Reimagining primary care

Presented by PhRMA: Delivered daily by 10 a.m., Pulse examines the latest news in health care politics and policy.

Nov 27, 2023 View in browser   By Chelsea Cirruzzo and Ben Leonard Presented by With Carmen Paun  Driving The Day A dearth of primary care doctors has prompted the Biden administration and Congress to look for new approaches that would help patients access medical care. | Joe Raedle/Getty Images THE DOCTOR MIGHT SEE YOU NOW — It’s getting tough to get a doctor’s appointment these days. That’s a frustration for patients and a policy challenge Washington is trying to solve. Both Congress and the Biden administration are reimagining primary care to better serve patients. But the goal isn’t to restore the reign of independent practices where a town doctor served a community for a lifetime. “That day is largely gone,” Sen. Bernie Sanders (I-Vt.), chair of the Senate panel responsible for the nation’s health care, told POLITICO. The new primary care: Most of us are facing routine visits with a rotating cast of nurses and physician assistants, resulting in increasingly spare and online checkups with doctors, POLITICO’s Daniel Payne and Erin Schumaker report. Sanders has proposed legislation with Kansas Republican Sen. Roger Marshall that envisions a system in which more people would receive care at community health centers. Though far from the doctor practices of the past, the centers would help make prevention-focused treatment accessible and affordable. The bill also proposes funding to train additional doctors and nurses to build a larger workforce. More care online: Telehealth boomed during the Covid-19 pandemic, driven by decisions by the Trump administration and Congress to permit Medicare to pay for virtual visits. Congress has extended those permissions through 2024, and lawmakers look to make them permanent. In the private sector, investment in virtual care ballooned, with tech companies like Amazon hoping to capitalize on telehealth’s convenience. Why the change? Primary care doctors retiring or leaving the field outnumber new medical school graduates choosing a career in family medicine, according to a recent report from the Primary Care Collaborative, a nonprofit representing clinicians and health care organizations. Every state has seen a reduction in primary care doctors per capita. Doctors say high overhead costs and their growing administrative workloads make running a small private practice impossible. It’s already happening: Even before the pandemic accelerated a massive shift to virtual care, more than a quarter of Americans were seeing nurses and physician assistants instead of doctors at their health care visits, according to research published in the BMJ. WELCOME TO MONDAY PULSE. I’m still dreaming of the honey goat cheesecake I had at Thanksgiving dinner. Send your tips, scoops and feedback to ccirruzzo@politico.com and bleonard@politico.com and follow along @ChelseaCirruzzo and @_BenLeonard_. TODAY ON OUR PULSE CHECK PODCAST, host Alice Miranda Ollstein talks with Chelsea, who explains why a lack of funding has stalled the law recently signed by President Joe Biden to overhaul the nation's organ transplant system — its first major reform in 40 years.   A message from PhRMA: Patients. Not Politicians. The Inflation Reduction Act (IRA) lets politicians decide what medicines are valuable and which diseases get researched. This could risk future treatments, including possible cures. No one should stand between you and your medicine. Get more details.   Listen to today’s Pulse Check podcast Public Health Chinese health officials said they didn't detect any "unusual or novel diseases" in the country amid a potentially worrying spike in respiratory illnesses and clusters of pneumonia in children. | Ng Han Guan/AP Photo PNEUMONIA SPIKE IN CHINA — Chinese health officials said at a news conference Sunday that a spike in respiratory illnesses is caused by known viruses, including the flu, respiratory syncytial virus and pneumonia, as reported by several news outlets. Health officials there are asking people to wear masks and local authorities to open so-called fever clinics and encourage vaccination for vulnerable groups. Reports of illness prompted the World Health Organization last week to ask China for detailed information on clusters of pneumonia among children. The WHO says the information China provided showed an increase in hospital admissions among children due to viruses like RSV, the cold and the flu. Some internal accounts in China say hospitals in northern parts of the country have been swamped with cases, which officials deny. Dr. Ashish Jha, dean of Brown University’s School of Public Health and former White House Covid response coordinator, wrote on X, formerly known as Twitter, on Friday that there wasn’t much to be concerned about given the circumstances of cases. “[B]ased on what we know, am I worried?” Jha wrote. “No.”   GET A BACKSTAGE PASS TO COP28 WITH GLOBAL PLAYBOOK: Get insider access to the conference that sets the tone of the global climate agenda with POLITICO's Global Playbook newsletter. Authored by Suzanne Lynch, Global Playbook delivers exclusive, daily insights and comprehensive coverage that will keep you informed about the most crucial climate summit of the year. Dive deep into the critical discussions and developments at COP28 from Nov. 30 to Dec. 12. SUBSCRIBE NOW.     Elections TRUMP WANTS ACA REPEAL — Presidential candidate and former President Donald Trump says he’s “seriously looking at alternatives” to the Affordable Care Act. The Saturday post on his social media app Truth Social criticized Senate Republicans who Trump says “campaigned for 6 years against it, and then raised their hands not to terminate it. It was a low point for the Republican Party, but we should never give up!” White House staff and Biden allies were quick to roll their eyes on X, formerly known as Twitter, including White House assistant press secretary Kevin Munoz, who wrote that Trump wants to take away Americans’ health care and Emily’s List communications SVP Christina Reynolds, who said Trump has yet to introduce any alternatives. “Believe him at your own risk,” she wrote.   A message from PhRMA:   In Congress MA DENIALS TRIGGER HILL SCRUTINY— A bipartisan group of lawmakers are increasingly concerned about rising complaints over private sector-run Medicare Advantage plans denying care too often, POLITICO’s Robert King reports. “It was stunning how many times senators on both sides of the aisle kept linking constituent problems with denying authorizations for care,” Sen. Ron Wyden (D-Ore.) said in an interview, referring to a bevy of complaints from colleagues during a recent Senate Finance Committee hearing. Lawmakers have already raised concerns over celebrity-filled ads and misleading physician directories. This new round of scrutiny over denials stemming from cost containment tools like prior authorization — where doctors get insurer approval before delivering a treatment or prescribing a drug — could lead to major changes for the increasingly growing market. “CMS is very attuned to what is going on on the Hill,” Sean Creighton, managing director of policy for consulting firm Avalere Health, said of CMS. The agency has a track record of responding to liberal concerns. CMS recently proposed a rule to improve standards for behavioral health networks and has installed new oversight of Medicare Advantage television ads. Sen. Elizabeth Warren (D-Mass.) is pressing CMS to go further, demanding that the agency publish and collect data from plans on their prior-authorization practices.   JOIN WOMEN RULE ON 12/12: For centuries, women were left out of the rooms that shaped policy, built companies and led countries. Now, society needs the creativity and entrepreneurship of women more than ever. How can we make sure that women are given the space and opportunity to shape the world’s future for the better? Join POLITICO's Women Rule on Dec. 12 for Leading with Purpose: How Women Are Reinventing the World to explore this and more. REGISTER HERE.     Telehealth ELEVATED TELEHEALTH USAGE PERSISTS — Telehealth continues to be used at a rate well above pre-pandemic levels — about 30 times higher — despite falling from a pandemic peak, according to new data on hundreds of millions of visits from Epic Research, Ben reports. Before the pandemic, virtual care made up about 0.2 percent of overall visits. That spiked to 31.2 percent of overall visits in the second quarter of 2020, according to Epic, but fell to 13.9 percent in the beginning of 2021. It dropped to 5.8 percent in 2023's third quarter. Telehealth visits for mental health care have had the most staying power among specialties, accounting for 36.8 percent of visits in the most recent quarter. That's well above telehealth’s next highest use case — infectious diseases, of which 10.6 percent of visits were through virtual care in 2023’s third quarter. One in 10 obstetrician and transplant encounters remain virtual as of 2023’s third quarter. The data reflect high demand for virtual mental health care after the end of the public health emergency but less for other specialties. The results echo previous data showing strong demand for telemedicine for minor illnesses, routine prescription refills, chronic conditions and mental health care. Public Health MALARIA VAX SET TO EXPAND — The rollout of the first malaria vaccine has moved from the pilot phase into a wider campaign expected to save thousands of children under 5 years old from dying from the mosquito-borne disease in sub-Saharan Africa, Carmen reports. More than 330,000 doses of the GSK’s Mosquirix vaccine arrived last week in Cameroon, the first country not involved in a pilot program for the vaccine to receive shots. Some 1.7 million vaccines are expected in Burkina Faso, Liberia, Niger and Sierra Leone in the coming weeks, said Gavi, the vaccine alliance; UNICEF; and the World Health Organization. Why it matters: A child under 5 dies from malaria nearly every minute, according to the global health organizations. Nearly 620,000 people died of malaria in 2021, the latest year for which data is available, most of them children younger than 5. More than 2 million children have been vaccinated with the four-dose Mosquirix since 2019 in a pilot program in Ghana, Kenya and Malawi, leading to a 13 percent drop in mortality in children eligible to receive the vaccine, according to the groups. The program has also substantially reduced rates of severe malaria illness and hospitalization.   A message from PhRMA: Government price setting could put patients at a disadvantage. The Inflation Reduction Act (IRA) could have unintended consequences such as: Putting barriers between patients and their prescribed medications. Jeopardizing continued research into approved medicines. Shifting research and development away from pills and tablets. Learn more.   WHAT WE'RE READING POLITICO’s Arek Sarkissian reports on the University of Florida revolt against the state’s surgeon general. The New York Times reports on whether older Americans get better health benefits from senior living arrangements or intergenerational households. The Washington Post reports on the medical mystery surrounding a rabid kitten.   Follow us on Twitter Dan Goldberg @dancgoldberg Chelsea Cirruzzo @chelseacirruzzo Katherine Ellen Foley @katherineefoley Lauren Gardner @Gardner_LM Kelly Hooper @kelhoops Robert King @rking_19 Ben Leonard @_BenLeonard_ David Lim @davidalim Megan Messerly @meganmesserly Alice Miranda Ollstein @aliceollstein Carmen Paun @carmenpaun Daniel Payne @_daniel_payne Evan Peng @thepngfile Ruth Reader @RuthReader Erin Schumaker @erinlschumaker Megan R. Wilson @misswilson   Follow us

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