Good morning, I’m Fenit Nirappil and I’m a health reporter for The Washington Post. I was irritated when I got an email showing the results of the bloodwork from my annual physical without ever hearing from my doctor about the warning signs the test highlighted. Turns out I’m not alone, and that’s the subject of today’s newsletter.
Today’s edition: Vice President Harris is touting her accomplishments on countering medical debt on the campaign trail. A Senate committee subpoenaed the leader of the nation’s largest physician-led hospital system. But first …
Patient portals deliver scary news before doctors can weigh in
Mike Day’s cancer diagnosis arrived while he lounged in his living room recliner last summer. His wife, a former registered nurse, spotted “adenocarcinoma” in biopsy results posted to his electronic patient portal.
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His gastroenterologist was on vacation, and Day struggled to get an appointment to talk to a doctor about the cancerous tumor in his esophagus. Day died within weeks, and his family is astounded by how much trouble they had to go through to get an explanation for a cancer that serious.
“Getting medical results shouldn’t be like tracking a DoorDash order,” said Andrew Day, Mike’s son.
Day’s story provides a powerful example of the dilemma I covered in an article for The Washington Post: A new federal requirement requires people to receive immediate access to medical test and scan results. But does that help them or hurt them?
The idea of medical transparency undergirding provisions in the 2016 Cures Act is broadly supported. But implementation of the regulations expanding access to medical records, which took effect in 2021, has been more divisive.
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As more people receive troubling results online at the same time as their doctors — often waiting days or weeks for treatment plans — medical associations have been pushing to give doctors more time to release records revealing cancer and other grim diagnoses so patients don’t have to bear the news alone.
The American Medical Association has been lobbying federal health officials, unsuccessfully, to adopt a rule providing physicians 72 hours to reach patients before electronically releasing life-altering results or deadly diagnoses. California and Kentucky have enshrined similar exceptions in recent state laws.
“It’s one more instance in which we feel like there are other people who don’t know our patients who are getting in the way of that really sacred doctor-patient relationship,” said Jack Resneck, the medical association’s former president who led the group’s advocacy on the issue.
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Federal health officials say the concerns will be resolved as technology improves and as medical practices adjust how they prepare patients for results.
“There is just a moral imperative here, which is for patients, this is their information. They ought to be able to access it whenever they want,” said Micky Tripathi, the national coordinator for health information technology who oversees the requirement for the Department of Health and Human Services. “They also pay for it. They ought to be able to get things they pay for.”
Grace Cordovano, a patient advocate, said one of the best ways to ease anxieties without overwhelming doctors is for insurers to pay health navigators who can prepare patients before they meet with a physician. The Centers for Medicare and Medicaid Services created billing codes to allow the public insurers to pay for “principal illness navigation” to connect patients with cancer and other high-risk conditions to health and social services.
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Before medical records were readily accessible, Cordovano said, patients struggled to obtain the documents needed to get a second opinion, enroll in clinical trials or book appointments with specialists.
You can read more about the effects of instant patient notification — good and bad — and the experiences of doctors and patients navigating the new environment here.
Election watch
How Kamala Harris is tackling medical debt — with Roy Cooper’s help
Harris has spent nearly three years steering federal efforts to alleviate medical debt — an often-overlooked effort she is likely to highlight as her presidential campaign takes shape, our colleague Dan Diamond reports this morning.
Key context: Working with the Consumer Financial Protection Bureau and other agencies, Harris-led initiatives in 2022 triggered credit reporting agencies to remove medical bills from the credit reports of about 30 million Americans. The administration also proposes blocking medical debt from being used to evaluate borrowers’ fitness for mortgages and other types of loans. That rule could be finalized next year, if she’s elected president.
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- Harris has also championed efforts to use funds made available by the American Rescue Plan to buy medical debt from health providers. The effort is on track to forgive $7 billion for 3 million Americans by 2026, her office said yesterday.
What’s next: Harris is coordinating with North Carolina officials on a pilot project to forgive the medical debt of about 2 million residents. Under the proposal, hospitals that take steps to relieve patients’ existing medical debt and adopt policies to prevent accumulation of new debt would receive additional funding through the Medicaid program. Federal approval from CMS could come today.
“Getting sick or taking care of loved ones should not mean financial hardship, and I applaud North Carolina for their innovative proposal,” Health and Human Services Secretary Xavier Becerra said in a statement.
North Carolina Gov. Roy Cooper (D), who is being vetted by the Harris campaign as a potential running mate, said he believed his state’s plan could be “a really big deal — if it works.” But some hospitals have suggested that they may not participate.
We have already forgiven about $500 million of medical debt for hundreds of thousands of Americans across the nation. pic.twitter.com/pd73Qy8iPy
— Kamala Harris (@KamalaHarris) May 15, 2024Readers help us
The Post’s Sabrina Malhi wants to speak with people who have taken the postpartum pill zuranolone, sold under the brand name Zurzuvae, for an upcoming article. If you have used the medication, please fill out this form.
On the Hill
Senators open probe into Steward Health, subpoena CEO
The Senate health committee has officially launched a bipartisan investigation into Steward Health Care, the nation’s largest physician-led hospital system, and voted to subpoena its CEO, Dan reports.
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Key context: Steward is in bankruptcy proceedings and trying to sell its 31 hospitals nationwide. Community leaders and health workers have criticized leaders of the for-profit company for extravagant paydays while hospitals struggled to meet mortgage payments and cover other expenses.
Senators echoed those concerns in a hearing yesterday, accusing Steward executives of “outrageous corporate greed” that harmed access to medical services, including spending nearly $100 million on a pair of private jets.
“At a Steward-owned Massachusetts hospital, a woman died after giving birth when doctors realized mid-surgery that the supplies needed to treat her had been repossessed due to Steward’s financial troubles,” said Sen. Bill Cassidy (R-La.), a physician and the panel’s top Republican. “Patients’ lives are at risk. Americans deserve answers.”
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The committee previously sought testimony from Ralph de la Torre, Steward’s CEO and founder, but was rebuffed. Now, for the first time since 1981, the panel has issued a subpoena to force him to testify at a Sept. 12 hearing.
Private equity vultures are making a fortune by taking over hospitals and leaving them in shambles.
It's time for the CEO of Steward Health Care to get off his yacht and explain to Congress how he got rich while bankrupting the hospitals he manages. https://t.co/2VoBZ1qHqq
— Bernie Sanders (@SenSanders) July 25, 2024In other news from Capitol Hill …
GOP leaders on the House Energy and Commerce Committee are seeking transcribed interviews and documents from HHS and the National Institutes of Health about mpox virus research. Lawmakers threatened to issue a subpoena if the agencies don’t comply with their request by Aug. 8.
Agency alert
HHS revamps ONC, boosting focus on health technology and AI
The federal health department unveiled a sweeping reorganization aimed at streamlining and bolstering its efforts in artificial intelligence, cybersecurity, data and technology.
The details: Oversight of technology, data and AI policy and strategy will be consolidated under the newly named assistant secretary for technology policy and the Office of the National Coordinator for Health Information Technology.
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Micky Tripathi will head the new office while staying on as national coordinator for health IT and acting chief AI officer. The agency is seeking candidates to fill the permanent chief AI officer role, and new chief technology and data officer positions.
Separately, responsibility for private-public partnerships between the health sector and federal government on cybersecurity will be transferred to the Administration for Strategic Preparedness and Response.
Meanwhile …
- CMS approved New Mexico’s request to provide continuous Medicaid eligibility for children up to age 6, along with other proposals to expand access to care.
- The Food and Drug Administration is urging people not to consume El Servidor brand ground cinnamon, citing elevated levels of lead detected in samples.
From our notebook
The Post’s Lena H. Sun sends this dispatch:
Colorado is reporting three additional poultry workers infected with bird flu, bringing the total human cases in the state to 10.
The workers have mild illness, according to the Centers for Disease Control and Prevention. They were working directly with infected poultry at a commercial egg layer operation.
Colorado’s dairy herds and poultry farms have been hard hit in this year’s H5N1 outbreak, which has infected 13 people nationwide. On Tuesday, Colorado said it was requiring weekly milk testing of all licensed dairy herds for signs of virus, the first state to do so. The health department will also post twice-weekly data on bird flu cases in humans.
Six workers on a different poultry farm were infected earlier this month after heat limited their ability to properly wear protective personal gear, CDC officials said. One dairy worker was infected in early July. Colorado has tested 118 people for bird flu.
In other health news
The Post’s Camila Kerwin is out with a graphic deep dive on a Republican who once blocked gun violence research. Check out her full comic here.
Quote of the week
“We are witnessing the dismantling of our health system.”
— Susie Keller, CEO of the Idaho Medical Association, regarding the exodus of doctors since the state's near-total abortion ban took effect nearly two years agoHealth reads
Medicaid was a boon to insurers during the pandemic. Now, not so much. (By David Wainer | The Wall Street Journal)
Sugar rush
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