Although compensation stagnated in the first year of the pandemic, doctors saw their salaries rebound by 7% by the end of last year, according to Medscape’s Physician Compensation Report released last week. The report includes financial details from about 13,000 physicians across 29 specialties and found primary care doctors earned $260,000 on average while specialists average $368,000. Of those specialties surveyed, plastic surgery averaged the highest compensation at $576,000 while public health and preventative medicine ranked lowest at $243,000.

Fighting a global pandemic on the frontlines of underserved communities has decimated the health center workforce with unprecedented rates of attrition. A new survey by the National Association of Community Health Centers (NACHC) reveals that 68% of health centers report a loss of workforce of up to 25 % in the last six months alone. Health centers are losing nurses more than any other staff, a trend that has brought into focus a worsening national crisis and an immediate challenge to future pandemic readiness. “The future of the Community Health Center workforce and our readiness to meet public health challenges is uncertain,” said Rachel Gonzales-Hanson, interim President and CEO of NACHC. “We must immediately invest in policies that will retain current health center staff, broaden the pipeline for the future workforce, and foster creative strategies at the community level for short and long-term solutions.” Read the entire press release from NACHC or download the report.

Investing in primary care as a preventative measure is associated with improved medical care quality, fewer hospital visits, and lower spending overall, a study has found. If all California providers spent as much on primary care as the highest investing health systems, they could avoid 25,000 acute hospital stays and 89,000 emergency department visits while saving $2.4 billion in healthcare spending a year, according to a study funded by the California Health Care Foundation, Covered California and the Milbank Memorial Fund. Read more.

On April 15, 2022, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule that would update payment rates for the Skilled Nursing Facilities (SNFs) Prospective Payment System (PPS) for Fiscal Year (FY) 2023 and propose changes to SNF Quality Reporting Program (QRP), SNF Value Based Purchasing Program (VBP), and requests information regarding requirements for Long-Term Care (LTC) facilities to establish mandatory minimum staffing levels.

Key proposals include:

• Updated payment rates by 3.9%, reflecting a market basket index percentage change of 2.8%, increased by the forecast error adjustment of 1.5% and reduced by the productivity adjustment of 0.4% required under the Affordable Care Act. However, a 4.6% proposed parity adjustment to ensure budget neutrality results in an approximately $320 million decrease in Medicare Part A payments to SNFs in FY 2023.
• Requesting information on establishing mandatory minimum staffing requirements for LTC facilities. Specifically, feedback on evidence that establishes an appropriate minimum staffing requirement, associated costs, rural considerations including workforce recruiting challenges, and how the minimum staffing requirement should be measured.
• Adopting the Centers for Disease Control (CDC) Influenza Vaccination Coverage among Healthcare Personnel (HCP) measure for the SNF QRP in FY 2025 to report the percentage of HCP that receive the influenza vaccine each season.
• Revising the compliance date to October 1, 2023, for collecting data on Transfer of Health (TOH) Information to Provider-PAC measure, TOH Information to Patient-PAC measure, and certain standardized patient assessment data elements.
• Adopting new SNF VBP quality measures including the SNF Healthcare Associated Infections (HAI) Requiring Hospitalizations measure and the Total Nursing Hours per Resident Day staffing measure in FY 2026 and the Discharge to Community Post-Acute Care (DTC PAC) measure in FY 2027. Currently, hospital readmissions are the only quality measures for VBP.
• Implementing case minimums and measure minimums as eligibility requirements for inclusion in VBP programs and incentive-based payments.

NRHA plans to submit comments on the proposed rule. Please share any questions or concerns with NRHA staff before the June 10, 2022, deadline. CMS’s FY23 SNF PPS Fact Sheet can be found here. President Biden’s remarks on improving nursing home safety and quality can be found here. The proposed rule can be found here.

For further questions, please contact Alexa McKinley, NRHA Government Affairs and Policy Coordinator, at amckinley@ruralhealth.us or another member of the Government Affairs team.

Most children from 5 to 11 years old hospitalized with COVID-19 during the U.S. surge driven by the Omicron variant were unvaccinated, per a Centers for Disease Control and Prevention study published Tuesday. The study of children hospitalized in the U.S. from Dec. 19 to Feb. 28 found the hospitalization rate was 2.1 times higher for those unvaccinated than their vaccinated peers. Read more.

While many people are cheering the lifting of the masking requirement for public transportation, others are fearful that the lax rules now could lead to more cases of COVID-19 infections. Those who face higher risks say they are especially nervous. In interviews, older Americans, people with compromised immune systems, parents with young children, and low-income workers who rely on public transportation worried that they would now be at even greater risk with every bus ride or plane trip.

Pregnancy and those first weeks and months with your child are a beautiful, transformative time. Those times can also be physically and mentally difficult and occasionally overwhelming.

Nearly 60 percent of pregnancy-associated deaths happen between 42 days and one year after giving birth. In Pennsylvania, these pregnancy-related deaths are higher among Black women and women whose births were covered by Medicaid. The most common cause of death in the late postpartum period is heart failure or heart attack. Again, this disproportionately affects Black women and women with low incomes who receive their health coverage through Medicaid.

This is unacceptable. Black mothers deserve better.

Black mothers deserve comprehensive care for the physical and emotional trauma of birth that does not disappear at a six-week postpartum visit. Since taking office, Governor Wolf has prioritized expanding access to health care and supportive services that help parents through pregnancy and the postpartum period and gives children a strong, healthy start that can lead to continued good health, well-being and positive outcomes throughout their lives.

Medicaid Extension of Postpartum Coverage Period

Effective April 1, 2022, under the American Rescue Plan Act, Pennsylvania extended the Medicaid postpartum coverage period for mothers and birthing people who are eligible for the program because of their pregnancy to one year following the birth of a baby. Previously, Medicaid — or Medical Assistance in Pennsylvania — provides coverage for people eligible due to their pregnancy ended 60 days after giving birth. Extending postpartum coverage for those covered through Medicaid will provide continuity in health care by allowing birthing parents to maintain relationships with and access to care providers undisrupted through a critical period in their lives and their babies’ lives.

Press Release: Extension Increases Access to Critical Postpartum Care

Statistics & Facts

• About 3 in 10 births nationwide are paid for through Medicaid, but traditionally, coverage for people who qualify because they are pregnant ends 60 days following the birth of a baby unless their income or circumstances change.

Maternal Mortality

• In Pennsylvania, pregnancy-related deaths grew by more than 21 percent between 2013 and 2018.
• Nationally, about 12 percent of pregnancy-related deaths occur between six weeks and one year postpartum, but almost 60 percent of those are preventable.
• Black women are 3 to 5 times more likely than white women to die after giving birth.
• Statistics from 2020 show the pregnancy-related mortality rate of Black mothers was disproportionate to White and Hispanic mothers:
  • Black Mothers: 55.3 deaths per 100,000 births
  • White Mothers: 19.1 deaths per 100,000 births
  • Hispanic Mothers: 18.5 deaths per 100,000 births

Perinatal Mental Health

• Perinatal depression is the most common complication during pregnancy and the postpartum period.
• 1 in 7 women experience depression during or following a pregnancy, but too often it can go undiagnosed.
• A 2018 study published by the National Institute of Health (NIH) reported that just 1 in 5 women report symptoms of depression or anxiety during or after a pregnancy to a health care provider, but follow through for treatment may be even lower, especially for women of color.

Quality of Care

• People from some racial groups are more likely to be uninsured than non-Hispanic Whites.
• Research indicates that 22 percent of Black women receive a lower quality of care than white women and are subject to discrimination in the health care field.
• According to the American College of Obstetricians and Gynecologists (ACOG), in 2008 only 6.4 percent of obstetricians-gynecologists practiced in rural areas.

Additional Maternal Health Resources

• Health Resources & Services Administration (HRSA) Maternal & Child Health
• Black Mamas Matter Alliance
• March of Dimes
• Strong Start for Mothers and Newborns Initiative — Centers for Medicaid & Medicare Services
• World Health Organization (WHO) response
• Proclamation on Black Maternal Health Week, 2022 — The White House
• The U.S. Surgeon General’s Call To Action to Improve Maternal Health

An initial $200 million in funding from the 2021 coronavirus relief package is supporting the development of a forecasting center for infectious diseases at the Center for Disease Control and Prevention (CDC). The center has awarded $21 million to academic institutions to develop modeling and forecasting methods. Read more.

The Food and Drug Administration (FDA) announced last Thursday that A COVID-19 breathalyzer test with the ability to provide diagnostic results in three minutes has won FDA emergency use authorization. The test, made by Frisco, Texas-based InspectIR Systems, is authorized for those 18 and older and in settings where samples are both collected and analyzed, such as doctor’s offices, hospitals, or mobile testing sites. The device is about the size of a piece of carry-on luggage, the FDA said and works by detecting chemical compounds in breath samples associated with SARS-CoV-2 infection.

The 2022 Healthy Grants Workshop web series is for current HRSA award recipients and will offer multiple presentations on how to successfully manage your HRSA award. In addition to presentations by HRSA’s Office of Federal Assistance Management, this year’s workshop will feature presentations by the Grants Quality Service Management Office and the Office of the Inspector General. Other HRSA bureaus and offices will also be present, including the Office of Civil Rights, Diversity, and Inclusion and the Office of Information Technology.