The end of the federal COVID emergency will usher in changes to the healthcare system

The Biden administration’s decision to end the COVID-19 public health emergency in May will institute sweeping changes to the health care system that go far beyond many people facing pay more for COVID-19 testing.

In response to the pandemic, the federal government in 2020 suspended many of its rules on the provision of care. It has transformed virtually every corner of American health care – from hospitals and nursing homes to public health and treating people recovering from addiction.

Now, as the government prepares to roll back some of those steps, here’s a look at the ways patients will be affected.

The rules for training nursing home staff are tightening

The end of the emergency means care homes will have to meet higher standards when it comes to worker training.

Advocates for nursing home residents are eager to see the old, stricter training requirements reinstated, but the industry says the move could worsen staffing shortages plaguing facilities nationwide.

At the start of the pandemic, to help nursing homes operate under the onslaught of the virus, the federal government relaxed training requirements. The Centers for Medicare & Medicaid Services has instituted a nationwide policy that nursing homes do not need to follow regulations requiring health care aides to complete at least 75 hours of state-approved training. Normally, a nursing home could not employ carers for more than four months unless they met these requirements.

In 2022, the centers decided that the relaxed training rules would no longer apply nationwide, but states and facilities could seek permission to be held to the lower standards. As of March, 17 states had such exemptions, according to the centers – Georgia, Indiana, Louisiana, Maryland, Massachusetts, Minnesota, Mississippi, New Jersey, New York, Oklahoma, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Vermont and Washington – as well as 356 individual retirement homes in Arizona, California, Delaware, Florida, Illinois, Iowa, Kansas, Kentucky, Michigan, Nebraska, New Hampshire, North Carolina, Ohio, Oregon, Virginia, Wisconsin and Washington, DC

Nursing aides often provide the most direct and laborious care to residents, including bathing and other duties related to hygiene, feeding, monitoring vital signs, and keeping rooms clean. . Research has shown that nursing homes with staff instability maintain a lower quality of care.

Advocates for nursing home residents welcome the end of training exceptions, but fear the quality of care will deteriorate nonetheless. This is because the Centers for Medicare & Medicaid Services have reported that, after the looser standards expire, some of the hours care aides logged during the pandemic could count towards their 75 hours of required training. On-the-job experience, however, is not necessarily a good substitute for training workers miss, advocates say.

Proper training of assistants is crucial so that “they know what they are doing before providing care, for their own good as well as that of the residents,” said Toby Edelman, senior policy advocate for the Center for Medicare. Advocacy.

The American Health Care Association, the largest nursing home lobbying group, released a December poll finding that about 4 in 5 establishments were facing moderate to high levels of staff shortages.

Treatment under threat for people recovering from addiction

An impending rollback to wider access to buprenorphine, an important drug for people recovering from opioid addiction, has patients and doctors worried.

During the public health emergency, the Drug Enforcement Administration said providers could prescribe certain controlled substances virtually or over the phone without first performing an in-person medical evaluation. One such drug, buprenorphine, is an opioid that can prevent debilitating withdrawal symptoms in people trying to recover from addiction to other opioids. Research has shown using it more than half the risk of overdose.

Amid a nationwide epidemic of opioid addiction, if the expanded buprenorphine policy ends, “thousands of people will die,” said Ryan Hamptona recovering activist.

The Drug Enforcement Administration at the end of February proposed settlement this would partly reduce the prescription of substances controlled by telemedicine. A clinician could use telemedicine to order an initial 30-day supply of drugs such as buprenorphine, Ambien, Valium and Xanax, but patients would need an in-person assessment to get a refill.

For another group of drugs, including Adderall, Ritalin, and Oxycodone, the Drug Enforcement Administration’s proposal would institute stricter controls. Patients looking for these medications should see a doctor in person for an initial prescription.

David Herzberg, a drug historian at the University at Buffalo, said the Drug Enforcement Administration’s approach reflects a fundamental challenge in developing drug policy: meeting the needs of people who depend on drugs. a drug that can be abused without making that drug too readily available to others. .

The Drug Enforcement Administration, he added, is “clearly seriously grappling with this problem.”

Hospitals are back to normal, somewhat

During the pandemic, the Centers for Medicare & Medicaid Services tried to limit the problems that could arise if there were not enough health care workers to treat patients – especially before there were COVID vaccines – 19 when workers were at greater risk of becoming ill.

For example, the centers have allowed hospitals to make greater use of nurse practitioners and physician assistants when caring for Medicare patients. And new doctors who were not yet accredited to work in a particular hospital – for example, because the governing bodies lacked the time to carry out their examinations – could nevertheless practice there.

Other changes during the public health emergency were aimed at bolstering hospital capacity. Critical access hospitals, small hospitals in rural areas, did not have to comply with federal Medicare rules stipulating that they were limited to 25 inpatient beds and that patient stays could not exceed 96 hours in mean.

Once the emergency is over, these exceptions will disappear.

The hospitals are try to persuade federal officials to maintain several COVID-19 era policies beyond the emergency or work with Congress to change the law.

Surveillance for outbreaks of infectious diseases

The way state and local public health departments monitor the spread of the disease will change after the emergency ends, as the Department of Health and Human Services will not be able to require labs to report data from COVID-19 testing.

Without a uniform federal requirement, how states and counties track the spread of the coronavirus will vary. Also, while hospitals are still providing COVID-19 data to the federal government, they may do so less frequently.

Public health departments are still figuring out the scope of the changes, said Janet Hamilton, executive director of the Council of State and Territorial Epidemiologists.

In some ways, the end of the emergency offers public health officials an opportunity to rethink COVID-19 surveillance. Compared to the early days of the pandemic, when home testing was unavailable and people relied heavily on labs to determine if they were infected, lab test data now reveals less about how the virus is spreading.

Public health officials no longer believe that “getting all the results of all the lab tests is potentially the right strategy,” Hamilton said. Influenza surveillance provides a potential alternative model: for influenza, public health departments seek test results from a sample of laboratories.

“We are still trying to figure out what is the best consistent strategy. And I don’t think we have that yet,” Hamilton said.