Medical community speaks out on effects of government shutdown

On Oct. 1, the Department of Health and Human Services launched new health insurance exchanges despite a government shutdown that furloughed more than half of its employees. Yesterday, in the second attempt to selectively restart parts of the federal government, the House of Representatives passed a measure to restore funding for the National Institutes of Health.

The spending bill, introduced by Rep. Jack Kingston (R-Ga.), would provide immediate funding for the NIH “at the same rate and under the same conditions as in effect at the end of the just completed fiscal year,” according to the bill, at least through Dec. 15.

“Reports suggest that NIH may turn away patients as a result of the shutdown,” according to a statement on the House Republican Conference website.

The American Public Health Association immediately issued a statement opposing the measure.

“While NIH funds important medical research that we strongly support, funding other critical agencies such as the Centers for Disease Control and Prevention and the Health Resources and Services Administration is essential to saving lives, preventing disease and disability, conducting disease surveillance, protecting and responding in times of crisis, ensuring the safety of our food, training health care professionals and providing care to the nation’s most vulnerable,” the statement read.

Meanwhile, PubMed, the online service of the National Library of Medicine, remains affected by the shutdown. Its website, like many other government sites, now reminds users that it is being “maintained with minimal staffing ... Information will be updated to the extent possible, and the agency will attempt to respond to urgent operational inquiries.”

A summary of President Barack Obama’s meeting Wednesday night with Congressional leaders offered little hope for any agreement on selective agency funding.

“The president made clear to the leaders that he is not going to negotiate over the need for Congress to act to reopen the government or to raise the debt limit to pay the bills Congress has already incurred,” according to the summary.

Healio.com spoke with members of the medical community to determine what effects – if any – the shutdown is having on clinical practice, patients and medical research.

Perspective
Janis A. Abkowitz, MD

Janis L. Abkowitz

  • As the world’s largest professional society concerned with the causes and treatment of blood disorders, many of ASH’s more than 14,000 members heavily rely on government funding, namely from the National Institutes of Health, to conduct cutting-edge research that results in better treatments and cures for millions of patients with blood diseases and cancer around the world.

    As a consequence of Congress’s inability to pass a federal budget, our members — physician-scientists already reeling from sequestration-related NIH budget cuts — face additional uncertainty, since NIH has announced that it will be unable to process grant applications or offer grantee support during a government shutdown.

    Over the last 10 years, NIH-funded research in hematology has transformed a once uniformly fatal form of leukemia into a disease managed by a daily pill, increased cure rates for pediatric leukemia, and led to the development of new blood thinners that can better treat and prevent strokes. However, continued progress is in jeopardy.

    We simply cannot afford to place lifesaving biomedical research on hold on account of congressional bickering. As Congress continues efforts to pass a fiscal year 2014 budget, we urge lawmakers to recognize the value of biomedical research and support a balanced approach to deficit reduction that does not include further cuts to NIH.

    • Janis L. Abkowitz, MD
    • President, American Society of Hematology
Perspective
Samuel M. Silver, MD, PhD, MACP

Samuel Silver

  • For the hem/onc community in general, the government shutdown has had fairly little effect in terms of day-to-day practice issues. Claims from Medicare and Medicaid are continuing; however, there is a concern about claims in Washington, D.C., due to the unique relationship the District of Columbia has with the federal government. There may be claims issues for patients in the District.

    One of the two things that are of major concern is that the fact that the NIH is no longer processing new grant requests. Unless this is resolved relatively quickly, there will be major issues funding research. Enrolling people into research studies has been fairly difficult — if not impossible — at the NIH, which has been fairly well publicized in the press. Admitting new patients to the inpatient service at NIH, I believe, is becoming very difficult, as well. These are areas of major concern in terms of advancing research, especially surrounding the NIH/NCI and the processing of grants or bringing new patients on for intramural clinical trials.

    The government shutdown has also closed operations of the Congressional Budget Office. The area that gives information to congressional committees for bills is no longer able to take a look of those bills for analysis of fiscal issues. We’re once again coming down to the wire for SGR. Certainly, Congress has been diverted from consideration of SGR reform because of the Affordable Care Act and government shutdown. Congressional staff is not working on SGR reform language, and this is exacerbated by lack of Congressional Budget Office analysis. So are we headed for another Dec. 31 showdown for what’s happening with SGR, as we have every year for the last decade? This year was supposed to be different, but it looks like it’s going to be no different, and may be worse.

    Last week, at a meeting of the AMA/Specialty Society Relative Value Scale Update Committee (“The RUC”), CMS representation was notably absent because of the government shut down. The AMA formed the RUC to act as an expert panel in developing relative value recommendations and practice expense inputs to CMS. CMS has always had a seat at the table, and the dialogue between CMS and RUC members is very important in guiding recommendations to CMS. CMS, for the first time, was not at the table, and this important dialogue  did not occur. It is difficult to say what impact this will have, but in these increasingly uncertain times, it certainly will not help.

    • Samuel Silver, MD, PhD
    • Professor, Internal Medicine/Hematology-Oncology
      Director of the University Cancer Center Network
      University of Michigan Cancer Center
      Ann Arbor, Michigan
Perspective
Donald L. Trump, MD, FACP

Donald L. Trump

  • Shutdown on top of sequestration, which is exacting real reductions in support for important research, will substantially limit the support our cancer center will receive for the next 5 years as sequestration impacts base-year grant request calculation. This is another blow to the cancer research community that may well result in delayed and missed opportunities to improve the understanding and treatment of cancer. Cessation of the deliberative processes whereby grants and contracts are reviewed and awarded will slow progress, and even slowing of a week or two could make a difference.

    • Donald L. Trump, MD, FACP
    • President and CEO
      Roswell Park Cancer Institute
      Buffalo, New York
Perspective
Jed B. Gorlin, MD, MBA

Jed B. Gorlin

  • I heard on NPR that the NIH is unable to enroll new patients on clinical trials, which has a direct adverse effect on both research and potentially patient care.

    Amusingly, my blood center was in the middle of an FDA biannual inspection, which is now on hold as the FDA staff are furloughed. In fact, it would have been preferable to be able to complete the assessment, as it is disruptive to staff here as well as the FDA personnel.

    I assume that the FDA approval process for new medications, blood products, and blood screening and treatments are all on hold until the government funding crisis is resolved.

    • Jed B. Gorlin, MD
    • Medical director, Memorial Blood Centers
      Minneapolis, Minn.
      Assistant professor, Pediatrics and Laboratory Medicine and Pathology
      University of Minnesota
Perspective
Clifford A. Hudis, MD, FACP

Clifford A. Hudis

  • The country woke up [Tuesday] morning to the first government shutdown in 17 years. This is a sad state of affairs, and we must insist that — moving forward — our elected leaders do better to ensure that millions of Americans with cancer can continue to rely on their government for essential cancer care, life-saving research, and the advancement of safe and effective drugs into practice.

    The short-term impact on clinical and laboratory research was felt first thing [Tuesday] when investigators were notified that the federal agencies that are critical to ongoing and planned clinical research would not be available until further notice. However, it is the long-term disruption to government services that could be even more devastating to research innovation and the overall health of the nation for decades to come.

    We call on Congress and the administration to work together to pass a budget that will continue our country’s commitment to individuals with cancer. Millions of lives, scientific progress, and our worldwide leadership depend on their action.

    • Clifford A. Hudis, MD, FACP
    • ASCO President
  • Disclosures: Hudis reports no relevant financial disclosures.
Perspective
  • It’s impossible to tell if [the shutdown] has had an effect at this particular point. It will, without question, impact cardiovascular research if it continues. There are trials that are not being funded. There are issues regarding children’s research initiatives that have been put on hold. In the land of research, most of those projects are ongoing for long periods of time, so a brief period — like we hope this will be — will not have a material effect long-term, but it will certainly be disruptive during this period of time when they have the shutdown. Those programs that are federally funded will be considered discretionary and put on hold. I don’t know if the employees themselves would be sent home, but certainly we would stop enrollment in those types of programs for the period of the shutdown. 

    • David May, MD, PhD, FACC
    • Chairman, American College of Cardiology board of governors
      Secretary, American College of Cardiology board of trustees
      Managing Partner, Cardiovascular Specialists, P.A., Lewisville, Texas
  • Disclosures: May reports no relevant financial disclosures.
Perspective
Alan J. Garber, MD, PhD

Alan J. Garber

  • I don’t think we have any unique issues in endocrinology compared with other cognitive specialties such as infectious disease or hematology.

    The problems with government shutdowns are, of course, the result of not paying their bills. In an office-based practice such as endocrinology, there’s a high overhead cost, which has to be met week by week. If a third of patients are Medicare- or Medicaid-paid patients for whom reimbursement is late or not forthcoming, then these offices will have to meet their overhead from other sources and hope to recover those funds later. The cost of carrying these unpaid bills is never repaid.

    I don’t see any reason it should affect our patients; the real problem is with research. So much of modern academic medicine is dependent on government-funded research that I don’t know what they’re going to do.

    It seems to me the problem is beyond what we [as physicians] can advocate for. It’s a situation where the aims of the political process have become more important than the welfare of the country. As a result, there is posturing for the political benefit of the individual representatives or senators that is unrelated to the good or the ill of the country and it’s a fundamental transformation of the government. It used to be — at a time I can remember in my own lifetime — that the welfare of the country always came first. Now it’s party first, country second. This is equally true on both sides. The attempts by one side to lay blame at the feet of the other side are pretty futile here.

    The current impasse is also a political commentary on passing major legislation through a one party super majority where the other side has no input whatsoever. You invite this kind of sniping later on because the other side never got a chance to buy into it or have input. You can’t do that in medicine. You can’t treat patients that way. You can hardly handle politics that way.

    I think we endocrinologists need to tend to business and ignore Washington. There will always be the Chicken Littles of the world who insist the sky is falling. Yet, somehow it never does.

    • Alan J. Garber, MD, PhD
    • Professor, departments of Medicine, Biochemistry and Molecular Biology,
      and Cellular and Molecular Biology,
      Baylor College of Medicine
  • Disclosures: Garber is a consultant/advisory board member and on the speakers’ bureau for GlaxoSmithKline, Merck, Novo Nordisk and Daiichi Sankyo.
Perspective
Margery Gass, MD

Margery Gass

  • Abruptly discontinuing a funding source has the potential to seriously derail important research; that is an unfortunate and unnecessary waste of time, energy and taxpayer dollars.

    • Margery Gass, MD
    • Executive Director of the North American Menopause Society
      Consultant to the Cleveland Clinic Center for Specialized Women’s Health
  • Disclosures: Gass reports no relevant financial disclosures.
Perspective
James C. Quick, PhD

James Campbell Quick

  • The key effect [the government shutdown] will have on mental health professionals is awareness that their patients are going to feel threatened by the shutdown, and that their stress and anxiety levels are probably going to go up a good deal. That is very understandable in light of the circumstances that these patients have literally been thrown into; psychiatrists, psychologists and social workers are going to be in a place where they need to be aware of that and be ready to support and catch and frame the reality of the circumstances for these people. Psychiatrists will be a critical resource for patients.

    • James Campbell Quick, PhD
    • Professor of Leadership and Organizational Behavior;
      John and Judy Goolsby - Jacqualyn A. Fouse Endowed Chair,
      The University of Texas at Arlington
  • Disclosures: Quick reports no relevant financial disclosures.