The House and Senate  Appropriations Committees last night released the fiscal year 2023 Omnibus Appropriations legislation that would fund the government through Sept. 30, 2023. The bipartisan bill includes various provisions beneficial to hospitals and health systems.  
 
The legislation would:  

• Prevent the 4% Statutory Pay-As-You-Go (PAYGO) sequester for two years; 
• Extend for two years critical rural Medicare programs, telehealth flexibilities and the Acute Hospital Care at Home; 
• Reduce the physician fee schedule cut from 4.5% to 2% for 2023 and approximately 3% for 2024; 
• Provide 200 additional Medicare-funded graduate medical education positions, half of which would be dedicated to psychiatry and psychiatry subspecialty residencies; 
• Take several steps to improve access to behavioral health services; 
• Make improvements to the government’s ability to prepare for future emergencies. 

 
In a statement released today, AHA President and CEO Rick Pollack said, “The AHA is pleased that on a bipartisan basis Congress recognizes the immense pressure America’s hospitals, health systems and our caregivers are facing. This legislation will deliver critical support and resources so we can better care for our patients and create healthier communities. Due to skyrocketing cost increases for supplies, equipment, drugs and labor, challenging workforce shortages, and the ‘tripledemic’ of COVID-19, flu, and RSV, the hospital field is stretched thin and on the brink.  
 
“Specifically, we are pleased that this bill prevents significant four percent Medicare PAYGO cuts to providers, extends two key programs for two years that help rural hospitals keep their doors open, and extends for two years critical waivers for telehealth and hospital-at-home programs that have led to improvements in care and made medical treatment more convenient and accessible for patients. Additionally, we appreciate Congress giving partial relief to physicians by rolling back Medicare payment cuts and including important provisions to improve the nation’s preparedness for the next pandemic, train the next generation of caregivers, bolster behavioral health care providers and expand access to behavioral health services. Finally, helping states prepare for changes in Medicaid eligibility due to the end of the Public Health Emergency could help them transition those individuals to other forms of health coverage. 
 
“However, this is just a part of what needs to be done to support those on the front lines caring for patients. In the new year, we will continue to advocate for Congress and the Administration to take action to address patient discharge backlogs, support our current workforce and increase the pipeline into the future, hold commercial health insurers accountable for policies that compromise patient safety and add burden to care providers, and strengthen hospitals that care for a disproportionate number of patients covered by government programs or are uninsured, to name a few of our priorities.”  
 
The Senate is expected to begin debate on the measure today and to pass the spending bill first. The House is likely to vote by Friday. The president is expected to sign the bill into law before current funding for the government expires at 11:59 p.m. ET on Dec. 23.

The post Omnibus bill includes relief from Medicare cuts, extensions of rural and telehealth programs  appeared first on mTelehealth.

RSV and other respiratory illnesses in children are climbing well before the typical winter busy season.

Physicians are reporting unseasonably high numbers of respiratory illnesses in children, straining many children’s hospitals before the typically busier winter months.

Juan Salazar, physician in chief at Connecticut Children’s Medical Center in Hartford, Conn., said a sharp increase in cases of respiratory syncytial virus, or RSV, has filled up hospital beds at his facility, creating capacity issues. 

Officials at the 187-bed children’s hospital are now considering setting up a field hospital outside of the hospital’s main facilities in the event the surge of cases gets worse, he said. 

“We aren’t there yet, but we obviously have to be prepared,” Dr. Salazar said.  

RSV is an easily transmissible virus that infects the respiratory tract. The virus spreads through droplets from coughing and sneezing and on surfaces. Positive tests for RSV have been on the rise across the U.S., according to the Centers for Disease Control and Prevention. The rise in cases has come ahead of the typical winter peak for such illnesses, hospital officials said. 

For most people, RSV amounts to a cold, and nearly all children come in contact with the virus by the age of two, health authorities said. But it can be severe for some infants and older adults, especially for those that have pre-existing health conditions. 

Much like influenza, RSV cases were flattened during the first year of the Covid-19 pandemic. The respiratory virus that typically circulates in the fall and winter then rebounded in the summer of 2021.  

This summer, the virus continued to smolder at a lower level, instead of going away like it normally does, said Mark Kline, a pediatric infectious disease specialist at Children’s Hospital New Orleans. Then, it started heading upward again in recent weeks. Dr. Kline said the hospital was also seeing an early uptick in positive flu tests, as well as other common viruses. 

“We’re seeing the co-circulation of four or five viruses that are not unusual in the sense that they’re not rare,” he said, while noting that it is unusual to see them all circulating together at this time of year. 

“It’s just a viral petri dish out there right now,” he added. 

RSV is the most common cause of bronchiolitis, a lung infection, and pneumonia in children younger than 12 months in the U.S., according to the CDC. About 58,000 children younger than five years old are hospitalized due to RSV each year, leading to about 100 to 500 deaths annually, according to the CDC.

Most children and adults with RSV feel better after a week or two. But pediatricians may give high-risk children monoclonal antibody treatments to prevent them from getting sick or developing a severe infection.

There is no vaccine for RSV. Many companies, however, are racing to develop one. 

Children’s hospitals have reported that other respiratory viruses, such as the rhinovirus or enteroviruses, which cause common cold-like symptoms but can trigger more serious disease, have also fueled hospitalizations. 

In September, the CDC sent an alert to health providers about increases in pediatric hospitalizations, with severe respiratory illness in patients who tested positive for rhinovirus or enterovirus.  

Cases of respiratory illnesses like RSV fell during the beginning of the pandemic as people isolated and used masks, said Richard Malley, a senior physician in pediatrics at Boston Children’s Hospital. Children who would have typically become ill from a respiratory virus in 2020 or 2021 didn’t get the immunity protection that would come from an infection, he said.

Isolation and masking, which saved lives during the pandemic, also produced a sort of epidemiological experiment, Dr. Malley said. When society stopped isolating and fewer people wore masks, that allowed these viruses to start spreading again, likely leading to the current increases in cases, he said. 

The early surge in RSV cases has come amid a particularly severe season of enteroviruses, which has begun to trail off, said Larry Kociolek, the medical director of infection, prevention and control at Ann & Robert H. Lurie Children’s Hospital of Chicago. The increase in cases also occurred when many community hospitals have closed their pediatric beds, leaving pediatric hospitals strained to pick up the slack, he said. 

“All of those things are making it feel difficult and challenging for children’s hospitals across the country,” Dr. Kociolek said. 

Dr. Kociolek said the early onset of RSV cases means it may tail off before flu season gets in full swing, which could help hospitals with their capacity. But pediatricians are also preparing for the possibility that flu season will overlap with another rise in Covid-19 cases, which would offset the benefit of having an early RSV season, he said.

And flu season was light the past two winters, meaning most children under the age of two and half haven’t been exposed to it, Dr. Kociolek said.

“We are strongly encouraging parents, particularly with young children, to have their children immunized with influenza soon,” he said.

The post A Surge in Pediatric Respiratory Viruses Is Straining Hospitals appeared first on mTelehealth.