Will expanded health worker roles help patients?

Apr 12, 2023

With Carmen Paun

A nurse writes on a form.

The shortage of health workers has grown to be many providers’ biggest concern about the future. | Christopher Furlong/Getty Images

FUEL TO THE FIRE — A decadeslong debate among health providers of all kinds over who can deliver what type of care is taking on new urgency amid health worker shortages and eased regulations spurred on by the pandemic, your host reports.

In what many groups believe is a unique opportunity to change policy, health providers are pushing for — or against — nearly 200 bills across state governments that would change the licensing or supervision requirements for certain types of care.

Some proposed legislation would allow pharmacists to prescribe hormonal contraceptives and administer vaccines or give optometrists the authority to inject local anesthetics before minor surgery.

Several other bills would reduce the supervision required for some care, such as those in Colorado, Connecticut, Florida, Iowa and Montana that would emphasize more collaboration than supervision in the relationship between physician assistants and doctors.

The legislative battles represent lawmakers’ efforts to balance patient safety and access.

Many of the groups, representing providers like pharmacists to nurse practitioners, say the changes would increase patient access to health care amid a labor crunch and point to the relaxed rules from the pandemic to prove they’re adequately trained for the tasks.

But doctors groups have warned that patient safety is at risk and argue they alone have the training needed for performing and overseeing many procedures and prescriptions.

Arguments over scope of practice are entering the federal government, too, with the Department of Veterans Affairs looking to set its own standards for which providers are allowed to give certain types of care within VA clinics.

Providers are not only trying to convince the VA to adjust its policies in their group’s favor but also looking to take any federal wins back to the states to convince lawmakers to make further changes.

WELCOME TO WEDNESDAY PULSE. The age of smartphones, smart homes and smart toilets is now offering a new point of connection: smart knee replacements. The smart joints being created would be able to tell doctors how the replacements are working — from gait to step count.

Is there any smart policy in development? Let us know at dpayne@politico.com and kmahr@politico.com.

TODAY ON OUR PULSE CHECK PODCAST, host Megan Messerly talks with Daniel, who provides more insight into his report on lawmakers' proposals to ease the clinician shortage by expanding the roles of health care workers, allowing them to care for more patients than they currently do — even though some doctors say the proposed changes would put patient safety at risk.

Listen to today’s Pulse Check podcast

At the Agencies

A hand holding Descovy, left, and Truvada, right, which are HIV prevention medications.

A U.S. District Court judge tossed out the requirements for insurance companies to cover the HIV prevention drug PrEP and to offer a range of preventive services. | Rich Pedroncelli/AP Photo

DOJ ASKS COURT TO PAUSE OBAMACARE RULING — The Justice Department is seeking a stay of a late-March ruling that imperils insurance coverage of preventive care services under the Affordable Care Act, POLITICO’s Alice Miranda Ollstein reports.

“As we’ve said before, for over a decade, the Affordable Care Act has ensured that millions of Americans have access to critical preventative health care,” a DOJ spokesperson said in a statement.

U.S. District Court Judge Reed O’Connor, the author of several previous anti-Obamacare rulings, blocked enforcement of the rules requiring insurers to cover cancer screenings, mental health checks, HIV prevention drugs and other forms of preventive care.

Though most insurance plan benefits are locked in for the rest of the year, the stay request could protect beneficiaries from being hit with out-of-pocket costs for those services.

O’Connor’s ruling comes at an already fraught moment. The Centers for Disease Control and Prevention released a report on Tuesday confirming that sexually transmitted disease rates worsened significantly during the pandemic. Syphilis infections, for example, jumped 32 percent in 2021 to more than 176,000 — the highest total since 1950.

EPA GOES AFTER CANCER-CAUSING GAS — A newly proposed EPA rule could reduce emissions of a cancer-causing gas used at facilities that sterilize medical equipment, POLITICO’s Alex Guillén and David Lim report.

EPA said its Tuesday proposal to emissions rules for commercial sterilizers, along with directives issued via EPA’s authority under the federal pesticide law, will curb ethylene oxide emissions by 80 percent from 86 facilities nationwide.

Billions of medical devices and equipment are sterilized annually using ethylene oxide, a gas that is colorless and, at low concentrations, odorless but can cause cancer in people who face chronic exposure. Ethylene oxide has emerged as an environmental justice issue in recent years as communities close to sterilizer facilities raised health concerns.

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HEALTH TECH

NEW RULES FOR AI IN HEALTH — HHS’ Office of the National Coordinator for Health IT will formally propose new rules next week to require makers of artificial intelligence used in health care to open their algorithms to public scrutiny if they want HHS’ certification, POLITICO’s Ben Leonard reports.

That certification is voluntary but required when the technology is used in many government and private health care settings.

The proposed rules, set for publication on April 18, would also require the software developers to take up document risk-management practices and offer real-world testing plans.

Public Health

GOING AFTER TRANQ — The White House Office of National Drug Control Policy said yesterday that the horse sedative xylazine is showing up in an increasing number of fentanyl overdoses and is an emerging threat to public health, Carmen reports.

The designation, which Congress created in a 2018 law aimed at combating the opioid epidemic, obligates the administration to take steps to combat the drug.

Because xylazine, also known as Tranq, is not an opioid, it’s harder to reverse overdoses with opioid antagonists like naloxone. Those who survive taking Tranq-laced fentanyl can develop severe wounds and rotting tissue requiring amputation.

The number of overdose deaths where xylazine was detected increased by more than 1,000 percent between 2020 and 2021 in the South, according to the Drug Enforcement Administration, with several-hundred-fold increases in other parts of the country.

On Tuesday, the White House said it would widen its efforts to combat the fentanyl crisis, increasing sanctions for drug traffickers, POLITICO’s Matt Berg reports.

The sanctions come as Mexican President Andrés Manuel López Obrador and members of his security cabinet plan to meet with U.S. officials this week about fentanyl and arms trafficking.

Providers

HOSPITALS UNHAPPY WITH PROPOSED CMS RULE — Hospitals called CMS’ proposed inpatient prospective payment system proposed rule “woefully inadequate,” arguing more reimbursements are needed to sustain the industry.

Though some hospitals said they appreciated the administration’s moves toward improving health equity, like asking for more information on helping safety-net hospitals, a push for higher reimbursement rates will be a point of contention between the administration and hospital groups.

Names in the News

Giancarlo Pellegrini is now Democratic chief counsel for the Select Subcommittee on the Coronavirus Pandemic. He was previously Democratic elections counsel for the Committee on House Administration.

Kelly O’Keeffe is now Democratic communications director and senior adviser for the Select Subcommittee on the Coronavirus Pandemic. She was previously communications director for Rep. Raul Ruiz (D-Calif.), the committee’s new ranking member.

Elsy Boglioli will be an independent director at FTI Consulting. She previously founded and has been CEO of the health tech consultancy Bio-Up.

What We're Reading

The Atlantic reports on the American system used to treat severe mental illness.

ProPublica reports on secretive medical malpractice panels making it harder to sue providers.

The Wall Street Journal reports on the former Outcome Health executives found guilty of fraud.

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