The U.S. healthcare system, post-COVID emergency: 4 key changes

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The Biden administration’s decision to end the COVID-19 public health emergency in May will sweep across the healthcare system, far beyond many people having to pay more for COVID tests. will bring about significant change.

In response to the pandemic, the federal government has suspended many rules on how care is provided in 2020. It has fundamentally changed every corner of American healthcare, from hospitals and nursing homes to public health and treatment of people recovering from addictions.

Now, as the government prepares to reverse some of these measures, we can get a glimpse of how patients will be affected.

The hospital is back to normal, somewhat

During the pandemic, CMS has tried to limit the problems that can arise when there are not enough medical workers to treat patients. Especially because before the COVID vaccine, workers were at high risk of getting sick.

For example, CMS has made nurse practitioners and physician assistants more widely available to hospitals in caring for Medicare patients. Also, new physicians who were not yet qualified to work at a particular hospital (for example, the governing body did not have time to conduct a review) could practice there.

Other changes during the public health emergency were aimed at increasing hospital capacity. Critical Access Hospital, a small rural hospital, did not have to comply with federal Medicare regulations, which limit patient stays to no more than 96 hours on average, limited to 25 inpatient beds.

Once the emergency is over, these exceptions will go away.

Hospitals are trying to persuade federal officials to maintain multiple COVID-era policies beyond the emergency or work with Congress to change the law.

Threatening treatment to people recovering from addiction

The looming setback in widespread access to buprenorphine-k, an important drug for people recovering from opioid addiction, has alarmed patients and physicians.

During the public health emergency, the Drug Enforcement Administration said providers can prescribe certain controlled substances online or over the phone without first undergoing an in-person medical evaluation. One of these drugs, buprenorphine, is an opioid that can prevent debilitating withdrawal symptoms in people recovering from other opioid addictions. Studies have shown that using it more than halves the risk of overdose.

“Thousands of people will die” if the expansion of buprenorphine ends amid a nationwide epidemic of opioid addiction, said recovering activist Ryan Hampton.

In late February, the DEA proposed regulations that would partially curtail prescriptions of controlled substances via telemedicine. Clinicians can use telemedicine to order her first 30 days of medications such as Buprenorphine, Ambien, Valium and Xanax, but patients must be evaluated in person to receive replacements.

For another group of drugs, such as Adderall, Ritalin, and Oxycodone, the DEA’s proposal would introduce tighter controls. Patients seeking these drugs should see their doctor in person for an initial prescription.

David Hertzberg, a drug historian at the University of Buffalo, said the DEA’s approach reflects a fundamental challenge in formulating drug policy.

The DEA “clearly takes this issue seriously,” he added.

Nursing home staff training rules become stricter

The end of the emergency means nursing homes will need to meet higher standards for training workers.

Advocates for nursing home residents are eager for the previous tougher training requirements to be reinstated, but the industry says the move could exacerbate staffing shortages plaguing facilities across the country. It has said.

Early in the pandemic, the federal government relaxed training requirements to help nursing homes function under the onslaught of the virus. The Centers for Medicare & Medicaid Services has enacted national policy that nursing homes are not required to comply with state-approved regulations requiring nursing aides to have at least 75 hours of training. Typically, nursing homes could not employ caregivers for more than four months without meeting these requirements.

Last year, CMS decided that relaxed training rules would no longer apply nationwide, but states and facilities can seek permits to retain lower standards. According to CMS, as of March, Georgia, Indiana, Louisiana, Maryland, Massachusetts, Minnesota, Mississippi, New Jersey, New York, Oklahoma, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Vermont, Arizona, California, Delaware and Florida. 356 private homes in , Illinois, Iowa, Kansas, Kentucky, Michigan, Nebraska, New Hampshire, North Carolina, Ohio, Oregon, Virginia, Wisconsin, and Washington DC

Nursing aides often provide the most direct and labor-intensive care to residents, such as bathing and other hygiene-related tasks, eating, monitoring vital signs, and keeping rooms clean. Research shows that care is poor in understaffed nursing homes.

Nursing home occupant advocates are happy that the exception to training is ending, but fear it may still reduce the quality of care. Later, CMS informed us that some hours recorded by nursing assistants during the pandemic may count toward the 75 hours of required training. But supporters argue that on-the-job experience doesn’t always replace training that workers miss.

Toby Edelman, senior policy attorney at the Center for Medicare Advocacy, said, “Aides should know what they’re doing for themselves and their residents before providing care.” It is important to have proper training to be able to

The American Health Care Association, the largest nursing home lobbying group, released its December findings, which found that about four out of five facilities are dealing with moderate to high levels of staff shortages.

Monitoring infectious disease debris

The way state and local public health departments monitor the spread of the disease will change after the emergency ends. This is because the Department of Health and Human Services cannot require labs to report her COVID test data.

Without uniform federal requirements, states and counties will track the spread of the coronavirus differently. Additionally, hospitals will continue to provide COVID data to the federal government, but likely less frequently.

Public Health remains aware of the extent of the changes, said Janet Hamilton, executive director of the National and Territorial Council of Epidemiologists.

In some ways, the end of the emergency offers public health officials an opportunity to rethink COVID surveillance. Compared to the early days of the pandemic, when at-home testing was not available and people relied heavily on laboratories to determine if they were infected, test data from laboratories is showing how the virus Not much is known about how widespread it is.

Public health officials no longer believe that “getting all test results from all lab tests may no longer be the right strategy.” Influenza surveillance offers a potential alternative model . In the case of influenza, public health departments require test results from laboratory sampling.

“We’re still trying to find the best and most consistent strategy. I don’t think we’ve done that yet,” said Hamilton.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. KHN is one of the three main operating programs of KFF (Kaiser Family Foundation), along with policy analysis and polls. KFF is a donated non-profit organization that provides information on health issues to the public.

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