The Biden administration’s decision to end the COVID-19 public health emergency in May will institute sweeping changes across the health care system that go far beyond many people having to pay more for COVID tests.
The pandemic prompted the federal government to temporarily waive numerous regulations regarding healthcare delivery in 2020. This led to a complete overhaul of the American healthcare landscape, impacting various sectors such as hospitals, nursing homes, public health, and addiction recovery treatment.
As the government gears up to undo certain measures, let’s take a look at the potential impact on patients:
Training Rules for Nursing Home Staff Get Stricter
Nursing homes will be required to adhere to elevated training standards as the emergency situation comes to a close.
Advocates for nursing home residents are enthusiastic about the reinstatement of stricter training requirements, but the industry argues that this action may exacerbate the existing staffing shortages afflicting facilities across the country.
During the initial stages of the pandemic, the federal government eased training regulations to aid nursing homes in coping with the impact of the virus. The Centers for Medicare & Medicaid Services implemented a nationwide policy stating that nursing homes were not obligated to adhere to the regulations mandating at least 75 hours of state-approved training for nurse aides. Under normal circumstances, nursing homes would be unable to hire aides for more than four months unless they fulfilled these requirements.
CMS made the decision last year to eliminate nationwide relaxed training rules. However, states and facilities were given the option to request permission to adhere to lower standards. According to CMS, as of March, 17 states had received exemptions: Georgia, Indiana, Louisiana, Maryland, Massachusetts, Minnesota, Mississippi, New Jersey, New York, Oklahoma, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Vermont, and Washington. Additionally, 356 individual nursing homes in Arizona, California, Delaware, Florida, Illinois, Iowa, Kansas, Kentucky, Michigan, Nebraska, New Hampshire, North Carolina, Ohio, Oregon, Virginia, Wisconsin, and Washington, D.C., also received exemptions.
Nurse aides often provide the most direct and labor-intensive care for residents, including bathing and other hygiene-related tasks, feeding, monitoring vital signs, and keeping rooms clean. Research has shown that nursing homes with staffing instability maintain a lower quality of care.
Advocates for nursing home residents are pleased the training exceptions will end but fear that the quality of care could nevertheless deteriorate. That’s because CMS has signaled that, after the looser standards expire, some of the hours that nurse aides logged during the pandemic could count toward their 75 hours of required training. On-the-job experience, however, is not necessarily a sound substitute for the training workers missed, advocates argue.
Toby Edelman, a senior policy attorney for the Center for Medicare Advocacy, emphasized the importance of providing adequate training to aides. She stressed that it is essential for aides to be well-equipped with knowledge and skills before delivering care, not only for the benefit of the residents but also for their own well-being.
The American Health Care Association, the largest nursing home lobbying group, released a December survey finding that roughly 4 in 5 facilities were dealing with moderate to high levels of staff shortages.
Treatment Threatened for People Recovering From Addiction
Patients and doctors are expressing concern over the imminent reduction in accessibility to buprenorphine, a crucial medication for individuals recovering from opioid addiction.
During the public health emergency, the Drug Enforcement Administration said providers could prescribe certain controlled substances virtually or over the phone without first conducting an in-person medical evaluation. One of those drugs, buprenorphine, is an opioid that can prevent debilitating withdrawal symptoms for people trying to recover from addiction to other opioids. Research has shown using it more than halves the risk of overdose.
Amid a national epidemic of opioid addiction, if the expanded policy for buprenorphine ends, “thousands of people are going to die,” said Ryan Hampton, an activist who is in recovery.
The DEA in late February proposed regulations that would partly roll back the prescribing of controlled substances through telemedicine. A clinician could use telemedicine to order an initial 30-day supply of medications such as buprenorphine, Ambien, Valium, and Xanax, but patients would need an in-person evaluation to get a refill.
For another group of drugs, including Adderall, Ritalin, and oxycodone, the DEA proposal would institute tighter controls. Patients seeking those medications would need to see a doctor in person for an initial prescription.
According to David Herzberg, a drugs historian at the University at Buffalo, the DEA’s strategy presents a crucial dilemma in formulating drug policies: striking a balance between catering to the needs of individuals dependent on a potentially addictive substance and preventing widespread availability that could lead to abuse.
He added that the DEA is evidently dealing with this problem in a serious manner.
Hospitals Return to Normal, Somewhat
In an effort to mitigate potential issues resulting from an insufficient number of healthcare professionals available to treat patients, CMS has made concerted efforts during the pandemic. This became particularly crucial prior to the availability of COVID vaccines, when healthcare workers faced heightened vulnerability to illness.
As an illustration, CMS granted hospitals the flexibility to expand the involvement of nurse practitioners and physician assistants in providing care to Medicare patients. Additionally, new physicians who had not yet obtained credentials to work at a specific hospital, possibly due to time constraints for governing bodies to conduct their evaluations, were still able to practice there.
In an effort to strengthen hospital capacity, additional measures were implemented during the public health emergency. Critical access hospitals, which are small healthcare facilities situated in rural regions, were exempted from adhering to the federal regulations governing Medicare. These regulations previously restricted such hospitals to a maximum of 25 inpatient beds and imposed an average limit of 96 hours for patients’ stays.
After the emergency concludes, the exceptions will no longer be present.
Hospitals are trying to persuade federal officials to maintain multiple COVID-era policies beyond the emergency or work with Congress to change the law.
Surveillance of Infectious Diseases Splinters
After the emergency subsides, there will be a change in the method utilized by state and local public health departments to track the transmission of diseases. This alteration is due to the inability of the Department of Health and Human Services to mandate laboratories to provide COVID testing data.
The tracking of coronavirus spread across states and counties will differ due to the absence of a standardized federal mandate. Furthermore, hospitals might reduce the frequency of providing COVID data to the federal government.
According to Janet Hamilton, the executive director of the Council of State and Territorial Epidemiologists, public health departments are still trying to fully understand the extent of the changes.
The conclusion of the emergency presents public health officials with a chance to reconsider COVID surveillance. In contrast to the initial stages of the pandemic, when individuals lacked access to at-home tests and heavily depended on labs for infection detection, the data obtained from lab testing now offers limited insights into the virus’s transmission patterns.
According to Hamilton, public health officials have reconsidered the idea that obtaining all test results from every laboratory test is the most effective strategy. Instead, they are considering flu surveillance as a potential alternative model. In the case of influenza, public health departments collect test results from a selected number of laboratories as a representative sample.
Hamilton said, “We are currently in the process of determining the most effective and reliable strategy. At this point, I don’t believe we have reached a definitive answer.”
