/Gallup poll found that nearly four in 10 Americans in the last six months have delayed or skipped health care treatments, trim regular household expenses, or borrow money, because of rising health care costs. Extrapolated across the entire population, that means 98 million adults are having to figure out how to afford health care.

While half of adults in households earning less than $48,000 per year report cutting spending, the effects also extend to more influential households. For those earning at least $180,000, 19% said they have pared back spending to pay for health care.

 under 50 are disproportionately being compelled to cut back on health care with 36% reporting they have done so, compared to 22% of men. having done so, compared with 22% of men.

Overall, 26% of adults report delaying or avoiding medical care or purchasing prescription drugs in the prior six months due to higher health care prices. This rises to 43% among adults in lower-income households (those making less than $24,000 annually).

For those cutting costs, health care is usually on the chopping block with other expensed. The report found:

Of those who cut back on utilities, 59% also cut back on medical care and medicine.

Of those who skipped a meal, 71% also cut back on medical care and medicine.

Of those who borrowed money, 60% also cut back on medical care and medicine.

Of those who drove less, 55% also cut back on medical care and medicine.

The effect of inflation exacerbates an already significant issue for millions of Americans struggling to pay for health care and medicine. Prior findings from the 2021 West Health-Gallup Healthcare Study showed that an estimated 18% of adults, or about 46 million people, 

could not afford needed care if they required it today

unable to pay for prescribed drugs in the prior three months

Health care inflation, which stood at 4.5% in June, is lagging overall 

, which spiked to 9.1% in June, a new 40-year high primarily because of rising prices for gas, food and rent. According to the report, inflation has not yet fully hit health care prices due to prenegotiated contracts with insurers and providers for 2022, but inflation is likely to impact prices later in the year -- something that consumers may not fully appreciate given the mere 3% that cite health care as the service expected to rise in price the most in the next six months.

This article originally appeared on Medical Economics®. 

Articles

Patients are either skipping care completely, cutting costs elsewhere, or borrowing money to pay for health care.

Nearly 4 in 10 Americans say inflation affecting their health care

Hormonal changes are among a host of issues that can influence psychiatry and medical conditions in women, and being aware of the total picture can deeply impact these patient’s treatment, C. Neill Epperson, MD told attendees at the 2022 

TM World CME Conference being held in San Diego this week.1

Epperson, who is a professor and chair of the department of psychiatry at the University of Colorado in Aurora, Colorado, discussed the interaction between the endocrine system, early childhood influences, the brain, and the nervous system at the meeting.

Epperson noted that it is important for psychiatrists to consider the 

 when treating patients, particularly as it relates to women, since there are pronounced differences between genders in how hormones impact their mental health. The differences in how hormone treatments affect women begin in adolescence she said, with young girls twice as likely than male counterparts to be prescribed a steroid, often related to addressing unprotected sexual intercourse at sexual debut.

“Always think about what kind of steroid/contraception they are on, as they can profoundly affect the endocrine system,” Epperson explained. This is also true for women who are menopausal, as hormones have been shown to influence executive function, sexuality, cardiovascular disease, and mental health issues including major depressive disorder in women undergoing life transition. Postpartum, oxytocin has been shown to play a key role in milk letdown and uterine contraction, and it has a profound impact on maternal nurturing.

“I’m not saying it’s all about the hormones, but I am saying if you don’t think about it you’re missing a big piece of the puzzle,” Epperson said.

Shifting gears to another “piece of the puzzle,” Epperson addressed how early life experience can impact hormones, which in turn can have an influence on a patient’s mental health. She discussed the work ofIda Haahr-Pedersen, PhD, from Trinity Center for Global Health in Dublin, Ireland, and colleagues in a study that looked at 1839 US household survey participants and assessed self-reported rates of 

 The investigators found that women were twice as likely as their male counterparts to report ACE as well as social and emotional difficulties in childhood. 2

In perimenopausal women, Epperson said, the most common ACEs associated with 4+ status for women included emotional abuse, domestic violence, emotional neglect, and physical neglect, and 15% of women in this age range are in the 4+ ACE group. There is also wide variability of ACE impact on women depending upon where they live, so taking that into account when considering how to interact with patients, and female patients in particular, is important as well, she said.

Looking at the total picture of the patient, including medication they may be taking, in addition to performing a thorough initial assessment that assesses past trauma, is key to helping address any mental health issues that may present, Epperson concluded.

This article originally appeared on Psychiatric Times®. 

1. Epperson N. Practical psychoneuroendocrinology: how the brain, nervous system, and endocrine system interact. Presented at: 

2022 Annual Psychiatric TimesTM World CME Conference

2. Haahr-Pedersen I, Perera C, Hyland P, et al. 

Females have more complex patterns of childhood adversity: Implications for mental, social, and emotional outcomes in childhood

The endocrine system is an important puzzle piece when addressing psychiatric disorders.

Consider the endocrine system when addressing mental health

You can reach her a lcarr@mjhlifesciences.com.

Vivjoa approved for recurrent vulvovaginal candidiasis

Oteseconazole is a treatment option for those living with a previously unmet medical need.

Correct terms and education can help normalize the conversation for patients.

Neighborhood disadvantage and fertility rates

Residing in a socioeconomically disadvantaged neighborhood was linked to moderately decreased fecundability, according to a study published in JAMA Network Open.

Maternal mortality before and during COVID pandemic

Maternal deaths in the United States rose by a staggering 33% after the onset of the COVID-19 pandemic in March 2020, which is a significantly higher percentage than the 22% overall excess death estimate linked to the pandemic, according to a research letter published in JAMA Network Open.

Monkeypox vaccine gets emergency approval to increase vaccine supply

Smaller dose given by intradermal injection creates five-fold increase in total supply, FDA says.


In case you missed it: August 8 to August 12

Neonatal Antimicrobial Stewardship Programs (ASPs) can decrease antibiotic initiation at birth, according to a recent study published by the 

Early-onset sepsis is a condition which leads to greater chances of morbidity and mortality in preterm infants. ASPs are put into place for high-risk infants to mediate the adverse effects of antibiotic exposure with the need for empiric treatment.

In the study, preterm infants with a gestational age of less than 34 weeks were reviewed 6 months after ASP was implemented. The review consisted of comparisons for the presence of perinatal sepsis risk factors, along with the effectiveness of initial empiric antibiotics treatment.

There were 479 infants involved in the study, with an average gestational age of 30 weeks and a birth weight of 1400 g.

In the pre-ASP infants, there was a 73.6% presence of sepsis risk factors, while post-ASP infants had a 68.4% presence of sepsis risk factors. Initial antibiotics were not given to 42% of infants despite risk factors, while 20% did not have perinatal sepsis risk factors and were not treated.

Investigators encouraged neonatal ASP teams to think about the dangers of antibiotic use.

Stritzke A, Tierney A, Keister F, Srivastava A, Dersch-Mills D, Hamilton C. Antimicrobialstewardship at birth in preterm infants. 

. 2022;41(5)394-400. doi:10.1097/INF.0000000000003462


This article originally appeared on Contemporary Pediatrics®. 

ASP treatment lowered the presence of sepsis risk factors in preterm infants.

Antimicrobial Stewardship Programs decrease antibiotic initiation at birth

The psychological effect of birth weight leads to the most attention problems in children aged 9 to 10, according to a recent study.

In previous studies, children with lower birth weights were seen with more symptoms of attention-deficit/hyperactivity disorder (ADHD). This study set out to model the continuous dose–response association between birth weight and psychological outcomes.

Specificity was defined as one of the criteria for the study, to determine if the psychological effects caused by low birth weight are specific to attention problems. In many prior instances of association, other disorders were found in children, such as affective disorders, schizophrenia, substance-use disorders, and stress-related disorders. Because of this information, it is not certain that birth weight effects are specific to ADHD.

One study found that birth sex was associated with birth weight and issues of mental health that followed. Male children were more likely to have negative effects from lower birth weight than female children. Other studies contradicted this information, indicating that there was no difference in mental illnesses brought on by low birth weight between sexes. To address this contradiction, investigators tested for how sex might affect the outcome of the study.

Given the difference between gestational age and fetal growth, investigators wanted to determine which of these factors was associated with mental health issues because of low birth weight.

Data was analyzed from the Adolescent Brain Cognitive Development (ABCD) study, a study of children aged 9 to 10 years representing a wide range of demographic and socio-economic diversity within the United States. Just over 9000singleton-born participants wereselected to take part in the study.

Parents of the children in the study reported birth weight in pounds and ounces, which researchers converted into kilograms. If ounces were not included in the measurement, the number of pounds was rounded to the nearest number of kilograms. Children with an unlikely small weight or a gestational age lower than 28 weeks were excluded from the analysis.

Parents filled out a Child Behavior Checklist (CBCL) containing subscales on their children’s behavior patterns. These subscales included: anxious-depressed, withdrawn depressed, somatic complaints, social problems, thought problems, attention problems, rule breaking behavior, and aggressive behavior. The presence of autism spectrum disorder (ASD) was also noted in children. Finally, family history of mental illness and socioeconomic factors were asked about in the survey.

When examining birth weight, attention problems was the most common subscale noted. After controlling for gestational age alongside other variables, the only results observed were attention problems and somatic complaints. Of all the subscales, sex only had a major effect on attention problems, with male children having more attention problems than female children. ASD was also not associated with birth weight.

Investigators noted how the results of their study contrasted with prior studies. They recommended a variety of study designs on the subject.

Dooley, N., Clarke, M., Cotter, D. et al. Birth weight and childhood psychopathology in the ABCD cohort: association is strongest for attention problems and is moderated by sex. 

 50, 563–575 (2022). doi:10.1007/s10802-021-00859-0


This article originally appeared on Contemporary Pediatrics®.

Investigators found that symptoms of attention-deficit/hyperactivity disorder were more often seen in children with a lower birth weight.

Low birth weight associated with attention problems in children

n the hospital nursery, a 4-week-old boy has creamy white patches on his lips, right and left buccal mucosa, palate, and tongue. He had been admitted to the nursery intensive care unit (NICU) 2 days ago. His mother brought him to the pediatric emergency department because he refused to feed and felt warm. Seven days previously, his mother received a diagnosis of COVID-19 infection. He had a sepsis work-up and was started on intravenous (IV) antibiotics.

Diagnosis: COVID-19–associated pseudomembranous candidiasis

He was born at term via normal vaginal delivery with no complications. His mother received a diagnosis of gestational diabetes in the second trimester and was started on insulin.

On initial examination in the emergency department, he was noted to be moderately built and nourished, slightly irritable, and refusing to feed. His body temperature was 37.3 °C, heart rate was 134 beats per minute, oxygen saturation was 98%, and respiratory rate was 52. A chest x-ray showed no abnormal findings. A reverse transcriptase–polymerase chain reaction assay was positive for SARS-CoV-2.

He was admitted to the NICU after the sepsis work-up and treated with IV fluids and antibiotics. During hospitalization, he developed white creamy patches over the right and left buccal mucosa, palate, and tongue that on scraping left an erythematous, somewhat eroded mucosal surface. He also had red patches with superficial pustules in the diaper area. Microscopic examination revealed pseudohyphae and spores, and a fungal culture grew 

. He was treated with IV fluconazole once daily for 2 days and then transitioned to oral fluconazole for a week with complete clearing of the patches and a negative oral fungal culture on follow-up. Bacterial cultures were negative, and he was discharged home at the end of the week.

Candida is a type of yeast, part of the fungus family that normally lives in and on our bodies.

It can be found on the skin and in the mouth, for example, and in the intestinal tract and genital area. Candidiasis infection of the mouth, also referred to as oral thrush, is common in infants and toddlers. Up to 37% of newborns may develop thrush during the first months of life. Most of the time, 

 does not cause any problems. However, when it overgrows, it can cause infections ranging from simple asymptomatic oral candidiasis to life-threatening septicemia. Thrush also can affect fingernails, eyes, skin folds of the neck and armpits, as well as diaper area (

 diaper dermatitis), including genital and perianal skin.

Male sex and birth asphyxia are predominant risk factors. It also has been observed that neonates developing candidiasis had received antibiotics such as amoxicillin or amoxicillin-clavulanic acid for a significantly longer duration. Newborns can get a Candida infection from their mothers. This can occur before delivery, but also during passage through the birth canal during delivery. Infants at the highest risk of bloodstream infections with Candida include premature or very low birthweight infants, children with long-term IV catheters, and children with weakened immune systems caused by HIV, cancers, or medicines. Children on inhaled steroids also have an increased incidence of oral candidiasis. Maternal risk factors also include diabetes mellitus and immunosuppressive states such as HIV. Risk factors for systemic candidiasis also include prolonged administration of total parenteral alimentation and IV fluids, and being on a ventilator.

Lichen planus is reticulated and erythematous rather than plaque-like. Twenty percent of oral lichenoid lesions will have superimposed candidiasis.

Geographic tongue usually affects lateral/dorsal, rather than midline posterior, tongue.

Oral hairy leukoplakia is an HIV-associated disease. It often has an associated secondary Candida infection and is most common on the lateral borders of the tongue, often (but not always) in a bilateral and symmetric distribution.

Aphthous ulcers are much more painful and episodic than candidiasis.

Chronic cheek chewing is usually painless, with a gelatinous, shaggy consistency.

Hypersensitivity reaction to denture base material is rare.

Diphtheria membrane can be mistaken for candidiasis, although in diphtheria there may be hemorrhagic crusts around the mouth and nares.

Hairy tongue is hyperkeratosis of the filiform papillae, not a yeast infection.

White sponge nevus is a very uncommon genodermatosis; there may be a family history.

Leukoplakia presents as thick, white patches on the inside surfaces of the mouth. It can be a sign of precancerous changes in the mouth or mouth cancer.

Uremic stomatitis is a rare disease affecting the oral mucosa and causing painful plaques and crusts. It is associated with acute or chronic advanced kidney failure.

Oral thrush in infants often disappears within 2 weeks, and parents or caregivers may be advised to monitor the infection without using medication. The length and type of the therapy will depend on several factors, such as the severity of the infection and any other health problems. In case of chronic infection or severe immunodeficiency, topical application of clotrimazole (1%) 3 to 4 times a day with the maintenance of good oral hygiene is effective. However, resistant cases may require oral fluconazole or itraconazole. Fluconazole is available in convenient oral formulations for infants and children of 10 mg/cc and 40 mg/cc. In certain cases, nystatin also may be used.

When a mother receives a diagnosis of gestational diabetes, she should be educated about candidiasis risk to her and to the baby. Women who have nipple discharge or pain during breastfeeding should notify their health care provider so they can be evaluated for yeast infection, which can be transmitted to the mouth of a nursing infant. When breastfeeding, women should use breast pads that do not have a plastic barrier. Long-lasting thrush is sometimes related to pacifiers or bottles that have not been properly cleaned.

Good oral hygiene is vital. If any chronic health issues are detected, they should be managed properly. If a patient is on inhaled corticosteroids, the inhaler should be cleaned properly and a spacer should be used. To reduce the risk of diaper candidiasis, change diapers often, especially if the patient has loose stools. Use a barrier cream as needed.

A 4-week-old boy presents with creamy white patches on his lips, right and left buccal mucosa, palate, and tongue.

White oral lesions in neonate with COVID-19

President Joe Biden signed into law the Inflation Reduction Act (IRA) with health insurance subsidies, future negotiations for Medicare drug prices and caps on 

With reforms coming for health care, climate change and taxes, Biden called it one of the most significant laws in American history, by which “the American people won and the special interests lost.” He spoke during a White House signing ceremony broadcast over whitehouse.gov, flanked by Senate Majority Leader Chuck Schumer, D-New York, and Rep. James E. Clyburn, D-South Carolina, the House majority whip.

 generally have praised the legislation for its effects on health insurance and drug prices for Medicare. The president recounted several provisions that already have made news:

Medicare prescription drug costs will be capped at an estimated $4,000 a year in 2024 and $2,000 a year starting in 2025.

An estimated 13 million people will continue to save on health insurance costs via premium subsidies for insurance purchased through the Affordable Care Act Marketplace.

Medicare beneficiaries with diabetes will have insulin costs capped at $35 a month.

The American College of Physicians (ACP) was glad to see that the 

 was passed by the House and would be signed into law. The 

 includes many policies that ACP has long advocated for and will help millions of Americans better access necessary health care services and treatments, said an 

 published Aug. 15, the day before the president was scheduled to sign the bill.

“ACP strongly supports the provision that will extend the increased subsidies for health insurance plans purchased on the Affordable Care Act health insurance exchanges, as these increases have led to record numbers of Americans gaining access to health insurance,” college President Ryan D. Mire, MD, FACP, said in the statement.

“We also support the provisions that will help Medicare beneficiaries to better afford needed medications,” Mire said. “Allowing Medicare to negotiate with pharmaceutical manufacturers for lower drug prices and capping the cost of insulin for beneficiaries are both necessary steps that ACP has long supported as tactics to tackle the rising cost of prescription drugs. Finally, the changes to fund clean energy projects and reduce carbon pollution are essential steps in starting to mitigate climate change and ensure our planet continues to be healthy enough to support healthy humans.”

The IRA is “an important milestone in the fight to ensure access to quality, affordable healthcare,” said Avenel Joseph, PhD, MS, vice president for policy at the Robert Wood Johnson Foundation.

“This is an enormous accomplishment toward developing policies that will improve people’s lives,” Joseph said in a published statement. “Keeping healthcare affordable will make care more accessible at a time when people need relief. However, this is only a first step in the right direction. As a country, we must do more to create an equitable nation where everyone – no matter who they are, where they live, or how much they make – has an opportunity to live their healthiest life.”

Joseph called for legislative action to provide insurance coverage to almost 4 million uninsured adults, including at least 2.4 million people of color, 500,000 people with disabilities and almost 1 million older Americans. They are not eligible for insurance coverage through Medicaid because of the states they live in, according to the foundation.

Congress should renew the expanded Child Tax Credit, create national standards for family and medical leave, and create affordable and stable housing, Joseph said. He and RWJF President published a 

Leaders of the Commonwealth Fund also used the word “milestone” to describe the effects of making health care more accessible and affordable for people. The bill provides ACA insurance premium subsidies and lowers prescription drug prices and out-of-pocket costs for Medicare beneficiaries, said Lovisa Gustafsson, fund vice president for controlling health care costs, and Sara R. Collins, senior scholar and vice president of health care coverage and access, and tracking health system performance.

“This historic bill greatly reduces the cost of health care for millions of Americans who buy coverage on their own and for many Medicare beneficiaries,” they said in a summary published Aug. 15. “It will enable people to get and keep affordable coverage in the ACA marketplaces, where 

 is the most oft-cited reason people don’t enroll or drop coverage. The progress on prescription drugs is a milestone achievement toward making prescription drugs more affordable for Medicare patients and could pave the way for future reforms.

On Aug. 15, the White House published an IRA summary “

 with various facts and figures relating to health care and other parts of the bill.

The section “Defeating Special Interests,”stated:

$187 million: The amount the pharmaceutical industry spent on lobbying in 2022

1,600: number of pharmaceutical company lobbyists in 2021, which was three times the number of members of Congress

33 years: length of time congressional Democrats were trying to lower prescription drug costs by allowing Medicare to negotiate prices

19 years: length of time Medicare has been blocked from negotiating prescription drug costs

Physicians groups, analysts, have praised insurance premium subsidies, Medicare drug cost caps.

 President signs Inflation Reduction Act with health care provisions

A recent study investigated the links between breastfeeding and preterm birth history with the duration of hospitalization due to lower respiratory tract infections (LRTIs) in infants and toddlers.
LRTIs are among the leading causes of morbidity and mortality among infants and young children, accounting for about 12,197.8 new cases per 100,000 children aged less than 5 years worldwide.1 The study found that infants who were breastfed for more than 6 months had recovered after a mild infection and thus experienced a lower duration of hospitalization due to LRTIs than infants who were breastfed for less than six months.2

The study included 125 patients with a mean age of 9.44 months. Among the patients, nine had a history of premature birth, defined as any birth before the completion of 37 weeks of gestation. However, no significant differences were found in hospitalization duration due to LRTIs among infants with and without a history of preterm birth.

Daniel Ganjian, MD, a pediatrician at Providence Saint John’s Health Center in Santa Monica, California, said in regards to both the study and general breastfeeding pratices, “Stick to the motto: breast is best. As soon as you get pregnant or have a baby, team up with a great lactation consultant who can make the process as easy and enjoyable as possible. In addition, if you breastfeed, you will not have to worry about formula shortages.”

According to the American Academy of Pediatrics, infants should be exclusively breastfed for the first 6 months of birth and be continued breastfeeding for one year or longer.

Although breast milk has several bioactive factors that contribute to short- and long-term health outcomes, the study did not find breastfeeding to be responsible for reducing the frequency and improving symptoms of wheezing or incidence of atopy.

Preterm infants are at greater risk of developing respiratory infections due to immature lungs at birth and less strength to take nutrients from breastfeeding by mouth. In an attempt to resolve the issue, Ganjian suggested, “We can isolate the different ingredients in breast milk and see which ones help prevent such infections. We can then isolate this molecule from donors (or produce it synthetically) and give it to babies who cannot take breast milk because of contraindications to breastfeeding (eg, if mom is on strong medications).”

The authors concluded the study by encouraging exclusive breastfeeding for at least six months of age to improve the prognosis and reduce the duration of hospitalization in children with LRTIs.

This article originally appeared on Contemporary Pediatrics

Quantifying risks and interventions that have affected the burden of lower respiratory infections among children younger than 5 years: an analysis for the Global Burden of Disease Study 2017. 

. 2020;20(1):60-79. doi:10.1016/S1473-3099(19)30410-4

Demir A, Karadas NO, Karadas U. Effect of breastfeeding and preterm births on the severity of lower respiratory tract infections and associated risk of hospitalization in infants and toddlers. 

A recent study examined the links between breastfeeding and preterm birth history with hospitalization duration due to LRTIs in infants and toddlers.

Breastfeeding reduces the severity of LRTIs in infants

In 2020, health care spending accounted for 19.7% of the nation’s gross domestic product, up from 5% in 1960, according to a 

. A total of $4.1 trillion was spent on health care in 2020, or $12,530 per person. In 2030, health care spending is projected to account for 19.6% of GDP, a total of $6.8 trillion.

A large percentage (31.2%) of total health care 

 in 2020 was on health insurance premiums and out-of-pocket costs for employers and individuals. According to the report, employers paid $521.3 billion toward premiums, while workers paid $366 billion. Another $388.6 billion was spent on out-of-pocket costs.

The remaining 68.8% of health care spending breaks down as follows: 

 20.1%, Medicaid 16.3%, other health insurance programs 3.8%, other third-party payers and programs 17.8%, investment 4.7%, government contributions and subsidies 6.4%.

EBRI says that larger employers are much more likely than smaller employers to offer health benefits to workers. Nearly all private-sector employers with 1,000 or more employees offered health benefits in 2021. Similarly, 97.5% of those with 100–999 employees did so as well. Those with lower headcounts were less likely to offer health benefits: 77.9% of employers with 25–99 employees, 52.4% of employers with 10–24 employees, and 24.6% of employers with fewer than 10 employees offered health benefits.

According to the report, the share of adults and children with employment-sponsored health insurance fell since 2019. Overall, 70.8% of workers had employment-based health benefits in 2020 either through their own job or through a family member’s job. Only 36.6% of non-working adults had employment-based health benefits. Over one-half (53.9%) of children were covered by employment-based health benefits.

Premiums for health insurance have continued to trend upward since at least 1996. In 2021, average annual premiums for employee-only coverage were $7,380. They were $21,381 for family coverage. Despite rising premiums, for the last decade, the percentage of total health insurance premiums paid by workers has been relatively flat. On average, workers paid 22.3% of the premium for employee-only coverage and 28.9% of the premium for family coverage in 2021, according to EBRI data.

The report reveals that almost everyone is paying for health coverage. In 2021, only 7.3% of workers were not required to contribute to employee-only coverage, and only 12.6% were not required to contribute to family coverage. In contrast, in 1996, 37.1% of workers were not required to contribute to employee-only coverage, and 19.3% were not required to contribute to family coverage.

The types of plans vary, but Preferred provider organizations are the most common type of health plan, covering 46% of workers in 2021. High-deductible health plans covered 28% of workers, health maintenance organizations covered 16%, and point-of-service plans covered 9%.

Another trend the report studied was how the percentage of private-sector employees enrolled in a health insurance plan with a deductible has been steadily rising over time. While only 47.6% of employees had a deductible in 2002, 88.5% did in 2021. Among individuals with a deductible, the average deductible increased from $446 to $2,004 from 2002 to 2021 among those with employee-only coverage. And it increased from $958 to $3,868 among those with family coverage. The average copayment for an office visit has remained constant at $27 from 2016–2021. Coinsurance rates for office visits increased modestly, from 20% in 2019 to 20.8% in 2021.

Almost a third of spending is on insurance premiums and out-of-pocket payments.

Health care spending continues decades long rise

Primary care physicians support legislation that could improve patient care while cutting 

 obtaining prior authorizations for medical services in Medicare Advantage plans.

Meanwhile, lawmakers hope for a fall vote on at least one version of the identical bills in the U.S. Senate and House of Representatives.

The “Improving Seniors’ Timely Access to Care Act of 2022” has amassed more than 500 endorsements from organizations across the health care industry and bipartisan support from dozens of legislators in the House and Senate.

Sen. Roger “Doc” Marshall, MD, R-Kansas, introduced the 

“Improving Seniors’ Timely Access to Care Act,”

 S. 3018, with the goal of improving health care for seniors while reducing the workloads for physicians and their staff, Will Bensur, Marshall’s press secretary, told 

With cosponsorships from 37 senators and more than 300 representatives, lawmakers took a key step move at the end of July, when the 

 advanced it by voice vote. That sets up a possible floor vote in the fall, House sponsor Rep. Suzan DelBene, D-Washington, said in a 

“It is 2022 and even Congress has moved beyond the fax machine,” DelBene said in a news release. “The health care system is complicated in the best of times. Doctors and their patients shouldn’t have to call or fax back and forth with insurance companies or send documents multiple times for procedures that are approved over 95 percent of the time.”

As an obstetrician/gynecologist, Marshall experienced firsthand medical paperwork burdens that contribute to workplace burnout, while potentially hurting patient outcomes. Physicians practice medicine to put 

 and Marshall and the other lawmakers recognize that, Bensur said.

“We want to make it easier for physicians to spend more time with their patients,” Bensur said. “In the context of burnout, I think that's getting people back to what they're passionate about, why they're doing this. This certainly can help with that.”

The bill would establish a prior authorization process to streamline approvals and denials, with national standards for clinical documents to reduce administrative burdens for physicians and Medicare Advantage plans, according to Marshall’s office.

Marshall and the other lawmakers acknowledge prior authorizations are an important cost management tool – with potentially serious consequences for patients and physicians.

Prior authorizations may delay or deny care for seniors who need it, according to 2018 and 2022 reports by the U.S. Department of Health and Human Services’ Inspector General. The 2022 review found 13% of prior authorization requests were denied, even though they met Medicare coverage rules, and 18% of payment requests that were denied, met the rules, but had errors from workers or in system processing. The audit’s title stated the problem: “Some Medicare Advantage Organization Denials of Prior Authorization Requests Raise Concerns About Beneficiary Access to Medically Necessary Care.”

 for its effects on patient outcomes, along with being a serious drag on office productivity and morale.

In that survey, physicians reported an average of 41 PAs per physician, per week, taking up to 13 hours of work time a week. The PA burden is high or extremely high, according to 88% of respondents.

AMA and the American Academy of Family Physicians (AAFP) are among the 

“The federal government needs to automate and streamline prior authorization, as well as reduce the overall volume of prior authorizations to improve patient care and minimize physician burden,” AAFP said in a July news release announcing its letter urging lawmakers to streamline the PA process.

“We know firsthand from family physicians that prior authorization creates an administrative burden for physicians and other clinicians,” AAFP said. “The manual, time-consuming processes used in prior authorization programs burden family physicians and their practice staff, divert valuable resources from direct patient care and can delay the start or continuation of necessary treatment, leading to lower rates of patient adherence to treatment and negative clinical outcomes.”

Bill has strong support from medical groups and lawmakers, but House and Senate votes are not scheduled yet.