The Centers for Medicare and Medicaid Services is threatening to withhold payments to healthcare facilities unless they require the Covid-19 vaccine for their workers. This action is misguided. I am vaccinated and support the goal of increasing vaccination rates. But the CMS policy has the potential to backfire and jeopardize patient access, safety and the quality of care for millions of Americans.
Medicare and Medicaid serve more than 140 million Americans and pump over $1 trillion into the U.S. economy. No healthcare entity can ignore CMS requirements without devastating financial implications. The CMS mandate will undoubtedly create patient safety and quality concerns, violating the purpose of the agency’s regulatory authority. It already is giving rise to legal challenges: On Monday a federal judge blocked enforcement of the mandate in 10 states that had sued over the requirement.
Many healthcare facilities have spent months encouraging and creating incentives for staff to get vaccinated, because they recognize that patients and staff risk contracting Covid without the shot. The healthcare system served patients last year without vaccines. That wasn’t ideal, but it was better than turning away people who need care. Scores of healthcare workers are resigning, retiring and cutting back their hours. The September jobs report showed 18,000 fewer Americans working in healthcare, with the nation’s hospitals losing 8,000 employees.
Many facilities are limiting the number of patients they see because they lack staff. Rick Pollack, president of the American Hospital Association, said the new CMS policy may end up “exacerbating the severe workforce shortage problems that currently exist.” Forcing the resignation of unvaccinated healthcare workers could lead to the closing of hospitals and nursing homes, especially in rural areas where even losing a few staff could be catastrophic to operations.
The consequences could lead to life-or-death issues for patients across the country. A hospital in Long Beach, N.Y., shut down its emergency room due to a lack of vaccinated nurses. A hospital in Lewiston, Maine, closed its neo-natal intensive-care unit—one of only five in the state—in advance of the governor’s Oct. 31 deadline for all healthcare workers to be vaccinated.
The CMS mandate could generate a downward spiral: Already-exhausted healthcare workers would have to work longer hours to compensate for the termination of unvaccinated colleagues, leading to more burnout and retirements. This could lead to delays in care, or the postponement of needed healthcare services. If patients put off needed surgeries or preventive services like mammograms that can lead to more diagnoses of advanced diseases, which are more complicated and expensive to treat. Amid an uptick in Covid-19 cases in some states and warnings of a potential fourth wave, we need healthcare workers on the frontlines, not the unemployment lines.
The CMS should maintain the goal of universal vaccinations for healthcare workers, but the rule should allow for more ramp-up time before enforcing draconian consequences, while carving out exemptions for rural providers and other healthcare facilities facing staff shortages. These facilities could be required to put together a plan to increase vaccines and reduce transmission. Such a plan could include further incentives for staff to be vaccinated, requirements for public transparency around overall facility immunization rates, regular testing of unvaccinated workers, and removal of unvaccinated staff from patient-facing activities, without terminating their employment.
I don’t fault the CMS for trying to get more healthcare workers vaccinated. But we are talking about individuals who have already endured the stress of losing patients to Covid-19 and working grueling hours. Local healthcare providers need the flexibility to implement those approaches, not a Washington-knows-best, one-size-fits-all nationwide rule.
Ms. Verma is a health policy consultant based in Indiana. She served as CMS administrator, 2017-21.
Read the original article on the Wall Street Journal.
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