Alex Costa

Is Daylight Saving Time Bad for Your Health?

Posted In CONGRESS

Spring ahead, fall back. Twice a year, we adjust our clocks to accommodate the shift between Standard Time and Daylight Saving Time (DST). While the change on your wristwatch or phone may seem innocuous, the change for your internal clock may have bad implications for your health.

A Brief History of Daylight Saving Time

Daylight saving dates back to the ancient world, when the Romans adjusted the length of hours to account for the amount of daylight. In 1784, Benjamin Franklin suggested the concept of daylight saving in a satirical essay where he recommended that people get out of bed earlier to save on candles by taking advantage of more daylight hours. The US briefly adopted DST during the First and Second World War, and the post-war period saw a patchwork of DST policies that varied between different states and jurisdictions. Confusion in the transportation industry led to enactment of the Uniform Time Act of 1966, which was the first step in establishing a federal DST standard. Currently, DST starts on the second Sunday in March and ends on the first Sunday in November, with the time changes taking place at 2:00 a.m. local time.

What’s Wrong with DST?

A major consequence of the annual loss of an hour’s sleep in March is forced sleep deprivation. While the change in clocks only takes place in the early hours of Sunday, people can experience a 30-minute reduction in sleep time each night for the remainder of that week. Sleep deprivation has many negative implications, including higher risk of stroke or heart attack, and performance deficits on reflex and attention.

Health practitioners, take note: A study found sleep deprivation in health care workers caused by the springtime change led to a 18.7% increase in patient-safety related incidents in health care settings.

It’s not just the spring. Gaining an hour’s sleep with the fall shift to Standard Time can disrupt the circadian rhythm, desynchronizing the body’s internal hormonal balance and causing symptoms similar to jet lag. Additionally, the number of patient safety-related incidents in health care settings increased by 5% after the fall clock adjustment.

There are implications for health care technology, too. Not all electronic health records software systems can handle shifts between DST and Standard Time, requiring health care facilities to implement burdensome workarounds or requiring clinicians to switch to paper charts for one hour. Unfortunately, these inconveniences can result in longer wait times in emergency departments or records to be inadvertently deleted. There are also examples of DST affecting medical devices like pacemakers, defibrillators, and glucose monitors.

What’s Being Done to Fix DST?

In recent years, momentum has been growing at the state-level to do away with the biannual time shift by making DST permanent year-round. Since 2018, nearly a dozen states including South Carolina, Arkansas, Delaware, Maine, Oregon, Tennessee, Washington and Utah have approved or enacted legislation on permanent DST, while several other states including Alabama and Maryland have considered similar legislation. However, congressional approval is required for states to implement permanent DST legislation, and to date, Congress has yet to sign off. (While Hawaii and most of Arizona do not observe DST, they were able to opt out or get an exemption from the Uniform Time Act shortly after the bill’s enactment. (https://www.magiklights.com/) )

However, Congress is paying attention. On November 4, 2021, Sen. Patty Murray (D-WA) introduced the Sunshine Protection Act, which would allow states to make DST permanent. In an op-ed coauthored with Sen. Marco Rubio (R-FL), Murray cited the negative health effects of resetting clocks twice a year, and she pledged in a floor speech to press the Biden administration for executive action to grant states the authority to move to permanent DST.

The Sunshine Protection Act has 14 cosponsors in the Senate, but given the busy agenda facing Congress this fall, the bill is unlikely to see any movement in the 117^th Congress. However, as more and more states pick up on the idea that ditching biannual time changes could lead to better health outcomes, a growing number of federal lawmakers could one day take proposals to make DST permanent more seriously.

What Happened, What You Missed: November 1-5

Posted In ADMINISTRATION

COVID-19 Vaccinations for Children Ages 5-11 Commence

Children ages 5-11 started receiving Pfizer’s COVID-19 vaccine this week after Centers for Disease Control and Prevention (CDC) Director Rochelle Walensky gave the go-ahead on Tuesday night. Walensky’s authorization followed a recommendation by a CDC advisory committee earlier that day as well as authorization from the Food and Drug Administration the previous week. The Biden administration has already confirmed that it has procured enough Pfizer vaccine doses to support vaccination for the country’s 28 million children that are 5-11 years old. However, vaccine hesitancy is likely to remain as much of a concern in children as it is in adults. According to a Kaiser Family Foundation poll, only a third of parents said they would get their kids vaccinated right away, while another third are opting for a “wait and see” approach.

Administration Issues New Rules on Vaccination Requirements

On November 5, the Biden administration issued a pair of rules that lays out vaccination requirements for 100 million American workers. The first rule, issued by the Occupational Safety and Health Administration (OSHA), stipulates that organizations with 100 or more employees must ensure that their workers are fully vaccinated against COVID-19 by January 4, 2022, or that they test negative for COVID-19 at least once a week. The second rule, issued by the Centers for Medicare and Medicaid Services (CMS), requires that all health care facilities that participate in the Medicare and Medicaid programs must make certain that eligible staff is also fully vaccinated by January 4, 2022. Unlike the OSHA rule, the CMS rule does not have the option to opt-out of getting the vaccine by testing weekly. While health care providers are supportive of the intent of the CMS rule, some are worried that the new requirements could exacerbate the industry’s staffing shortage.

House Tees Up Votes for Social Spending, Infrastructure Bills Today

The House is expected to vote Friday on both the $1.75 trillion social and climate spending package and bipartisan infrastructure bill. The vote follows a busy Thursday night where Democratic leadership hammered out last-minute deals with caucus members on state and local tax deductions, drug pricing, and immigration. Democrats can only afford to lose three votes on the social spending bill, as no Republicans are expected to vote for it. However, the fate of the social spending bill remains uncertain in the Senate, where centrist Sen. Joe Manchin (D-WV) has declined to offer his support until the Congressional Budget Office provides an estimate on how the measure will impact the deficit. The social spending measure will also require approval from the Senate parliamentarian, who must decide whether the updated bill can advance in the upper chamber through budget reconciliation.

Dems on Alert after GOP Sweeps Statewide VA Races

Democrats are preparing for a tough 2022 midterm election after Republican candidates won elections for governor, lieutenant governor, and attorney general in Virginia on November 2. Some pundits say the results mark a return of the swing-state status of Virginia, which hasn’t voted for a Republican presidential candidate since 2004. However, other pundits point out that in 10 of the last 11 gubernatorial races, the winner came from the opposite party as the president, indicating that the results are simply indicative of a longer pattern. Nonetheless, Democrats are fearful that enthusiasm for Republican candidates in Virginia could preview what was already expected to be a difficult 2022 midterm election for the party. Some Democrats in Washington have responded to the election by pledging to work together on passing high-priority items like the Build Back Better Act and the bipartisan infrastructure bill to show voters they can deliver on policy promises.

ICYMI: Capitol Police Prevail over Lawmakers in Congressional Football Game

At Wednesday’s Congressional Football Game, a team consisting of members of Congress lost to the Capitol Police team 26-6. First started in 2004 to raise money for the Capitol Police Memorial Fund, the annual tradition took on a different meaning this year after more than 130 officers were injured in the January 6 riot on the Capitol. This year’s game was played before an audience of 2,000 at Audi Field, while games in years past were played at Gallaudet University and the DC Armory. The game raised over $600,000 this year.

Where Are We at with Medicare’s Temporary Telehealth Waivers?

Posted In CMS

Telehealth usage has exploded during the COVID-19 pandemic, thanks to legislation like the CARES Act that expanded Medicare coverage of telehealth services to make it easier for beneficiaries to access health care services while minimizing their exposure to COVID-19. Now that the final stage of the pandemic is (hopefully) winding down, what are the implications for telehealth?

It’s all about the PHE. Expanded telehealth coverage is set to expire at the end of the COVID-19 public health emergency (PHE), which is currently January 16, 2021. The Secretary of the Health and Human Services (HHS) has the authority to renew the PHE for 90-day increments, meaning the PHE could potentially extend through April 2022 – or longer. Below are key Medicare telehealth coverage restrictions and rules that have been waived for the duration of the PHE.

Qualifying Technology: Medicare may now cover telehealth services conducted through devices like smartphones that offer audio-visual capabilities and can be used to facilitate two-way, real-time communication between a beneficiary and a practitioner. Previously, this was limited to beneficiaries in rural areas. Additionally, the requirement for visual capabilities is now waived for certain services, meaning some beneficiaries can now use audio-only telehealth services.
Geographic Location: Medicare will reimburse for telehealth services anywhere in the US, with no pre-existing patient relationship required.
Qualifying Service: Medicare can reimburse 238 telehealth services, compared to 101 prior to the PHE.
Qualifying Originating Site Type: Telehealth services can be provided to all patients in all settings, including at a beneficiary’s home.
Qualifying Site Practitioner: Any health care practitioner who can bill Medicare may now furnish Medicare telehealth service.

All of these temporary changes expire once the PHE ends, but Congress could take action and can change that. Lawmakers from both parties have been pushing to take some of these temporary telehealth coverage extensions and make them permanent, beyond the PHE.

Several bills (S. 368, S. 1988, H.R. 341, H.R. 1332, and H.R. 5425) would strike Medicare’s geographic site originating requirement and allow Medicare beneficiaries to access telehealth services in all settings.
Another (H.R. 2168) would permanently allow audiologists, physical therapists, occupational therapists, speech-language pathologists, and other providers to provide telehealth services under Medicare.
Additional bills (H.R. 5425 and S. 1988) would ensure permanent Medicare coverage of certain telehealth services using audio-only technology.

However, none of these have bills have advanced in either chamber since their introduction, and the Build Back Better Act, Democrats’ social spending and climate package, does not contain any provisions that address Medicare coverage of telehealth services.

It would be amiss not to highlight a major barrier to continued telehealth coverage is reimbursement. Under the PHE, telehealth services are reimbursed under Medicare at the same rate as in-person services, and lawmakers and stakeholders disagree over whether permanently expanded telehealth services should be reimbursed at or below the level of in-person services.

So, what does the future hold for telehealth? In summer and fall 2020, more than a quarter of Medicare beneficiaries used telehealth services, representing a massive increase in telehealth utilization since before the pandemic. Given that the waiver of Medicare’s telehealth restrictions will expire once the PHE ends, the question of what telehealth coverage will look like post-pandemic looms large. The numerous proposals on Capitol Hill to expand certain telehealth flexibilities suggest lawmakers want to ensure beneficiaries have continued access to telehealth services. However, absent any serious progress on these proposals, Medicare beneficiaries are still staring down the very real possibility of losing popular, safe, and convenient ways to access medical treatment that they gained in the early days of the pandemic.

Can Veterans Fix the Health Care Workforce Shortage?

Posted In WORKFORCE

Military servicemembers have stepped up throughout the course of the COVID-19 pandemic to care for a surge in patients, administer tests, and provide vaccinations. Meanwhile, civilian health care professions like nurses and paramedics are facing severe workforce shortages for the foreseeable future. Therefore, it begs to ask the question: could military medical personnel transition to the civilian world to help address gaps in the health care workforce?

Military medical personnel, in brief: The US armed forces have over 73,000 enlisted medical personnel, including Army and Air Force medics and Navy corpsmen. All medics and corpsmen receive three months of specialized medical training and have continuing education requirement throughout their enlistment. Medics and corpsmen who specialize in physical therapy, dental care, radiology, and other specialties are required to complete additional training that can last up to one year.

The issue – civilian shortages: Nearly all health care professions face staffing shortages that have been exacerbated by the COVID-19 pandemic. As an example, the American Hospital Association (AHA) estimates that the US needs more than 200,000 new nurses each year to keep up with a rising population of seniors and replace nurses existing currently in the workforce. Emergency medical services (EMS) agencies across the nation are also struggling to fill positions for emergency medical technicians (EMTs) and paramedics.

Let’s jump into the discussion – can former medics and corpsmen be a solution to the care health care workforce shortage? The closest equivalent civilian jobs where medics and corpsmen can apply their skills are as EMTs and paramedics, but many veterans find the transition challenging due to a lack of accreditation standards.

State EMS agencies have requirements that returning service members have difficulty meeting, like paying fees or undergoing background checks. Some states have particularly onerous requirements, like requiring sponsorship from an EMS office before granting a license.
EMT certification usually has college coursework requirements, but many colleges don’t know how to interpret training and experience from military transcripts, meaning veterans usually have to spend time and money on repeat coursework.

Possible fixes: To help transition veterans into the health care workforce, specifically as EMTs or paramedics, advocates are calling on state EMT agencies to develop policies to apply military experience to licensing standards. The Army has also been requiring its medics in recent years to maintain a National Registry of Emergency Medical Technicians (NREMT) certification, which can ease the transition to becoming a civilian EMT. Furthermore, pilot programs such as program that the Lansing Community College currently offers, which provides specialized training for former enlisted military medical personnel who wish to become paramedics, could serve as a national model for similar programs.

What Happened, What You Missed: October 25-29

Posted In FDA

FDA Panel Recommends Pfizer Vaccine for Children Ages 5-11

On October 26, the Food and Drug Administration (FDA) Vaccines and Related Biological Products Advisory Committee (VRBPAC) voted to recommend amending Pfizer’s Emergency Use Authorization (EUA) to allow its COVID-19 vaccine to be administered in children ages 5-11. Pfizer has reduced its vaccine dose for children under 12 to one-third of the adult dose and said clinical trials show the lower dose is over 90% effective in preventing symptomatic COVID-19 in children. Although the vote was unanimous (with one abstention), there was some discussion on weighing the benefits of vaccination against potential risks, namely rare instances of heart inflammation. Before the vaccine actually becomes available to kids under 12, it will be reviewed by the Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) on November 2-3, and the CDC director will need to sign-off on the ACIP’s decision.

Dems Release New $1.75T Reconciliation Proposal

On October 28, the House Rules Committee released the text of a new $1.75 trillion social spending and climate bill, a far cry from the $3.5 trillion budget resolution approved by Congress earlier this year. Notable provisions of the bill include investments in affordable housing, an extension of the child tax credit, and an extension of Affordable Care Act (ACA) premium tax credits through 2025. Notable provisions that were left out of the legislation, include paid family leave, prescription drug reform, and SALT. Since the proposal’s announcement, Sinema has issued a supportive yet noncommittal statement on the text, while Machin has declined to indicate his position. Based on the noncommittal responses from the Senators and wanting more time to read through the newly released text, the Congressional Progressive Caucus did not quite sign off on the reconciliation bill, which now has led to the delay in passing the bipartisan infrastructure bill.

Biden, Obama Get Involved with Consequential Virginia Gubernatorial Race

Over the past week, both President Joe Biden and former President Barack Obama have separately campaigned alongside Virginia Democratic gubernatorial candidate and former Governor Terry McAuliffe as polls show that McAuliffe is neck-and-next with his Republican opponent Glenn Youngkin. While Virginia has voted for the Democratic presidential candidate in every general election since 2004, Virginia’s off-year gubernatorial rate is widely seen as a bellwether for the midterm elections. Democrats are worried about an upset similar to Republican candidate Bob McDonnell’s victory in 2009 for the governorship of Virginia, which preceded historic midterm election losses for the party in the House of Representatives the following year. While former President Donald Trump has endorsed Youngkin, the two have not made any joint campaign appearances.

CDC Okays Fourth Booster Shot for Immunocompromised

On October 25, the CDC quietly updated its COVID-19 vaccine guidelines to allow “moderately or severely immunocompromised” people to receive a fourth “booster” dose six months after their third booster dose. Back in August, the FDA and CDC recommended third booster shots for immunocompromised who had been initially vaccinated with the two-dose Pfizer and Moderna vaccines. The CDC’s rationale for the new guidelines is to combat waning immunity and to account for the fact that immunocompromised people do not generate the same immune response to mRNA COVID-19 vaccines as people with healthy immune systems. The guidelines will impact an estimated 2.7 million immunocompromised Americans, according to the CDC.

Lawmakers Celebrate Third-Annual “Bipawtisan” Halloween Parade

On Wednesday, members of Congress gathered in the Hart Senate Office Building for the third-annual “bipawtisan” Halloween parade, which featured lawmakers’ dogs in costumes. Sen. Thom Tillis (R-NC), who started the parade back in 2018, brought along his two pups who were respectively dressed as Senate Majority Leader Mitch McConnell (R-KY) and Sen. Kyrsten Sinema (D-AZ). Other notable costumed canine include the dog of Sen. Mitt Romney (R-UT), who appeared as “Pierre Doglecto,” which is a play on his owner’s anonymous Twitter account. Additionally, Rep. Sara Jacobs (D-CA) brought her pup Nan, who was dressed as Speaker Nancy Pelosi (D-CA).

ICYMI: Sinema’s Denim Vest Draws Reactions

On Tuesday, Sen. Kyrsten Sinema (D-AZ) sparked controversy when she wore a denim vest while presiding over the US Senate. The attention over Sinema’s sartorial choices comes as the Senator is under increased scrutiny for her role in negotiations over the Democrats’ social and climate spending bill. While the denim vest might be different from the attire usually spotted on the Senate floor, it’s not out of character for Sinema. The senior Arizona Senator is known for her eccentric fashion choices, which have ranged from colorful wigs to backpacks. Notably, journalists in the Senate press gallery are prohibited from wearing denim.

Insights^

Find our analysis on legislation, regulations, MedPAC meetings, and more.

Is Daylight Saving Time Bad for Your Health?

What Happened, What You Missed: November 1-5

Where Are We at with Medicare’s Temporary Telehealth Waivers?

Can Veterans Fix the Health Care Workforce Shortage?

What Happened, What You Missed: October 25-29

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