National

Data: The Commonwealth Fund; Chart: Alice Feng/Axios

Half of U.S. primary care physicians under the age of 55 say they're burned out and some anticipate leaving the profession in the next three years, per a new survey from the Commonwealth Fund.

Why it matters: It's the latest evidence of doctor shortages that could hamper efforts to reduce health disparities and fill gaps in care as the nation emerges from the pandemic.

What they found: Nearly two-thirds of young clinicians reported higher rates of emotional distress, but few of them are seeking out help or support.

Just 16% of clinicians under the age of 55 reported seeking help, while 6% of primary care physicians over the age of 55 sought support.

"Physicians often feel they are the ones who have to show strength in crisis and though they will tell their patients it's not a weakness to seek support, it's not always clear that they feel permission to do that themselves," said David Blumenthal, president of the Commonwealth Fund.

Go deeper: Burnout isn't limited to primary care physicians: A new report from the American Federation of Teachers, which represents nearly 200,000 health care workers, shows how staffing shortages are weighing on nurses and medical workers.

There were 55,000 fewer nurses working in 2021 than 2020, according to Bureau of Labor Statistics data cited in the report.

"The staffing shortages put a tremendous amount of strain on tired and overworked bedside caregivers," the report states.

The union recommends safe staffing requirements for nurses, investment in financial aid and scholarships for health workers and raising entry-level salaries to attract workers.

The Commonwealth Fund survey recommends increasing Medicare and Medicaid reimbursement for primary care services.

What's next: Provider groups are asking Congress for financial relief in the lame duck session, but it's unclear which requests will be accommodated.

Burnout plagues younger primary care docs

New reports from the Commonwealth Fund and a major health care workers union shows the impacts of burnout post-pandemic on health care workers.

Health care providers

Half of U.S. primary care physicians under the age of 55 say they&#x27;re burned out and some anticipate leaving the profession in the next three years, per a new survey from the <a class="gtmContentClick" data-vars-link-text="Commonwealth Fund" data-vars-click-url="https://www.commonwealthfund.org/publications/issue-briefs/2022/nov/stressed-out-burned-out-2022-international-survey-primary-care-physicians" data-vars-item="in_content_link" href="https://www.commonwealthfund.org/publications/issue-briefs/2022/nov/stressed-out-burned-out-2022-international-survey-primary-care-physicians" target="_blank">Commonwealth Fund</a>.Why it matters: It&#x27;s the latest evidence of <a class="gtmContentClick" data-vars-link-text="doctor shortages" data-vars-click-url="https://www.aamc.org/media/54681/download" data-vars-item="in_content_link" href="https://www.aamc.org/media/54681/download" target="_blank">doctor shortages</a> that could hamper efforts to reduce health disparities and fill gaps in care as the nation emerges from the pandemic.What they found: Nearly two-thirds of young clinicians reported higher rates of emotional distress, but few of them are seeking out help or support.<ul><li>Just 16% of clinicians under the age of 55 reported seeking help, while 6% of primary care physicians over the age of 55 sought support.</li><li>&quot;Physicians often feel they are the ones who have to show strength in crisis and though they will tell their patients it&#x27;s not a weakness to seek support, it&#x27;s not always clear that they feel permission to do that themselves,&quot; said David Blumenthal, president of the Commonwealth Fund.</li></ul>Go deeper: Burnout isn&#x27;t limited to primary care physicians: A <a class="gtmContentClick" data-vars-link-text="new report" data-vars-click-url="https://www.aft.org/sites/default/files/media/documents/2022/hc_StaffingTaskforceReport_Nov2022.pdf" data-vars-item="in_content_link" href="https://www.aft.org/sites/default/files/media/documents/2022/hc_StaffingTaskforceReport_Nov2022.pdf" target="_blank">new report</a> from the American Federation of Teachers, which represents nearly 200,000 health care workers, shows how staffing shortages are weighing on nurses and medical workers.<ul><li>There were 55,000 fewer nurses working in 2021 than 2020, according to Bureau of Labor Statistics data cited in the report.</li><li>&quot;The staffing shortages put a tremendous amount of strain on tired and overworked bedside caregivers,&quot; the report states.</li><li>The union recommends safe staffing requirements for nurses, investment in financial aid and scholarships for health workers and raising entry-level salaries to attract workers.</li><li>The Commonwealth Fund survey recommends increasing Medicare and Medicaid reimbursement for primary care services.</li></ul>What&#x27;s next: Provider groups are asking Congress for financial relief in the lame duck session, but it&#x27;s unclear which requests will be accommodated.

The U.S. faces a range of health care flashpoints — unaffordable drugs, opioids, vaping — as we debate whether to adopt universal care. For now, the Affordable Care Act is the law of the land, but Republicans want to issue it a final death blow.

Health

Amazon on Tuesday launched a new virtual care service called Amazon Clinic, which offers treatment with a few clicks and an out-of-pocket cost on par with a standard co-pay, for common medical conditions.

Why it matters: The move solidifies Amazon's intention to be a major player in the consumer-driven health care space, building out services and capabilities around their other offerings like Amazon Pharmacy and their recent purchase of OneMedical.

Yes, but: It comes on the heels of Amazon announcing it would shutter Amazon Care earlier this year, largely after the virtual care and telehealth service failed to take hold with large enterprise customers, per Fierce Healthcare.

Now, Amazon Clinic is targeting consumers directly, non-exclusively contracting with virtual providers Steady MD and HealthTap to offer services in 32 states at launch.

Customers get to choose which virtual health provider they'd like to use and see how much it will cost before they begin a consultation. The service does not yet accept insurance coverage.

The intrigue: Amazon Clinic could be a way for providers to break into the virtual care market without having to create their own "digital front door," Nathan Ray, a partner at West Monroe, told Axios.

Specifics on how Amazon Clinic directly connects to the company's OneMedical clinics are likely still being worked out, Ray said.

The new service line does clarify one of the company's goals: "It's clear they want patient data," Ray said.

Be smart: It's not all good news for Amazon, which plans to lay off approximately 10,000 workers, the New York Times reported this week.

Amazon expands health care footprint with virtual clinic offering

Amazon launched Amazon Clinic this week, offering virtual care appointments for specific medical conditions.

Illustration of a stethoscope made from Amazon's logo.

Amazon

Amazon on Tuesday launched a new virtual care service called Amazon Clinic, which offers treatment with a few clicks and an out-of-pocket cost on par with a standard co-pay, for common medical conditions.Why it matters: The move solidifies Amazon&#x27;s intention to be a major player in the consumer-driven health care space, building out services and capabilities around their other offerings like Amazon Pharmacy and their recent purchase of OneMedical.

Health worker shortages are keeping hospitals from discharging patients for post-acute care and prompting pleas to Congress for per diem Medicare payments to cover the longer stays.

Why it matters: The requests add to a long list of health industry asks that Congress will have to sort through in the lame-duck session and underscore how the fallout from the pandemic is still rippling through the health care system. 

How it works: Discharging patients to long-term care facilities was challenging even before the pandemic, but COVID-19 dramatically disrupted the process, making it hard for facilities to accept patients in the midst of outbreaks.

It's costly to keep patients in a hospital when they no longer need to be there, since facilities are typically paid a fixed rate based on a patient's condition or diagnosis.

The patients who can't be discharged are still too sick to go home and may have mobility issues, conditions like diabetes, or mental health needs. 

Providence Health in Spokane, Wash., for example, is on track to spend nearly $18 million this year on nursing care for patients who no longer need to be hospitalized at its two facilities. A handful of patients have been on the premises for more than 100 days, Susan Stacey, Providence chief executive for inland northwest Washington state, told Axios.

"We're having workforce issues downstream, so that per diem could provide some targeted temporary relief to hospitals," said Aimee Kuhlman, a vice president of advocacy at the American Hospital Association.

Zoom in: Long-term care facilities continue to grapple with staffing problems, which limits the available spots for a hospital to discharge to.

The backlog has left patients with medical emergencies waiting on beds and sometimes dying, the American College of Emergency Physicians wrote in a letter to President Biden this month.

Some emergency departments that board patients have had backups extending into hallways, waiting rooms, and ambulances waiting to offload patients.

Normally, an emergency department can handle a challenge of tight capacity, high acuity or a staffing shortage, but when all three come together at once, it can quickly overwhelm an ER.

"The system is at a breaking point," Christopher Kang, president of the American College of Emergency Physicians, told Axios. His group has asked the administration to establish a nationwide council to address capacity problems and other stresses throughout the health system.

Yes, but: The requests could be drowned out by myriad other health interests seeking their own relief by year's end.

Nursing homes, long-term care and home health providers each cite a severe shortage of workers as threatening their business models.   

What we're watching: The siloed health care system has many potential gaps in care, and while the pandemic forced closer collaborations, alliances may be difficult to formalize.

Facilities that accept Medicaid patients could limit the number of spots for those patients, due to payment rates that are lower than private coverage. 

Skilled nursing facilities are still rejecting patient referrals from hospitals at higher rates than before the pandemic, data from WellSky shows.

The rejection of hospital referrals also could be a sign some facilities are trying to stay above water and maintain higher standards of care.

"You shouldn't bring a person in you can't care for because it would cause harm to that individual," said Lori Smetanka, executive director of the advocacy group Consumer Voice.

Hospitals seek more aid to house patients they can't discharge

The stressed health care system is clogged in part due to patients who are still in the hospital who don't need to be.

Illustration of a hospital bed with a price tag.

Hospitals

Health worker shortages are keeping hospitals from discharging patients for post-acute care and prompting pleas to Congress for per diem Medicare payments to cover the longer stays.Why it matters: The requests add to a long list of health industry asks that Congress will have to sort through in the lame-duck session and underscore how the fallout from the pandemic is still rippling through the health care system.

Patient advocates are pressing Congress to use the lame duck session to give standalone Medicare drug coverage to some senior citizens who qualify for nursing-level care.

Why it matters: The "fix" would make up for how the Inflation Reduction Act's drug price controls stopped short of applying to the PACE Program, a comprehensive care alternative to nursing homes.

The IRA capped out-of-pocket spending at $2,000 annually for seniors using Medicare Part D, but in PACE, all costs are built into one set premium with no copays or deductibles. 

Driving the news: A plan from Sens. Thomas Carper (D-Del.) and Bill Cassidy (R-La.) which would enable Medicare beneficiaries enrolled in PACE to access the Part D drug plans and benefit from the price controls in the IRA.

"They shouldn't have to choose between the benefits of the PACE program and being able to afford prescription coverage," said Rep. Earl Blumenauer (D-Ore.), who's co-sponsoring a House companion bill.

What they're saying: The lawmakers and patient advocates argue the status quo will leave frail seniors less incentivized to participate in a PACE program and lead to hundreds of dollars more in monthly drug costs.

"It's a cost disincentive to enroll in PACE," Peter Fitzgerald, vice president of policy at the National PACE Association, told Axios.

Be smart: The vast majority of PACE participants are eligible for both Medicare and Medicaid, and an October Bipartisan Policy Center report estimates that just 1% of the nearly 62,000 participants in programs around the country are Medicare-only beneficiaries. 

PACE covers a wider range of services than traditional Medicare, including adult day care, transportation and dental health. PACE organizations serve as both providers and payers for enrollees.

Its origins trace back to 1970s San Francisco, when community leaders created a community-based system for elder care. Congress permanently recognized PACE as a provider type in 1997, and 147 organizations operate PACE programs in 32 states as of August 2022.

Yes, but: The proposed bipartisan fix joins a long list of health care policy changes that are in play during the lame duck and may test lawmakers' willingness to tinker with Medicare law. 

Standalone drug plans broached for frail seniors in community-based care

Illustration of rolls of bills behind a road barricade

Medicare Part D

Health care costs

Patient advocates are pressing Congress to use the lame duck session to give standalone Medicare drug coverage to some senior citizens who qualify for nursing-level care.Why it matters: The &quot;fix&quot; would make up for how the Inflation Reduction Act&#x27;s drug price controls stopped short of applying to the PACE Program, a comprehensive care alternative to nursing homes.<ul><li>The IRA capped out-of-pocket spending at $2,000 annually for seniors using Medicare Part D, but in PACE, all costs are built into one set premium with no copays or deductibles. </li></ul>Driving the news: A plan from Sens. Thomas Carper (D-Del.) and Bill Cassidy (R-La.) which would enable Medicare beneficiaries enrolled in PACE to access the Part D drug plans and benefit from the price controls in the IRA.<ul><li>&quot;They shouldn&#x27;t have to choose between the benefits of the PACE program and being able to afford prescription coverage,&quot; said Rep. Earl Blumenauer (D-Ore.), who&#x27;s co-sponsoring a House companion bill.</li></ul>What they&#x27;re saying: The lawmakers and patient advocates argue the status quo will leave frail seniors less incentivized to participate in a PACE program and lead to hundreds of dollars more in monthly drug costs.<ul><li>&quot;It&#x27;s a cost disincentive to enroll in PACE,&quot; Peter Fitzgerald, vice president of policy at the National PACE Association, told Axios.</li></ul>Be smart: The vast majority of PACE participants are eligible for both Medicare and Medicaid, and an October <a class="gtmContentClick" data-vars-link-text="Bipartisan Policy Center report" data-vars-click-url="https://bipartisanpolicy.org/download/?file=/wp-content/uploads/2022/10/BPC_PACE_Report_Final.pdf" data-vars-content-id="b709fa8f-9323-4e08-91eb-dff077ec4336" data-vars-headline="Standalone drug plans broached for frail seniors in community-based care" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://bipartisanpolicy.org/download/?file=/wp-content/uploads/2022/10/BPC_PACE_Report_Final.pdf" target="_blank">Bipartisan Policy Center report</a> estimates that just 1% of the nearly 62,000 participants in programs around the country are Medicare-only beneficiaries. <ul><li>PACE covers a wider range of services than traditional Medicare, including adult day care, transportation and dental health. PACE organizations serve as both providers and payers for enrollees.</li><li>Its origins trace back to 1970s San Francisco, when community leaders created a community-based system for elder care. Congress permanently recognized PACE as a provider type in 1997, and 147 organizations operate PACE programs in 32 states as of <a class="gtmContentClick" data-vars-link-text="August 2022" data-vars-click-url="https://www.npaonline.org/sites/default/files/PDFs/PACE_in_the_States_8.22.pdf" data-vars-content-id="b709fa8f-9323-4e08-91eb-dff077ec4336" data-vars-headline="Standalone drug plans broached for frail seniors in community-based care" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.npaonline.org/sites/default/files/PDFs/PACE_in_the_States_8.22.pdf" target="_blank">August 2022</a>.</li></ul>Yes, but: The proposed bipartisan fix joins a long list of health care policy changes that are in play during the lame duck and may test lawmakers&#x27; willingness to tinker with Medicare law.

Data: Trilliant Health national all-payer claims database; Chart: Axios Visuals

Cancer screening rates and diagnoses had yet to bounce back to pre-pandemic levels by the end of 2021, a new analysis published in JAMA Oncology shows.

👀 What they found: Using a set of nationally representative, all-payer data claims from analytics company Trilliant Health, researchers found that "screening quickly rebounded after the initial stages of the pandemic; however, the longer follow-up time reveals that gaps in preventive cancer screening returned and worsened."

The study adds data to provider anecdotes about patients being diagnosed with later-stage cancers after putting off screening during lockdowns.

They've also seen that patients have been slow to return to regular cancer screenings and check-ups as the pandemic has eased.

Data du jour: Cancer screenings post-pandemic

Cancer screening rates and diagnoses had yet to bounce back to pre-pandemic levels by the end of 2021.

Cancer screening

Cancer screening rates and diagnoses had yet to bounce back to pre-pandemic levels by the end of 2021

Cancer screening rates and diagnoses had yet to bounce back to pre-pandemic levels by the end of 2021, <a class="gtmContentClick" data-vars-link-text="a new analysis" data-vars-click-url="https://jamanetwork.com/journals/jamaoncology/fullarticle/2798851" data-vars-item="in_content_link" href="https://jamanetwork.com/journals/jamaoncology/fullarticle/2798851" target="_blank">a new analysis</a> published in JAMA Oncology shows.👀 What they found: Using a set of nationally representative, all-payer data claims from analytics company Trilliant Health, researchers found that &quot;screening quickly rebounded after the initial stages of the pandemic; however, the longer follow-up time reveals that gaps in preventive cancer screening returned and worsened.&quot;<ul><li>The study adds data to provider anecdotes about patients being diagnosed with later-stage cancers after putting off screening during lockdowns.</li><li>They&#x27;ve also seen that patients have been slow to return to regular cancer screenings and check-ups as the pandemic has eased.</li></ul>

Arielle Dreher

Stories

Standalone drug plans broached for frail seniors in community-based care

Data du jour: Cancer screenings post-pandemic

Burnout plagues younger primary care docs

Amazon expands health care footprint with virtual clinic offering

Hospitals seek more aid to house patients they can't discharge