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AHRQ Publishes Health Equity Report

The  federal Agency for Healthcare Research and Quality has published its annual report on health care disparities.

The report,National Healthcare Quality and Disparities Report,” is mandated by Congress “… to provide a comprehensive overview of the quality of healthcare received by the general U.S. population and disparities in care experienced by different racial and socioeconomic groups.”

Find the report here.

Health Policy Update for Monday, April 12

The following is the latest health policy news from the federal government as of 2:30 p.m. on Monday, April 12.

The White House

COVID-19

Health Policy and Budget News

  • The Biden administration has released its proposed FY 2022 discretionary budget, which addresses, among other things, many aspects of health care policy.  Find the news release announcing the proposed budget here and the budget document itself here.

Centers for Medicare & Medicaid Services

COVID-19

Proposed Rules

  • CMS has published a special edition of its online publication MLN Connects devoted entirely to its recently published regulations proposing FY 2022 Medicare payments for skilled nursing facilities, hospice providers, inpatient rehabilitation facilities, and inpatient psychiatric facilities.

Centers for Disease Control and Prevention

COVID-19

National Institutes of Health

COVID-19

  • The NIH has issued new guidance on the use of monoclonal antibodies to treat patients with COVID-19.  This varies from past guidance because of differences in the effectiveness of some monoclonal antibodies, used on their own or in combination with others, on COVID-19 and COVID-19 variants.  Go here to see the NIH’s notice, explanation, and rationale for the changing recommendations.

Food and Drug Administration

COVID-19

  • The FDA has issued a letter to health care personnel and facilities recommending transition from use of decontaminated disposable respirators.  The FDA recommends that health care personnel and facilities transition away from crisis capacity conservation strategies, such as decontamination or bioburden reduction, currently used on disposable respirators for reuse.  Based on the increased domestic supply of new respirators approved by the CDC’s National Institute for Occupational Safety and Health (NIOSH) currently available to facilitate this transition, the FDA and CDC believe there is adequate supply of respirators to transition away from use of decontamination and bioburden reduction systems.

Federal Emergency Management Agency

COVID-19

  • FEMA has published audit-related guidance to assist recipients and sub-recipients of COVID-19-related public assistance to document and account for disaster costs, minimize the loss of FEMA funding, maximize financial recovery, provide information about procurement and contracting requirements during emergency and exigent circumstances, and prevent fraud, waste, and abuse of disaster funds.  Find the FEMA fact sheet here.  Find information about emergency medical care activities eligible for FEMA support here.

Department of Labor

Health Policy News

The Department of Labor has posted resources to inform stakeholders about new COBRA premium assistance authorized by the American Rescue Plan.  Find those resources here.

Medicaid and CHIP Payment and Access Commission

Health Policy News

MACPAC has published an annotated bibliography of racial and ethnic disparities in Medicaid.

 

ACA Has Reduced Insurance Disparities

The Affordable Care Act is responsible for a major reduction in the disparity of insurance status among racial and ethnic minorities.

According to a new Commonwealth Fund analysis,

All U.S. racial and ethnic groups saw comparable, proportionate declines in uninsured rates…  However, because uninsured rates started off much higher among Hispanic and black non-Hispanic adults than among white non-Hispanic adults, the coverage gap between blacks and whites declined from 11.0 percentage points in 2013 to 5.3 percentage points in 2017. Likewise, the coverage gap between Hispanics and non-Hispanic whites dropped from 25.4 points to 16.6 points.

Learn more about specific differences among racial and ethnic groups, differences based on residence in Medicaid expansion states and non-expansion states, and differences in securing public or private health insurance in the Commonwealth Fund study “Did the Affordable Care Act Reduce Racial and Ethnic Disparities in Health Insurance Coverage?”

ACA’s Medicaid Pay Bump Helped But Benefits Now Lost, Study Says

Health status and access to care improved for Medicaid patients when the Affordable Care Act mandated a temporary rate increase for physicians serving newly insured patients covered through that law’s Medicaid expansion.

But when the mandate for increased physician payments ended and state Medicaid programs reverted to their previous, lower payments, many of those benefits were lost.

Or so reports a new study from the National Bureau of Economic Research.

According to the study, even a $10 rate increase improved access to care enough to reduce by 13 percent Medicaid recipients’ complaints about not being about to find a doctor.  Utilization also increased.  The temporary Medicaid pay increase has even been credited with improving school attendance and reducing chronic absenteeism.

Despite the benefits of the temporary increase in Medicaid payments to physicians, most states returned to lower payments when the mandated ended, most of the gains resulting from the better pay for treating Medicaid patients disappeared, and the disparities between privately insured individuals and Medicaid patients returned to their pre-Affordable Care Act levels.

Researchers estimate that increasing Medicaid payments to physicians by an average of $26 a visit would eliminate disparities in access to care.

These findings are especially relevant to private safety-net hospitals because the communities they serve have so many more Medicaid patients than the typical American community.

Learn more from the National Bureau of Economic Resarch study “The Impacts of Physician Payments on Patient Access, Use, and Health” and from the Healthcare Dive report “Even $10 increase in Medicaid payments helps erase disparities in care access, study says.”

Journal Looks at Health Disparities

The journal Health Affairs looks at health disparities and social determinants of health in its August 2016 issue.

health affairsThe article “Evaluating Strategies For Reducing Health Disparities By Addressing The Social Determinants Of Health” looks at interventions that focus on social determinants of health, addresses how such interventions can reduce health disparities and improve population health, and considers the challenges to implementing such approaches. Find it here.

The article “Achieving Health Equity: Closing The Gaps In Health Care Disparities, Interventions, And Research” also looks at health care disparities and how to address them, focusing on cardiovascular disease and cancer. Find it here.

Communities served by private safety-net hospitals usually suffer from the very health disparities policy-makers are currently working to address.

Docs Less Likely to Participate in ACOs in Disadvantaged Communities

A new study has found that physicians who practice in areas with higher proportions of low-income, uninsured, less-educated, disabled, and African-American residents are less likely than others to participate in accountable care organizations.

If ACOs ultimately are found to improve health care quality while better managing costs, their benefits might be limited in such communities, thereby exacerbating health care disparities.

It also would be disadvantageous to many of the communities served by the nation’s private safety-net hospitals.

health affairsTo learn more, go here to see the Health Affairs report “Physicians’ Participation In ACOs Is Lower In Places With Vulnerable Populations Than In More Affluent Communities.”

Tracking Medicare Disparities

Tracking disparities in medical conditions and outcomes will be easier with the help of a new “Mapping Medicare Disparities Tool” created by the Centers for Medicare & Medicaid Services’ Office of Minority Health.

cmsThe new disparities tool identifies disparities in utilization, outcomes, and spending by race, ethnicity, and geographic location. It tracks 18 chronic medical conditions along with ER use, readmissions, and other measures, providing data according to state, county, gender, age, dual eligibility status, race, and ethnicity.

To learn more about the Mapping Medicare Disparities Tool, go here to see a CMS news release describing the tool and go here to see and experiment with the tool itself.