Leadership changes at USAID
Volume 395 Number 102295 28 March 2020
WORLD REPORT Mark Green, the respected head of the US Agency for International Development, has resigned. Susan Jaffe reports from Washington.
“The timing is unfortunate”, said Jen Kates, senior vice president and director for global health and HIV policy at the Kaiser Family Foundation. “The agency is going to be significantlychallenged by the COVID-19 pandemic, potentially at a level that it has not seen before.” [continued here]
Coronavirus Stresses Nursing Home Infection-Control Practices
I-TEAM IN-DEPTH | CONNECTICUT HEALTH INVESTIGATIVE TEAM | MARCH 12,2020
As coronavirus cases increase, posing heightened risks to the elderly, nursing homes will face growing scrutiny from state health inspectors.
In Connecticut and nationally, complying with federal infection-control requirements is a challenge for some nursing homes. Between 2017 and 2019, 145 of Connecticut’s 217 nursing homes – or about 67 percent – were cited for infection-control violations, according to a Conn. Health I-Team analysis of data from the Centers for Medicare & Medicaid Services (CMS). [Continued here, with list of nursing home infection violations.]
Medicare for All scrutinised in Democratic primaries
Volume 395 Number 10225 29 February 2020
WORLD REPORT On March 3, 14 states will pick their nominees for the US presidential election. The feasability of a single payer insurance plan is a key issue. Susan Jaffe reports from Washington, DC.
Anxiety about rising health-care costs— the top issue for Democratic voters, according to recent polls—propelled Bernie Sanders to the head of the pack in last week’s Democratic primary contest in Nevada. Of the six leading candidates vying for the party’s presidential nomination, Sanders, a Vermont senator and self-described democratic socialist, has proposed the most radical solution for lowering medical bills and reaching universal coverage. His signature policy initiative, the Medicare for All single-payer programme, would eliminate private health insurance, including employment-based plans that cover about half of the US population. [Article compares Medicare for All and the public option proposal favoured by former Vice President Joe Biden; continued here]
Decisions to be made on US gun violence research funds
Volume 395 Number 10222 8 February 2020
WORLD REPORT The National Institutes of Health and the Centers for Disease Control and Prevention will decide how to spend new federal funds later this year. Susan Jaffe reports from Washington, DC.
After a hiatus of more than two decades, Congress and President Donald Trump agreed to add funding for gun violence research to the federal budget in December. With grants expected to be awarded in September, the priorities for research and its potential impact are crucial for halting the US’s record-breaking gun-related death toll. [Continued here.]
Congress Considers Bill to Address Medicare Late Penalties, Coverage Gap
Current enrollment rules can leave late enrollees liable for doc visits Medicare usually covers
By Susan Jaffe | Contributing Writer | MedPageToday | January 20, 2020
Some 10,000 Americans turn 65 every day and become eligible for Medicare, but enrollment mistakes can subject them to a lifetime of late penalties, as well as a months-long coverage gap.
Legislation that would fix these problems was one of the bills discussed at a hearing held by the House Energy & Commerce Health Subcommittee…. Although the panel focused on how the bipartisan Beneficiary Enrollment Notification and Eligibility Simplification (BENES) Act impacts Medicare patients, it also affects their physicians. [Continued here and PDF here]
Website Errors Raise Calls For Medicare To Be Flexible With Seniors’ Enrollment
Seniors will be able to change plans any time next year if they discover their coverage doesn’t provide what the government’s Plan Finder promised.
By Susan Jaffe | Kaiser Health News | December 6, 2019 | This article also ran on 
Saturday is the deadline for most people with Medicare coverage to sign up for private drug and medical plans for next year. But members of Congress, heal
th care advocates and insurance agents worry that enrollment decisions based on bad information from the government’s revamped, error-prone Plan Finder website will bring unwelcome surprises.
Beneficiaries could be stuck in plans that cost too much and don’t meet their medical needs — with no way out until 2021.
On Wednesday, the Centers for Medicare & Medicaid Services told Kaiser Health News that beneficiaries would be able to change plans next year because of Plan Finder misinformation, although officials provided few details. [Continued at Kaiser Health News or NPR.]
Will Trump snuff out e-cigarettes?
Volume 394 Number 10213 30 November 2019
WORLD REPORT President Trump promised to ban flavoured e-cigarettes, but 11 weeks later, they are still on the shelves. Susan Jaffe reports from Washington.
When US President Donald Trump announced a plan on Sept 11 to prohibit the sale of most flavoured electronic cigarettes, more than 450 people in the USA had a mysterious lung disease associated with vaping, and six had died, according to the Centers for Disease Control and Prevention (CDC). The ban would be finalised within 30 days, said Health and Human Services Secretary Alex Azar.
The number of cases of the lung disease has since soared to 2290, as of Nov 20, in 49 states, Washington, DC, and the US Virgin Islands. 47 e-cigarette smokers (vapers) have died, according to the CDC. However, as this report went to press, officials from the Trump administration would not disclose when the promised ban would be issued.
…The decision [to implement] a nationwide ban is up to President Trump. “It is a chain of command”, said Robert Califf, a professor of cardiology at Duke University School of Medicine and the FDA commissioner under Trump and former President Barack Obama. “The commissioner reports to the Secretary of Health and Human Services [HHS]and the secretary reports to the president. FDA policies are de facto policies of the Executive Branch, so if the HHS secretary or president chooses to do so, they can intercede.” [Continued here]
Cycling safety concerns grow in US cities
Volume 394 Number 10211 16 November 2019
WORLD REPORT As more bicycle riding is encouraged for health and environmental reasons, an increase in cycling deaths is causing a public health dilemma in the USA. Susan Jaffe reports.
Photo by Susan Jaffe Copyright © 2019
A record number of cycling deaths in the USA is attracting scrutiny from the US Congress, city officials, and the National Transportation Safety Board (NTSB), the government agency better known for investigating aeroplane crashes and other transportation disasters. …Last year, 859 cyclists were killed in road traffic crashes, the highest number in the USA since 1990, and a 6·3% increase since 2017, according to research from the US Department of Transportation’s National Highway Traffic Safety Administration published last month.
…In a preliminary report issued last week, the NTSB recommended that public officials take several steps to reduce the number of cycling deaths. The last time it examined bicycle safety was 47 years ago. [Continued here]
As Medicare Enrollment Nears, Popular Price Comparison Tool Is Missing
By Susan Jaffe | Kaiser Health News | October 8, 2019 | This article also ran in the
Millions of older adults can start signing up next week for private policies offering Medicare drug and medical coverage for 2020. But many risk wasting money and even jeopardizing their health ca
re due to changes in Medicare’s plan finder, its most popular website.
For more than a decade, beneficiaries used the plan finder to compare dozens of Medicare policies offered by competing insurance companies and get a list of their options. Yet after a website redesign six weeks ago, the search results are missing crucial details: How much will you pay out-of-pocket? And which plan offers the best value? [Continued at Kaiser Health News, San Francisco
Congress and President Trump take on high drug prices
Volume 394 Number 10204 28 September 2019
WORLD REPORT Proposals from the White House and Congress to lower prescription drug costs, which both rejected more than a decade ago, are making a comeback. Susan Jaffe reports.
The Trump administration’s Department of Health and Human Services (HHS) is the first federal health agency to claim they are “open” to the idea of importing cheaper drugs from Canada and overseas. And both Republicans and Democrats in Congress now advocate familiar strategies to rein in drug price increases. [Continued here]
Class-Action Lawsuit Seeks To Let Medicare Patients Appeal Gap in Nursing Home Coverage
By Susan Jaffe | Kaiser Health News | August 12, 2019 | This KHN story also ran on Salon and Next Avenue
Medicare paid for Betty Gordon’s knee replacement surgery in March, but the 72-year-old former high school teacher needed a nursing home stay and care at home to recover.
Yet Medicare wouldn’t pay for that. So Gordon is stuck with a $7,000 bill she can’t afford — and, as if that were not bad enough, she can’t appeal.
The reasons Medicare won’t pay have frustrated the Rhode Island woman and many others trapped in the maze of regulations surrounding something called “observation care.”
Patients, like Gordon, receive observation care in the hospital when their doctors think they are too sick to go home but not sick enough to be admitted. They stay overnight or longer, usually in regular hospital rooms, getting some of the same services and treatment (often for the same problems) as an admitted patient….
(Photo courtesy of Betty Gordon)
But observation care is considered an outpatient service under Medicare rules, like a doctor’s appointment or a lab test. Observation patients may have to pay a larger share of the hospital bill than if they were officially admitted to the hospital.Medicare’s nursing home benefit is available only to those admitted to the hospital for three consecutive days. Gordon spent three days in the hospital after her surgery, but because she was getting observation care, that time didn’t count.
There’s another twist: Patients might want to file an appeal, as they can with many other Medicare decisions. But that is not allowed if the dispute involves observation care.
Monday, a trial begins in federal court in Hartford, Conn., where patients who were denied Medicare’s nursing home benefit are hoping to force the government to eliminate that exception. A victory would clear the way for appeals from hundreds of thousands of people. [Continued at Kaiser Health News, Next Avenue or Salon]
Social Security Error Jeopardizes Medicare Coverage For 250,000 Seniors
By Susan Jaffe | Kaiser Health News | June 6, 2019 | This KHN story also ran on 
At least a quarter of a million Medicare beneficiaries may receive bills for as many as five months of premiums they thought they already paid.
But they shouldn’t toss the letter in the garbage. It’s not a scam or a mistake.
Because of what the Social Security Administration calls “a processing error” that occurred in January, it did not deduct premiums from some seniors’ Social Security checks and it didn’t pay the insurance plans.
[Continued at Kaiser Health News or NPR ]
Home Health Care Providers Struggle With State Laws And Medicare Rules As Demand Rises
“We can send prescriptions to the pharmacy, including [for] narcotics,” says Marie Grosh, a geriatric advanced practice nurse practitioner and the owner of a medical house calls practice in a Cleveland suburb. “We can order lab work, x-rays, ultrasounds, EKGs [electrocardiagrams]; interpret them; and treat patients based on that. But we’re just not allowed to order home care—which is absurd.”
By SUSAN JAFFE | Health Affairs | June 2019 | Volume 38, Number 8
When Christine Williams began working as a nurse practitioner some forty years ago in Detroit, Michigan, older adults who couldn’t manage on their own and had no family nearby and no doctor willing to make house calls had few options besides winding up in a nursing home.
Not anymore.
Home check: Nurse practitioner Marie Grosh visits Leroy Zacharias at his home in a Cleveland suburb, He has Parkinson disease, and Grosh says he would be living in a nursing home if he couldn’t get medical care at home. (Photo by Lynn Ischay.)
“The move towards keeping seniors in their homes is a fast-galloping horse here,” says Williams, who settled in Cleveland, Ohio, more than a decade ago. “We don’t have space for them in long-term care [facilities], they don’t want to be in long-term care, and states don’t want to pay for long-term care. And everybody wants to live at home.”
But despite the growing desire for in-home medical care for older adults from nearly all quarters, seniors’ advocates and home health professionals claim that rules set by the Centers for Medicare and Medicaid Services (CMS) along with state regulations have created an obstacle course for the very providers best positioned—and sometimes the only option—to offer that care. [Continued here]