Happy St. Patrick’s Day.

From Washington, DC,

• The House of Representatives and the Senate are in session on Capitol Hill this week for floor voting and Committee business.

• No later than this Friday March 22, Congress must enact the second package of six FY 2024 appropriations measures to avoid a partial government shutdown. Roll Call tells us
  • “The Biden administration is objecting to congressional leaders’ earlier plans to fund Homeland Security appropriations with a stopgap measure through Sept. 30, throwing a wrench into efforts to release the final fiscal 2024 appropriations package Sunday, sources familiar with the delay said. 
  • “The White House’s late ask for an extra $1.56 billion in border-related resources and reluctance to otherwise back the full-year continuing resolution under discussion for DHS was behind the latest hangup, these people said.
  • “However, White House and congressional staff were meeting Sunday to discuss options, and sources said offers are being exchanged as lawmakers continued to work toward a solution.”  

• MedPage Today reports,
  • “Hospital inpatient and outpatient services should get 1.5% more in 2025 Medicare payments, skilled nursing homes should receive 3% less, base payment rates for home health agencies should drop by 7%, and physicians should receive what current law allows plus 50% of the projected increase in the Medicare Economic Index, the Medicare Payment Advisory Commission (MedPAC) said in its annual March report to Congress.
  • “In two of the report’s 15 chapters, which took up 20% of the 561-page report, the commission addressed major problems with private Medicare Advantage (MA) plan quality and payments, which have been frequent topics of regular meetings. Commissioners reiterated that “a major overhaul of MA policies is urgently needed” to address lack of quality and overpayments compared with fee-for-service (FFS) plans.
  • “Other issues include the need for Medicare to change policies that disadvantage FFS beneficiaries who don’t want to use MA provider networks or undergo prior authorization. The commission advised Congress to push harder for information that is lacking about the value of MA plans’ “extra benefits.”
  • “The lack of information about the use and value of many MA supplemental benefits prevents meaningful oversight of the program such that we cannot ensure that enrollees are getting value from those benefits,” the report noted.”

From the public health and medical research front,

• The Washington Post reports,
  • “Healthy lifestyles are associated with better cognitive function in older adults — even those whose brains show signs of dementia, according to research published in JAMA Neurology last month. The study suggests a healthy lifestyle could buffer older adults against cognitive decline and boost their “cognitive reserve.”
  • “Researchers used data from the Rush Memory and Aging Project, a long-term study that looked at patients’ lifestyles and health and analyzed autopsy data from 1997 to 2022. * * *
  • “Among all the patients, higher healthy lifestyle scores in five domains — diet, late-life cognitive activity, physical activity, smoking cessation and low alcohol intake — were associated with better cognitive function before their deaths. The association held even when the autopsies showed signs of brain changes consistent with dementia.”

• Medscape offers five keys to helping long term COVID patients recover and points on Opill, the new OTC female contraceptive pill, for doctors to share with their patients.

• NPR Shots shares weight training tips for women and four steps to successfully process anger for all of us.

From the U.S. healthcare business front,

• The Washington Post reports,
  • “People over 65 use more health care than other age groups and make up nearly half of hospital admissions. But there are just 7,300 board-certified geriatricians in the United States, which is fewer than 1 percent of all physicians, according to the American Geriatrics Society. By contrast, more than 60,000 pediatricians were practicing in 2021, according to the Association of American Medical Colleges (AAMC).
  • “Yet research suggests that geriatricians more effectively and efficiently manage older patients than doctors without such training — leading to lower inpatient death rates, shorter hospital stays and reduced patient costs. Right now, the United States has roughly 1 geriatrician for every 10,000 older patients. Only 41.5 percent of geriatric medicine fellowship positions were filled in late 2023, down from 43 percent in 2022. Meanwhile, the number of people over 65 is expected to grow by nearly 40 percent within the decade.
  • “The vast majority of older people are getting care from people who have little to no training in the care of older adults,” said Louise Aronson, a professor of geriatric medicine at the University of California at San Francisco and the author of “Elderhood: Redefining Aging, Transforming Medicine, Reimagining Life.” * * *
  • “Experts highlight creative ways to boost financial incentives and exposure. “[Rosanne M.] Leipzig[, a professor and vice chair emerita in the Brookdale Department of Geriatrics and Palliative Medicine at the Icahn School of Medicine at Mount Sinai in New York” pointed out that since Medicare funds part of residencies and fellowships, regardless of the specialty, “why doesn’t Medicare require that these trainees demonstrate basic competency in the geriatric field?” Making program funding contingent on this would ensure some knowledge of geriatric issues for residents across specialties. Aronson suggested student loan forgiveness programs for doctors who specialize in geriatrics, similar to medical school loan forgiveness offered to doctors at qualifying nonprofit or government hospitals.
  • “Leipzig pointed to a new pilot program in the works to encourage more geriatric expertise by creating a midcareer pathway for general internists, similar to executive MBA programs. Some experienced internists will be able to pursue intensive short-term geriatric training without sacrificing their salaries or established practices.”

• MedPage Today informs us,
  • “A much-awaited treatment for postpartum depression, zuranolone (Zurzuvae), hit the market in December, promising an accessible and fast-acting medication for a debilitating illness. But most private health insurers have yet to publish criteria for when they will cover it, according to a new analysisopens in a new tab or window of insurance policies.
  • “The lack of guidance could limit use of the drug, which is both novel — it targets hormone function to relieve symptoms instead of the brain’s serotonin system, as typical antidepressants do — and expensive, at $15,900 for the 14-day pill regimen.
  • “So far [and the article was published today], only one of the country’s six largest private insurers, Centene, has set a policy for zuranolone.”

• Last Tuesday, the Wall Street Journal reported,
  • After the [Change Healthcare] hack, Availity set up a pared-down claims-processing service on Feb. 23 that medical providers can use for six months at no cost. The company has set up around 300,000 medical providers so far and has a backlog of at least 50 health systems waiting to start using the platform, Thomas said.
  • Availity’s CEO said he didn’t want to charge desperate healthcare companies in the middle of a crisis, and negotiating contracts would have meant a lot of work for the company’s employees. After the six-month contract-for-free service ends, Thomas said customers can decide if they want to keep using Availity’s platform or want to return to Change. “This event is going to sort of forever change the dynamics in this space,” he said.