Healthcare News of Note: Newest nurses now fill the greatest number of 12-hour shifts

• The greatest number of shifts are being filled by nurses with less than one year of tenure, and this number rose by 55.5% from March 2021 to March 2022.
• Medicare drug plans use cost sharing to restrict coverage of quadruple therapy for patients with heart failure, with out-of-pocket costs that are substantially higher than generic regimens.
• Inaccuracies in Medicare’s enrollment data limit the ability to assess and address health disparities, according to a June report by the HHS Office of Inspector General.

Over the last few weeks, I have found these industry news stories that should be of interest to healthcare finance professionals.   

1. Epic Research: Nurses with less than a year of tenure now fill the greatest number of 12-hour shifts

“‘The new nurse’ is the new normal,” according to a study released June 2 by Epic Research.

“The greatest number of shifts were filled by nurses with less than one year of tenure, and this number rose by 55.5% from March 2021 to March 2022,” wrote researchers. Although this change was consistent across regions, it was “most pronounced in the West and South.”

Findings, which were based on evaluations of a data set of more than 26 million 12-hour shifts for registered nurses across 189 U.S.-based Epic organizations, include the following:

Between March 2021 and March 2022, median nursing tenure fell by 19.5%. This decrease was seen across the U.S., led by a 32.2% decline in years of experience in the West, according to researchers. During the same time period, the median tenure fell by 17.7% in the Northeast, 16.4% in the Midwest and 11.3% in the South. 

Shifts covered by nurses new to the organization in the last 30 days increased nationwide. According to researchers, the percentage of shifts covered by new nurses — defined as those who started at an organization in the last 30 days — increased across all regions, with the largest increase seen in the South (3.4%).

2. Cost of treatment for Medicare patients with heart failure may be unaffordable, study shows

Quadruple therapy, which is recommended for patients who have heart failure with reduced ejection fraction (HFrEF), “may be unaffordable for many Medicare patients with HFrEF unless medication prices and cost sharing are reduced,” according to a study published June 28 in the Journal of the American College of Cardiology.

“Medicare drug plans restrict coverage of quadruple therapy through cost sharing, with out-of-pocket [OOP] costs that are substantially higher than generic regimens,” wrote the authors.

According to the study:

• The median 30-day standard coverage OOP cost of quadruple therapy was $94, including $47 for angiotensin receptor-neprilysin inhibitor (ARNI) and $45 for sodium-glucose cotransporter-2 inhibitors (SGLT2i).
• The median annual OOP cost of quadruple therapy was $2,217, compared with $1,319 when excluding SGLT2i and $1,322 when including SGLT2i and substituting an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker for ARNI.
• The median 30-day OOP cost of generic regimens was $3.

The study assessed cost sharing, prior authorization and step therapy in all 4,068 Medicare prescription drug plans in 2020. 

3. OIG report: Medicare’s inaccurate race and ethnicity data hinder assessment of racial disparities

“Inaccuracies in Medicare’s enrollment data limit the ability to assess and address health disparities,” according to a June 15 report by the Office of Inspector General (OIG) at the U.S. Department of Health and Human Services.

OIG said it conducted the review in response to CMS‘s ongoing efforts to advance health equity.

“Ensuring that Medicare is able to assess disparities is key to this goal,” wrote the authors. “The ability to assess health disparities hinges on the quality of the underlying race and ethnicity data.”

Key findings

Results of OIG’s analysis of the race and ethnicity data in Medicare’s enrollment database include:

• Medicare’s beneficiary race and ethnicity data are less accurate for some groups, particularly for beneficiaries identified as American Indian/Alaska Native, Asian/Pacific Islander or Hispanic.
• Inaccurate data limit the ability to assess health disparities.
• Limited race and ethnicity categories and missing information contribute to inaccuracies in the enrollment data.
• Although the use of an algorithm improves the accuracy of existing data to some extent, it falls short of self-reported data.
• Medicare’s enrollment data on race and ethnicity are inconsistent with federal data collection standards, and these inconsistencies inhibit the work of identifying and improving health disparities within the Medicare population.

Recommendations

OIG recommended the following steps to help improve CMS’s race and ethnicity data. CMS concurred with the proposals.

• Use self-reported race and ethnicity information to improve data for current beneficiaries.
• Develop a process to ensure that data are as standardized as possible.
• Educate beneficiaries about CMS’s efforts to improve race and ethnicity information.

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