer's disease."
Billy Dunn, MD, director of the Office of Neuroscience in the FDA's Center for Drug Evaluation and Research, called the treatment "the latest therapy to target and affect the underlying disease process of Alzheimer's, instead of only treating the symptoms of the disease."
The FDA approval follows clinical research that included a double-blind, placebo-controlled, parallel-group, dose-finding study of 856 patients with Alzheimer's disease (three of whom died during the trial, although it's not clear if the drug played a role), and which showed a 27% reduction in cognitive decline over 19 months among patients receiving the 10 milligram/kilogram intravenous dose of the drug every two weeks, when compared with those who received the placebo.
Upon learning Friday that the FDA had fast-tracked Leqembi, Eisai/Biogen immediately submitted a supplemental Biologics License Application to the agency for a traditional approval.
Costs
Leqembi is not cheap, which Tokyo-based Eisai and Cambridge, Mass-based Biogen acknowledge. However, the drugmakers cite an Alzheimer's Association estimate that Medicare, Medicaid, commercial payers and out-of-pocket spending would increase from $267 billion in 2020 to $451 billion in 2030 if no treatments exist to delay the disease.
With effective treatments, however, the drugmakers say they can reduce the average per-person cost of treating Alzheimer's patients from about $37,000 to $26,500 annually, and that the cost could be further reduced to about $15,000 a year for ongoing maintenance once the treatment is underway.
New research published in the Journal of the American Medical Association (JAMA) finds that telehealth was superior to in-person care in 11 of 16 quality performance measures for primary care.
The study, conducted by researchers at the Robert Graham Center in Washington DC and Pennsylvania-based Wellspan Health, focused on more than 526,000 patients receiving healthcare services at roughly 200 Wellspan Health outpatient sites between March 1, 2020, and November 30, 2021, and used HEDIS (Healthcare Effectiveness Data and Information Set) measurements.
UnitedHealthcare Inc. members logged more than 28 million virtual care visits in 2021, a 2,500% increase over pre-pandemic usage, the payer says.
"While the COVID-19 pandemic triggered an unprecedented spike in the number of virtual care visits, we are seeing that telehealth has staying power even as many people have returned to in-person appointments," UnitedHealthcare CMO Donna O'Shea, MD, tells HealthLeaders.
"Virtual care visits in 2021 by UnitedHealthcare members approximately matched the total for 2020, with continued significant use of telehealth so far in 2022."
Only 1,714 of the 742,000 providers who billed Medicare and Medicare Advantage for telehealth services for about 28 million beneficiaries during the first year of the pandemic "posed a high risk" to the program integrity, a federal audit shows.
Now the not-so-good news.
These high-risk providers represent only 0.2% of the audit sample, but they billed for about 500,000 beneficiaries and collected $127.7 million in Medicare fee-for-service payments for care provided between March 2020 and February 2021, according to an audit by the Department of Health and Human Services, Office of the Inspector General.
Congress is halfway toward extending telehealth flexibilities enacted during the pandemic until the end of 2024.
The US House of Representatives this week passed the Advancing Telehealth Beyond COVID-19 Act of 2021 (HR 4040) by a 416-12 vote, sending the issue on to the Senate. The bill, introduced more than a year ago by US Rep Liz Cheney (R-Wyoming), expands the definition of "originating site" to allow more locations to use telehealth, eliminates facility fees for new sites, expands the list of healthcare providers able to use telehealth, adds audio-only telehealth to the definition of "telecommunications system," and makes permanent the ability of federally-qualified health centers (FHQCs) and rural health clinics (RHCs) to use telehealth under the Medicare program.
Vermont’s governor has signed into law a bill amending the state’s assisted suicide statute to include telemedicine.
S.74, passed by the state House and Senate after an almost two-year process and signed by Gov. Phil Scott on April 27, amends the state’s medical aid in dying law, which was passed in 2013, allows a patient who meets specific criteria to request a prescription to aid in dying through telemedicine, eliminating the need for two in-person consults and a 48-hour waiting period. The bill also establishes legal immunity for licensed healthcare providers, including pharmacists.
The bill defines telemedicine for these purposes as an interactive audio-video platform that complies with the requirements of the Health Insurance Portability and Accountability Act (HIPAA).
Newly introduced bipartisan legislation to improve healthcare access for Medicare and Medicaid beneficiaries would expand authority for advanced practice RNs (APRNs) to treat those patients.
The legislation does not provide full practice authority (FPA) in all 50 states—individual states govern those guidelines—but it does reduce a number of federal barriers that impede access to care for millions who receive healthcare through Medicare and Medicaid. Read more here.
New York is the newest state to grant nurse practitioners (NPs) full practice authority, joining 24 other states and Washington, D.C.
New York Gov. Kathy Hochul signed the state budget into law on Saturday, that includes legislation that eliminates the requirement for NPs to have a written practice agreement with a physician and allows them to provide the full scope of services they are educated and clinically trained to provide. Read more here.
Hospital emergency departments have been under severe strain during the coronavirus pandemic, according to a pair of new research articles.
The new studies examine boarding of patients in emergency departments before they are moved to inpatient beds and patients who left without being seen (LWBS), the latter presumably because of ED crowding and long wait times. The Joint Commission has deemed extended boarding of patients in the ED as a patient safety risk, with boarding recommended not to exceed four hours. Relatively high LWBS rates can have significant negative consequences for patients if they are deferring care for acute conditions. Read more here.
Factors such as ability to grocery shop, whether and how often they smoked, and the amount of certain cholesterol particles present in their blood can help predict how likely an individual over 70 years old will live two, five, or 10 years into the future, researchers at Duke Health have found.
"This study was designed to determine the proximal causes of longevity—the factors that portend whether someone is likely to live two or more years or 10 more years," researcher Virginia Byers Kraus, MD, PhD, said in a statement. "Properly applied, these measures could help determine the benefits and burdens of screening tests and treatments for older people." Read more here.
A significant number of temporary nurse aides (TNAs) may lose their jobs Friday if the Center for Medicare and Medicaid Services (CMS) doesn’t reissue a blanket waiver.
The American Health Care Association (AHCA) and National Center for Assisted Living (NCAL) have asked the Center for Medicare and Medicaid Services (CMS) to reissue the blanket waiver originally intended to allow nursing homes to employ temporary nurse aides beginning during the pandemic.
TNAs handle non-clinical tasks, serving as companions for nursing home residents. In June, the section of the 1135 waiver permitting their employment ended, giving them four months to become certified nursing assistants (CNAs), which would allow them to remain at their facilities. Read more here.
A primary care clinic start-up is differentiating itself by staffing its facilities only with nurse practitioners (NPs).
Minneapolis-based The Good Clinic chain is designed to emphasize patient engagement, continuity of care, and an emphasis on wellness and convenience through a unique nurse practitioner-driven model, says Larry Diamond, CEO of Mitesco Inc., which operates The Good Clinic brand.
More than half of U.S. states—26 states, Washington, D.C., and two U.S. territories—have granted patients full and direct access to care by NPs in adopting Full Practice Authority (FPA), according to the American Association of Nurse Practitioners (AANP). Read more here.
UnitedHealth is the target of a lawsuit by Envision Healthcare and several other physician practices, who claim the country's largest health insurer engages in a nationwide practice of low reimbursement rates for providers to force them out of network.
In doing so, UnitedHealth is allegedly driving physicians to its subsidiary, Optum, and paying providers at rates lower than the company offered for in-network.
Once UnitedHealth forces providers out of network, it allegedly pays the provider less than its billed charges and then charges the patient's plan a commission or surcharge for the savings. UnitedHealth, however, has no intention of paying the billed charges for out-of-network services and denies entitlement to payment for those charges. Read more here.
The No Surprises Act may have the unintended effect of causing millions more emergency department (ED) visits, according to a study from the Agency for Healthcare Research and Quality.
Since going into effect on January 1, 2022, the federal ban protects patients from surprise bills for emergency services at out-of-network facilities or for out-of-network providers at in-network facilities.
The study, published in The American Journal of Medical Care, compares ED visits in 15 states with balance billing bans between 2007 and 2018 to ED visits in 16 states without bans to examine the ripple effects of a significant reduction in out-of-pocket payments under the No Surprises Act. Read more here.
Atrium Health—a Charlotte, North Carolina-based healthcare network with over 40 hospitals and $2 billion in net operating revenue—wants to turn its Harrisburg, North Carolina-based emergency room into a satellite hospital.
The health system submitted a "certificate of need" proposal to the Cabarrus County authorities for the $85.5 million expansion and is waiting on the state to approve the project.
"In an effort to bring high quality, convenient access to care to the residents of southern Cabarrus County that are already choosing AH Harrisburg for their health care needs, AH Cabarrus proposes to relocate 24 acute care beds and one operating room from its main campus to its existing Harrisburg hospital campus," Atrium said in a press release shared with HealthLeaders. "The proposed project also involves the replacement and relocation of an existing fixed MRI scanner to Atrium Health Harrisburg from Atrium Health MRI at its Concord Mills/Speedway location."
Additional inpatient, imaging, and surgical services will include 20 medical and surgical acute care beds, four ICU beds, a replacement CT scanner, a relocated and repaired MRI machine, fluoroscopy services, and the addition of a C-arm (a large, mobile imaging device) in the operating room.
The decision date for this project is set for the end of January. If approved, Atrium Health expects the satellite hospital to open on January 1, 2026. Read more here.
MA plans are under fire once again, this time with the introduction of new legislation that's aiming to take 'Medicare' out of the name.
The Save Medicare Act, sponsored by representatives Mark Pocan (D-Wis.) and Ro Khanna (D-Calif.), arrives just ahead of the open enrolment period, running from October 15 to December 7.
The bill would prohibit private insurers from using 'Medicare' in plan titles or advertising, and levy fines on payers that use the "deceptive practice."
"'Medicare Advantage' is just private insurance that profits by denying coverage and the name is being used to trick seniors into enrolling. That’s not right," Khanna said in a statement. "This bill will prevent these private insurers from labeling themselves as 'Medicare' and allow us to focus on strengthening and expanding real Medicare instead." Read more here.
The U.S. Department of Defense has awarded $136 billion for the "next generation" of TRICARE Managed Care Support Contracts that launch in 2024.
The T-5 MCS Contract maintains the requirement for two TRICARE regions in the United States – East and West. In addition, six states -- Arkansas, Illinois, Louisiana, Oklahoma, Texas, and Wisconsin with 1.5 million beneficiaries -- managed in the East Region will transfer to the West Region for a more equitable balance of the beneficiary population.
The $70.9 billion East Region T-5 MCS Contract was awarded to Humana Government Business of Louisville, KY. In the West Region the $65.1 billion T-5 MCS Contract was awarded to TriWest Healthcare Alliance of Phoenix, AZ. The new contracts will replace the T-2017 managed care contracts that provide care for the military and their dependents beginning in 2024.
"I am pleased that our new T-5 TRICARE contracts will continue to focus on enhancing the experience of care and great healthcare outcomes for our service members, retirees and their families," said Lt Gen. Ronald Place, director, Defense Health Agency.
The new contracts will continue to provide for the delivery of healthcare, customer service, claims processing and other administrative services to the estimated 9.6 million TRICARE beneficiaries. The new contracts do not change the TRICARE benefit and offer all the same TRICARE options.
"TRICARE is moving into a new era, making use of the lessons learned in the first three contract phases," Place says. "Defense Department leadership and the incumbent managed care support contractors are dedicated to managing a smooth transition to the new managed care support contractors, with minimum disruption to our beneficiaries."
The new contracts mandate improved integration between military medical facilities and the T-5 private sector care, with an emphasis on increasing interoperability with MHS GENESIS through Health Information Exchanges.
With T-5, beneficiaries can transfer care referrals when they move, whether their orders take them to a new duty station within their current region or to the other region. The DHA says that improving customer service also will be emphasized, with both regions required to reduce the average speed of answer calls to 20 seconds, matching general healthcare sector standards. In addition, the contract holders are mandated to improve call center resolutions and call backs, and first-call resolution requirements to align with industry standard for 85% of initial calls."
"We listened to our beneficiaries about what impacts their experience of care and address many of those concerns in T-5," Place says.
After the yearlong transition to T-5, military hospitals and clinics will have real-time access to medical management data, which increases data-sharing and promoting standardize care between civilian and military venues.
Blue Cross Blue Shield of Arizona says it will provide support for TriWest Healthcare Alliance’s new contract to administer the 26-state TRICARE West Region.
The U.S. Department of Defense's reconfigured "T-5" TRICARE program provides coverage for about active-duty service members, their families, National Guard and reserves and their families.
One bill would remove federal practice barriers for NPs. The other bill would restore collective bargaining rights for VA clinicians.
The nation's leading nursing associations are praising two bills advancing through Congress that would remove federal practice barriers for nurse practitioners and restore collective bargaining rights for nurses and other clinicians at the Department of Veterans Affairs.
ICAN Act
U.S. Sen. Jeff Merkley, D-OR, this month introduced theImproving Care and Access to Nurses (ICAN) Act (S.5212), which would remove administrative and practice barriers for advanced practice registered nurses (APRNs), which supporters say will improve access to healthcare for millions of Americans.
Companion legislation (H.R. 8812) was introduced in the U.S. House in September and assigned to the Health Subcommittee. It likely will not be heard before the lame duck Congress adjourns permanently this month. However, ICAN appears to have bipartisan support and could be taken up when House Republicans take control in January
April Kapu, DNP, APRN, ACNP-BC, FAANP, FCCM, FAAN, president of the American Association of Nurse Practitioners, notes that about 40% of Medicare and Medicaid patients receive care from nurse practitioners as their providers "and it is critical these patients receive timely, high-quality healthcare from their providers of choice."
"The ICAN Act will eliminate outdated barriers to care that impede the progress of our healthcare system," Kapu says.
Angela Mund, DNP, CRNA, president of the American Association of Nurse Anesthetists, says the bill will "eliminate burdensome laws and regulations."
"Allowing certified registered nurse anesthetists and other APRNs to practice to the full scope of their training and licensure will ensure that patients are put first, that competition drives down costs through the removal of artificial and unnecessary barriers, and that providers of all types are able to better serve their patients," Mund says.
This bill would authorize NPs to order and supervise cardiac and pulmonary rehabilitation, certify when patients with diabetes need therapeutic shoes, have their patients fully included in the beneficiary attribution process for the Medicare Shared Savings Program, refer patients for medical nutrition therapy, certify and recertify a patient's terminal illness for hospice eligibility, perform all mandatory examinations in skilled nursing facilities, and more.
The American Nursing Association says the bill "is consistent with the recommendations from numerous healthcare stakeholders, including the National Academy of Medicine in their The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equityreport," which recommends that "all relevant state, federal and private organizations enable nurses to practice to the full extent of their education and training by removing practice barriers that prevent them from more fully addressing social needs and social determinants of health and improve healthcare access, quality, and value."
American Nurses Association President Ernest J. Grant, PhD, RN, FAAN, says the ICAN Act means that APRNs, including nurse practitioners, nurse anesthetists, nurse-midwives, and clinical nurse specialists will be able to care for their patients at the fullest extent of their abilities.
"The ICAN Act is a significant bill that will eliminate many of the burdensome laws and regulations that have prevented patients from getting access to the kind of timely, evidenced-based care that APRNs are clinically trained and qualified to provide," Grant says.
"Allowing APRNs to practice at the top of their license, like they did during the height of the COVID-19 pandemic, will help to cultivate the kind of flexibility that modern healthcare requires. That flexibility will improve patient outcomes and lower costs. And in doing so it will ensure that more individuals, including those in rural and underserved communities, have access to the kind of healthcare that they deserve."
Collective Bargaining Rights
National Nurses United, the nation's largest nurses union, is cheering the House passage this month of the VA Employee Fairness Act of 2021 (HR 1948).
The bill, sponsored by Rep. Mark Takano, D-CA, chairman of the House Committee on Veterans Affairs, would reinstate collective bargaining rights for Veterans Affairs nurses and other clinicians. It passed the full House on Thursday on a 219-201 vote, with only four House Republicans signing on.
"VA nurses have dedicated their careers to serving veterans and have been instrumental in fighting the COVID-19 pandemic. Passing my VA Employee Fairness Act is a step towards recognizing this commitment to our veterans," Takano says
NNU Vice President Irma Westmoreland, RN, who works in the Charlie Norwood VA Medical Center in Augusta, GA, says the nurses play a critical role as patient advocates "and our input and insight is critical in determining best practices for patient care. Without full collective bargaining rights, VA nurses' ability to effectively advocate for the health and safety of our patients and ourselves is hindered."
Senate companion legislation likely will not be heard before the lame duck Congress adjourns this month. However, the pro-labor bill is expected to get a hearing when the Democrat-controlled Senate convenes next year. The bill has the support of the Biden administration.
The bill has been endorsed by every union representing VA clinicians and groups including the American Federation of Labor and Congress of Industrial Organizations (AFL-CIO), the Congressional Labor Caucus, the American Legion, and the Vietnam Veterans of America.
Proponents of HR 1948 say it will help with nurse recruiting and retention by restoring bargaining rights to RNs and other clinicians in the VA, who are banned from bargaining over issues relating to professional conduct or competence, patient care, and peer review.
NNU says restoring those rights "would reduce turnover, increase staffing levels, and improve the care that veterans receive by giving VA clinicians the tools they need to speak up for patient safety and care.
"This bill will ensure the rights of bedside nurses in the Veterans Administration are protected and, in turn, will serve to increase the quality of patient care in VA facilities," she continued. "We are extremely pleased that our representatives are recognizing our role in ensuring our nation's veterans get the very best care that they so rightly deserve."
The CNO at CommonSpirit Health asks if you don't know where you want to go, how can you get there?
Editor's note:This article appears in the March 2023 edition of HealthLeaders magazine.
It’s not exactly a news flash to say that staffing will be a top issue for nurse leaders in 2023. Kathleen Sanford, RN, DBA, FAAN, FACH, CNO at CommonSpirit Health, tells HealthLeaders that the massive challenge of recruiting and retaining nurses can be made more efficient when health systems know their mission and have a strategy for achieving it. The following interview was edited for brevity and clarity.
HealthLeaders: What big issues will nurse leaders address in 2023?
Kathleen Sanford: They’re going to continue to help staff with change. And when I am talking about staff I’m not just talking about the nurses. We need to remember that there's a whole team of people in health systems who are getting to be good at change management. Nurse executives must think strategically and have a strategy that's over several years. A lot of people say, “Oh, that's old fashioned now because change is happening so quickly.” I don't agree with that. If we don't have an idea in nursing or healthcare in general of where we want to go, how on Earth can we figure out the right things to do to get us there?
HL: How do you develop that strategic plan?
Sanford: You can’t do strategy unless you have a vision. What do you want to do? What do you want to deliver? You also need to balance change because, while there are many things we need to change, you can't change everything at once. We're going to have to balance what's right for our staff, our patients, or consumers, for the organization, for our communities and for our leaders. That's a tough balancing act. We're going to have to think about that as we set our strategy.
We’ll also have to change the idea of where patients are being taken care of. I’ve been told that we're going to have 16% growth in care outside of the hospital, but we're still going to have a 12% inpatient growth, and probably with higher acuity, too.
HL: How do you see the staffing crisis developing in 2023?
Sanford: That’s the issue that is on everybody's mind right now and that nurse leaders across the country are going to have to deal with this next year, and probably for the rest of our careers. That's going to be the number one issue in 2023. None of those things I’ve talked about—preparing for change, having a strategy, and balancing needs—is going to happen if we don't have staff.
I get concerned when people talk about having the right number of staff. Nurses are not a commodity. Nurses are professionals who have expertise in different areas. So, it's not just “having numbers of staff.” It's having staff who have the right tools, who are well educated for the work, that they're enjoying their jobs, that they are invigorated by their work, all the things you want in the people who are taking care of you.
HL: What are CommonSpirit’s staffing challenges?
Sanford: There are not enough nurses and other team members to meet the needs of our patients and communities unless we do things differently, and we need to have strategies to do things differently. I've seen various numbers about how much worse this is going to get that range all over the place. The highest one is that we're going to need two million more nurses in the next 10 years, but we're only going to graduate 500,000.
Part of our strategic journey and our nursing strategy at CommonSpirit started with bringing together a large group of stakeholders two years ago and started working on our vision. Our diversity leaders from our various organizations talked about what they’d love to see our system become and what partnerships they would have in this vision. We came up with a long list of projects that were taken back to the CNOs in our seven divisions and reviewed by their nurse executive councils.
Then we held focus groups of nurses across the system to come up with ideas for what the vision should be. When we got down to two different wordings for a vision, we allowed our 45,000 nurses to vote on what they thought the national vision should be.
Kathleen Sanford, RN, DBA, FAAN, FACH, CNO at CommonSpirit Healthcare. Photo courtesy of CommonSpirit Health.
HL: How did you build on that newly agreed-upon vision?
Sanford: Once we had a national vision, we asked ourselves what's the strategy for getting on the list? We prioritized because you cannot do everything at once. Our priorities, given what was happening during COVID, was to come up with four actions.
First is a one-year nurse residency program, the largest finished residency program in the country.
Second, we started our own national staffing agency so that our nurses who wanted to could choose to travel and not lose their seniority.
Third, we developed a virtually integrated care unit that uses virtual care nurses.
Fourth, we started working more closely with academic partners to increase the number of graduates and the diversity of our nursing workforce.
For 2023, our nurses were asked about our second-year priorities, and they told us that they want to have shared governance across the entire system, to have individualized professional development programs for staff, to accelerate our academic partnerships, and to continue resilience and well-being programs, all in that order of priority.
Of course, with shared governance, 45,000 nurses can’t have a say in every decision, but you have to ensure that they know they have a voice at every level, that they have representatives that meet with management to talk about all things nursing.
HL: When we talk about nurse satisfaction, is the most important element compensation?
Sanford: It’s not about the money. Compensation is not what’s making people leave nursing. It's more about whether they feel appreciated and that they get to do the work that they want to do that they're educated to do, that they have a voice, and that they have a good relationship with their supervisor. Research has shown that most human beings, if the salary is fair and about equal to what other people get for the same jobs, then they’re going to stick with you because they love the work and they feel appreciated.
HL: How does your nurse residency program work?
Sanford: Hospitals across the country say their highest loss of nurses are in their first year out of school, so I would advise every CNO to look carefully at their residency programs or their orientation. We have revised ours to be one year long. The nurses are paid their salary during that time to take care of patients, but it's not just learning how to attend patients. It's about learning how to manage the intricacies of an organization. We have classes on how to work well with other people, how you get your voice heard, how you deal with violence in the workplace, and how you deal with bullying.
The other piece is that our nurse residents will have 24-hours-a-day virtual preceptors and floor preceptors who work with new nurses so they don’t feel alone.
HL: Can smaller health systems and hospitals that lack the resources and staff still create a vision and build a strategy around it?
Sanford: You can gather 10 people and have a vision of what you want, and a strategy that gets you to that vision. If I was in a small hospital or a small health system, I would look for other systems I could partner with. You don’t have to be huge to get this done. It's about looking at what your vision is for your size and what would work best for you.
The main thing is to remember that there is not a one-size-fits-all solution.
