A look at what made news in healthcare in 2023.
By Pete Mercer
Last year was sort of a banner year for the 2020s – after all the challenges and obstacles we faced in 2020 and 2021, it felt like things were starting to turn around in 2022. Travel picked back up as COVID slowed down. Networking events came back in full force, allowing businesses to reconnect with their customers in a real and tangible way. 2022 also saw the combination of vaccinations and natural immunity begin to fight against the onslaught of COVID, giving humanity the edge that we desperately needed.
What about 2023? This year, we have continued to progress past the pandemic days and into periods of growth and disruption in the healthcare industry.
To fully understand the scope of the challenges and successes of 2023, let’s take a look at some of the biggest events Repertoire covered throughout the year.
The end of the public health emergency
Without a doubt, the biggest moment of the year was the end of the public health emergency order. In January, the Biden administration informed Congress that the COVID-19 national and public health emergencies would end on May 11. At the time, the Office of Management and Budget said that the “administration’s plan is to extend the emergency declarations to May 11, and then end both emergencies on that date. This wind-down would align with the administration’s previous commitments to give at least 60 days’ notice prior to termination of the PHE.”
In February, the Department of Health and Human services said, “We are in a better place in our response than we were three years ago, and we can transition away from the emergency phase.” Repertoire Magazine covered the end of the public health emergency in a two-part series for the May and June issues, where we dove into the details of what it would look like for your provider customers and their patients.
Many providers were concerned about how ending the public health emergency would affect Medicare coverage for millions of people. During the public health emergency, the federal government required state Medicaid agencies to provide coverage for people, even if their eligibility changed. The expiration of that “continuous enrollment provision” meant that 17.4% of Medicaid and Children’s Health Insurance Program (CHIP) enrollees would likely lose Medicaid coverage.
Some states were expected to be hit harder than others. Kaiser Health News found that enrollment in Medicaid and CHIP for the state of Nevada rose by 47% during the pandemic. Additionally, 25% of Illinois citizens were enrolled under the state’s rules. Rodney S. Alford, M.D., president-elect of the Illinois State Medical Society said, “The continuous coverage provision has provided much-needed stability to patients who rely on the program to get healthcare services and has helped ensure that physicians who accept Medicaid patients can trust that their enrollment status is current.”
One of the other significant ways that the end of the public health emergency affected the general public is through the COVID-19 vaccine. During the height of the pandemic, these were available to the general public free of charge through the federal government. As the public health emergency came to an end, the vaccine would be available through the traditional healthcare marketplace.
Tochi Iroku-Malize, M.D., the president of AAFP, said, “Transitioning COVID-19 vaccines to the commercial market may create financial and operational challenges for physician practices and could negatively impact access to and utilization of COVID vaccines for patients.”
Commercial healthcare providers emerge
Another interesting development from 2023 is seeing a new form of healthcare provider emerge: the commercial healthcare provider (CHPs). The CHP is a customer-facing primary care provider formed by major players like Optum, VillageMD, CVS Health, Amazon and Walmart that are meeting patients where they are with in-home, in-store and virtual care services as well as in primary care offices. Each organization has its own strategy for moving into the CHP space – some are acquiring physician practices and employing physicians to treat patients, others are looking to work on a contract basis to provide independent practices with support for IT, marketing and administration.
No matter which category they fall into, the emergence of the commercial healthcare provider is going to have a significant impact on medical care and medical sales. Bruce Penning, executive director, medical field sales for Henry Schein, told Repertoire back in May, “Sales representatives can no longer rely on one or two individuals in a practice to make buying decisions. They need to understand the alignment further ‘upstream.’ For example, is there a single person making decisions at the corporate level for all the satellite locations?”
Walgreens’ VillageMD acquired Summit Health-CityMD at the end of 2022, which was a significant step into creating one of the largest independent provider groups in the country. Walgreens has continued to make moves in this space as recently as August 2023, when Walgreens and VillageMD expanded their full-service primary care model to Chicago.
In January, Amazon Pharmacy introduced a prescription service for a flat, low monthly fee of $5. RxPass is designed to offer consumers the convenience of choice for all of their prescription needs, with medications that treat more than 80 common health conditions.
Walmart Health announced in March that it planned to add 28 new clinics by Q1 of 2024. These clinics will provide primary care, dental care, behavioral health care, labs and x-ray, audiology and telehealth services. In a press release, Dr. David Carmouche, SVP, Omnichannel Care Offerings at Walmart said, “We know the cost and convenience of healthcare remains a barrier for many Americans, which is why we decided to bring our one-stop model of healthcare to these communities. With 90% of the U.S. population located within 10 miles of a Walmart, Walmart Health is in a unique position to provide quality, affordable health and wellness services where our neighbors already live and shop.”
CVS Health made some major moves this year, starting with the acquisition of Signify Health, a tech and services company that works to close gaps in care and address social determinants of health. In April, CVS Health and Catholic Health worked together to expand value-based care and health care access for Medicare beneficiaries across the Catholic Health Physician Network in the New York area.
Optum introduced an interesting solution for healthcare in January with the Optum Mobile Clinic. These 45-foot-long, state-of-the-art RVs offer a wide range of health screenings and other services to augment the primary care experience.
Nursing shortage
Even with the end of the public health emergency and the worst days of COVID-19 (hopefully) behind us, we are still wrestling with some of the challenges that were exacerbated by the pandemic. The U.S. Department of Labor predicts that more than 275,000 nurses are needed from 2020 to 2030, with opportunities for employment expected to grow at 9%.
Early in 2023, Mark Keroack, M.D., president and CEO of Baystate Health wrote an op-ed for Mass Live where he discussed the staffing shortages that hospitals are dealing with. He predicts that staff shortages could cause the next public health crisis, saying, “The driving forces for this shortage existed before the onset of the COVID-19 pandemic, which has only accelerated those conditions. Baystate Health identified concerns with shortages in key staff categories as early as 2016 and forecasted a worsening as a larger portion of its workforce aged into retirement and patient demand increased due to an aging population in Western Massachusetts.”
This year, many organizations have tried to mitigate the nursing shortage through various programs and changes to the industry. An MGMA report went into great detail about the efforts of medical groups to overcome labor shortages and staffing hurdles. Dignity Health Global Education and CommonSpirit Health launched a program in April to retain nurses in 21 states throughout the country. Idaho State University and Kootenai Health partnered in July to address the critical nursing shortage in North Idaho. In August, Optum and Capella University announced a new nurse practitioner program designed to address the nursing shortage in the United States.
Push back against IPPS Proposed Rule
The Centers for Medicare and Medicaid Services issued the fiscal year 2024 Medicare hospital inpatient prospective payment system (IPPS) and long-term care hospital prospective payment system (LTCH PPS) proposed rule. The proposed rule would update Medicare fee-for-service payment rates and policies for inpatient hospitals and LTCHs. The proposed increase in operating payment rates is projected to be 2.8%. This would be for general acute care hospitals paid under the IPPS, that successfully participate in the Hospital Inpatient Quality Reporting (IQR) program and are meaningful electronic health record (EHR) users. This reflects a projected FY 2024 hospital market basket percentage increase of 3.0%, according to CMS, reduced by a 0.2 percentage point productivity adjustment.
Providers and other industry stakeholders publicly reacted to these changes, saying that the proposed inpatient hospital payment update of 2.8% was “woefully inadequate.”
The American Hospital Association said, “The AHA is deeply concerned with CMS’ woefully inadequate proposed inpatient hospital payment update of 2.8% given the near decades-high inflation and increased costs for labor, equipment, drugs and supplies. Moreover, long-term care hospitals would see a staggering negative 2.5% payment update under this proposal. These insufficient adjustments are simply unsustainable. 2022 was the most financially challenging year for hospitals during the pandemic, with half of hospitals finishing the year with a negative operating margin. So far, this worrying trend has continued in 2023, most recently with reports of record high hospital defaults. The AHA has repeatedly requested that CMS and the Administration remedy shortcomings in its previous market basket forecasts for all hospitals.”
Premier said, “The Centers for Medicare & Medicaid Services (CMS) continues to use data sources for calculating labor costs that fail to capture the stratospheric rise in the cost of labor that have plagued hospitals since the pandemic started. This chasm between the 2.8 percent payment update and reality, coupled with uncomfortably high inflation, delivers a one-two punch to hospitals that must be addressed. Premier will continue to press CMS to adopt new or supplemental data sources to calculate labor costs in the final rule that more accurately reflect the cost of labor, such as more real-time data directly from hospitals, inclusive of contract labor.”
After many organizations weighed in over several months, CMS released the final rule in August, finalizing the payment rate increase of 3.1% for items and services paid under the IPPS.
The first RSV vaccine is created, COVID numbers still low
In yet another landmark event for vaccines, Pfizer introduced a preventative vaccine for RSV in infants and the elderly. This is the first vaccine that is designed to address RSV, a highly infectious respiratory disease that can be dangerous for young children and older adults. ABYSVO was initially only approved for individuals 60 years of age and older, but in August the FDA approved it for preventing RSV in infants as well.
In June, Annaliesa Anderson, Ph.D., SVP and SSO, Vaccine Research and Development at Pfizer said in a media release, “A vaccine to help prevent RSV had been an elusive public health goal for more than half a century. Today’s approval is a monumental step forward in delivering on Pfizer’s commitment to help alleviate the significant burden of RSV in higher-risk populations, which includes older adults. ABRYSVO will address a need to help protect older adults against the potentially serious consequences of RSV disease. We are extremely grateful to the clinical trial participants, study investigator teams and our dedicated Pfizer colleagues for their roles in making this vaccine available.”
As for COVID, the WHO announced in May that it was no longer a global health emergency. WHO Director-General Tedros Adhanom said at the time, “For more than a year, the pandemic has been on a downward trend, with population immunity increasing from vaccination and infection, mortality decreasing and the pressure on health systems easing. This trend has allowed most countries to return to life as we knew it before COVID-19.”
Numbers are still low today, but many are grappling with the effects of long COVID. The American Heart Association found in August that COVID may trigger new-onset high blood pressure. Additionally, the Mayo Clinic found that getting a COVID vaccine may reduce the severity of long COVID symptoms.