Axios Vitals

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February 03, 2023

Happy Friday, Vitals readers. Today's newsletter is 1,092 words or a 4-minute read.

1 big thing: States eye compacts, scope of practice laws to fill holes in health workforce

Photo Illustration: Sarah Grillo. Photo: Spencer Platt/Getty Images

More states are working out their differences over what medical services non-doctors can provide in order to ease stubborn workforce shortages plaguing health systems, Axios' Arielle Dreher reports.

Why it matters: The pandemic prompted states to waive certain licensure requirements, which allowed providers to more easily practice in other states or to expand the services they were allowed to provide to patients, including via telehealth.

  • But making those temporary fixes permanent, and potentially giving health workers more autonomy over patient care, could conflict with "scope of practice" laws.

Driving the news: The most immediate focus is on the shortage of nurses, driven by some projections showing that the U.S. will have a nationwide deficit of more than 900,000 RNs by the decade's end.

  • New York Gov. Kathy Hochul last month endorsed making her state part of the Interstate Medical Licensure Compact and the Nurse Licensure Compact, which would allow physicians and nurses licensed in other states to practice in New York. The New York State Nursing Association, fresh off acrimonious contract talks with some health systems, doesn't support joining the compact.
  • A similar move may be on the way in Nevada after the state nurses association backed joining a compact after changes were made requiring background checks.
  • Meanwhile, California is embarking on a phased-in approach that will allow nurse practitioners to open their own practice by 2026, CalMatters reports.

Zoom in: The Nurse Licensure Compact allows a nurse licensed in a participating state to have the same privileges in any of 37 others. Pennsylvania, Ohio, Vermont, Guam and the Virgin Islands joined the compact during the pandemic, including via telemedicine.

  • During a pandemic or natural disaster, those nurses can relocate to another participating state and practice without the need for an emergency declaration or other state approval.
  • "States want to attract health care professionals to their state whether or not it's on a temporary basis or not, and the compact would enable a state to call on a recruit for that position more seamlessly," Nicole Livanos, the director of government affairs at National Council of State Boards of Nursing, told Axios.

Go deeper.

2. Most Americans support a tobacco ban

Illustration of a pack of cigarettes as a downward trending bar chart.

Illustration: Allie Carl/Axios

The majority of Americans (57%) support a ban on the sale of all tobacco products and even more support blocking sales of menthol cigarettes (62%), a CDC study published in Preventing Chronic Disease found.

Driving the news: Researchers asked nearly 6,500 people in 2021 about what extent they might support prohibiting tobacco sales.

What they're saying: "These findings can inform federal, state, and local efforts to prohibit all tobacco product sales, including menthol cigarettes, reduce tobacco use and tobacco-related disparities, and advance health equity," the researchers wrote.

Catch up quick: Last year, the Biden administration proposed a ban on menthol cigarettes and cigars.

Yes, but: Even so, New York Gov. Kathy Hochul ignited fierce debate this week after proposing a statewide ban on the sale of flavored tobacco and vape products.

  • It came after voters passed a referendum to uphold a ban on the sale of flavored tobacco products in California last year.

3. MA plans denied 2M prior authorization requests

Illustration: Annelise Capossela/Axios

There were more than 35 million prior authorization requests to Medicare Advantage insurers in 2021, according to an analysis from KFF.

Why it matters: Medicare Advantage plans make up around half of the plans seniors are choosing for their coverage.

  • Traditional Medicare beneficiaries are rarely required to receive prior authorization, while "virtually all" of the Medicare Advantage plans seniors are enrolled in appear to use the tool for higher-cost services, the KFF analysis says.

By the numbers: Of the 35 million prior authorization requests to MA plans, about 2 million, or 6%, were fully or partially denied by insurers.

  • Only about 11% of those denials were appealed.
  • But 82% of those appeals resulted in fully or partially overturning the original denial.
  • That high number of favorable outcomes raises questions about whether initial determinations should have been approved, but could also show initial requests failed to provide the necessary documentation, the authors say.

What they are saying: "In either case, medical care that was ordered by a health care provider and ultimately deemed necessary was potentially delayed because of the additional step of appealing the initial prior authorization decision, which may have negative effects on beneficiaries' health," they wrote.

Read the rest.

4. Redefining the STEM workforce

Illustration: Annelise Capossela/Axios

A new federal report describes a hidden economy of science and engineering jobs in the U.S., Axios' Alison Snyder writes.

What's new: The National Science Foundation's biennial "Diversity and STEM" report released this week expands the definition of a STEM job.

  • Previous analyses limited it to "white lab coat" jobs — engineers and scientists in the fields of math, computer science, biology, physics and social scientists — that typically require at least a bachelor's degree and earn an average of $90,000 per year.
  • But the new report includes science- and engineering-related jobs that draw on STEM skills and expertise. These are health care workers, technologists, technicians, K-12 science teachers and others whose typical salary is $67,000 per year.

What they're saying: "You can be a part of the STEM workforce on a practical level," says Amy Burke, head of the analysis team at the National Center for Science and Engineering Statistics at NSF that produced the report.

  • "It doesn't necessarily come at the cost of a four-year degree, which has been very prohibitive" for a lot of people, she adds.

Our thought bubble: In light of workforce shortages in health care (see above), ensuring workers have a clearer and faster path into the STEM economy at all levels is paramount.

5. Data du jour: Docs and stress

Data: Medscape U.S. Physician Burnout & Depression Report; Note: Respondents could choose multiple answers; Chart: Axios Visuals
Data: Medscape U.S. Physician Burnout & Depression Report; Note: Respondents could choose multiple answers; Chart: Axios Visuals

More than half of physicians report feeling burned out and nearly a quarter say they're depressed, according to the U.S. Physician Burnout & Depression Report from Medscape.

Why it matters: That reflects a big jump from just five years ago, when 42% of physicians say they felt burned out and 15% said they were depressed.

Zoom in: The survey of more than 9,100 doctors across 29 specialties during the pandemic found physicians used a collection of both "healthy" and "unhealthy" tactics to cope with stress.

  • Those in outpatient clinics or office-based group practices were most likely to report burnout compared to solo physician practices, the report found.

6. Dog of the week

Max. Photo courtesy: Jennifer Potash

Meet Max, a 2-year-old West Highland white terrier who lives in New Jersey with his human Jennifer Potash and has "tons of attitude."

  • "Max will do anything for treats," writes Potash, adding "he's got a repertoire of tricks" that include rolling over, shaking hands and touching down.

Thanks for reading, and thanks to senior editor Adriel Bettelheim and senior copy editor Bryan McBournie for the edits.