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A packed calendar and a D.C. standoff, inside the NIH unionization efforts & when algorithms override 

July 11, 2023
Reporter, D.C. Diagnosis Writer
Happy Tuesday, D.C. Diagnosis readers! Have you checked out STAT's summer reading list, compiled by colleagues and health leaders with a very broad definition of what constitutes a "beach read?" Send news, tips, and what you're reading to sarah.owermohle@statnews.com.

congress

The Capitol time crunch

Both the House and the Senate are in session for just under two weeks this month before returning home for August recess. There are a few things on the agenda this week – like a House committee planning to mark up a slate of public health and pandemic bills – but lawmakers are volleying other big priorities like Biden's NIH director pick, to the fall, much to the chagrin of health research advocates.

Cancer surgeon Monica Bertagnolli, Biden's languishing pick to lead the NIH, meets today with Sen. Elizabeth Warren (D-Mass.), who's asked that she pledge not to join pharmaceutical companies after her tenure. Bertagnolli hasn't buckled, though FDA Commissioner Robert Califf (who, some critics point out, is older and has a pack of pharmaceutical consulting fees behind him) signed a similar promise. 

Warren's office told STAT that's her main priority, distinguishing her from HELP Chair Bernie Sanders (I-Vt.) who simply refuses to schedule a hearing for Bertagnolli until Biden makes some more drug pricing concessions, like reinstating NIH's "reasonable pricing" clause. NIH alums and Biden officials themselves say that's unlikely — so for now, and maybe into the election season, the impasse remains. Read more from me on the closed-door deliberations here.


Drug pricing

The administration doesn't want to do this in public

Bernie-HIV-768x432

As sources said to me this weekend, openly pressuring Sanders might not get the White House where they want to go with Bertagnolli and other potential nominees. The senator holds the keys to a big chunk of the Senate's health care calendar and definitely shares some cost-cutting priorities with the administration.

Asked Monday about the potential holdup on Bertagnolli's confirmation process and its potential impact on Biden priorities, Medicare chief Meena Seshamani swerved from reporters and underlined her agency's looming drug negotiation deadlines. 

"That is the focus of everything we're doing," Seshamani told STAT's John Wilkerson and other reporters. "Where Congress is thinking about new ideas, and they ask us for what's called technical assistance, to provide them input on how our programs work, we absolutely provide that."


Science and research

​​NIH union efforts meet budget realities

Thousands of NIH research fellows want to unionize, in large part to push pay stipends to livable levels for the D.C. area. But with the debt ceiling budget caps and brewing congressional pressures on the agency, it might not be easy to find that money, STAT's Brittany Trang reports.

The NIH operates with a unique and in some way, more flexible structure than other federal agencies. But experts are pretty clear that unless the budget increases, any raises would have to come out of the agency's existing $5 billion intramural research budget

That's not all the burgeoning union is requesting, though. Representatives also want NIH to support more international researchers and improve the process to report abuse or harassment. Organizers have also highlighted a pay gap between different institutes like the well-funded cancer department and lesser-known campuses. More from Brittany.



 

the AI debate

Data versus doctors: Insides the algorithm disputes at NaviHealth

An algorithm was overriding clinicians' recommendations that intensely ill Medicare patients, many of them older or disabled, stay in care. And while employees raised alarms in 2021 about the growing disconnect, some say the disparity between data and doctors' advice continues. 

With an investigation out today, STAT's Casey Ross and Bob Herman revisit the algorithm dispute they first reported and delved into when tension began to fester at NaviHealth, now owned by Optum.

As Casey and Bob write, the company's turmoil is a powerful example of the potential dark side of artificial intelligence and its incursion into health care. Dive into the story.


opioid crisis

Biden's emerging tranq plan

The White House on Tuesday unveiled a new plan for addressing the increasing presence of xylazine, a veterinary tranquilizer increasingly mixed into illicit opioids like fentanyl, amid the country's drug crisis, STAT's Lev Facher reports.

Since xylazine is not an opioid, it does not respond to naloxone, the medication used to reverse opioid overdoses. So while xylazine is known to suppress breathing and cause unconsciousness, it has no antidote. 

There are six initial pillars to the White House plan including testing, research, data collection, disrupting the xylazine supply, and developing evidence-based treatment and harm reduction practices. But more could come: White House Office of National Drug Control Policy Director Rahul Gupta said the government will "explore" adding xylazine to the list of medications scheduled under the Controlled Substances Act. More from Lev.


Medicare

Medicare to balance 340B books with multibillion-dollar fix

The agency plans to send $9 billion to more than 1,600 hospitals in the 340B drug discount program after the Supreme Court found the program underpaid them for prescription drugs. It's not all rosy: Medicare is going to pay for the fix in part by slashing hospital payments for other services by 0.5% over the next 16 years, D.C.D. co-writer Rachel Cohrs wrote late Friday.

The trouble started when the Trump administration in 2018 began underpaying the program, which is controversial with Republicans. The court ultimately ruled that change illegal, delivering the Biden administration a nearly $10 billion bill to balance.

Medicare proposed Friday to do that by calculating how much each underpaid hospital should have been reimbursed by Medicare, subtracting the amount Medicare actually paid, and then paying that remaining amount in a one-time lump-sum payment. Read more from Rachel on the plan and hospitals' reactions.


More around STAT
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What we're reading

  • How the political right came to back psychedelics to treat trauma, STAT
  • Nonprofit hospitals under growing scrutiny over how they justify billions in tax breaks, KFF Health News/CNN
  • Opinion: How ARPA-H can master the subtle art of risk-taking, STAT
  • Are seniors more likely to enroll in Medicaid if states expand home-based long-term care? Forbes  

Thanks for reading! More on Thursday,


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