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Connection newsletter July 6, 2023 – this week's health news highlights for the Arizona healthcare community

Read about the ground ambulance draft rule extension, AzHHA’s comments on the proposed Medicaid Managed Care rule, and updates on the oncology and penicillin drug shortages.

Ground ambulance draft rule extension

The Arizona Department of Health Services (ADHS) has extended the online comment period for its posted ground ambulance draft rules for review to Sunday, July 16. AzHHA members have increasingly expressed concern over delays in interfacility transports, including transports for patients needing a higher level of care. In the rules, ADHS proposes a methodology for holding ambulance providers accountable for interfacility delays.

AzHHA is concerned the methodology does not appropriately take into consideration all patients needing a hospital-to-hospital transfer. AzHHA members will receive a Regulatory Advisory with more detail, urging them to comment on the proposed rule. We are also working on scheduling a member call. In the meantime, ADHS will participate in listening sessions in each EMS region to gather additional input from stakeholders. At the end of July, a revised draft rule will be posted for additional comments due in August.

AzHHA submits comments to CMS on proposed Medicaid Managed Care rule        

On Monday, July 3, AzHHA submitted comments to the Centers for Medicare and Medicaid Services (CMS) on the proposed rule on Medicaid Managed Care Access, Finance and Quality.

Summary of key points from AzHHA’s comments:

  • The majority of the letter focused on CMS’ potential changes to state directed payments (SDPs).
    • In Arizona, there are a number of SDP programs, including:
      • Hospital Enhanced Access Leading to Health Improvement Initiative (HEALTHII)
      • Differential Adjusted Payments (DAP)
      • Access to Professional Services Initiative (APSI)  
    • In the letter, AzHHA:
      • Supported CMS’ codification of the current practice in establishing the average commercial rate (ACR) as the upper payment limit.
      • Expressed strong opposition to possible alternatives on limiting the growth of SDPs, such as reducing the upper payment limit to Medicare rates or having an aggregate cap as a percentage of Medicaid managed care spending.
      • Urged CMS not to prohibit interim payments with reconciliation and continuing to allow states flexibility in their approach in tying SDPs to utilization of Medicaid services.
  • Additionally, AzHHA expressed support for establishing maximum wait times for certain types of providers, but suggested that CMS also adopt similar provisions to strengthen the post-acute provider networks as well as consider additional programs which would increase the pipeline for medical professionals, especially in high professional shortage areas and in rural locations.  

Updates on the oncology and penicillin drug shortages and a potential UPS strike

Currently, AzHHA is closely following current drug shortages for oncology and penicillin as well as a potential strike for unionized drivers and workers for UPS that could disrupt distribution services.

The latest on the oncology drug shortage:

  • Overview: Drug shortages are at an all-time high across the nation with more than 300 drug shortages recorded. Among those shortages, a number of chemotherapy medications are of major concern, including cisplatin and carboplatin.
  • What’s currently happening: American Society of Clinical Oncology (ASCO) continues to urge Congress to help prevent and mitigate drug shortages by reauthorizing the Pandemic and All-Hazards Preparedness Act (PAHPA) and provided recommendations to help mitigate oncology drug shortages.
  • Shortages remain ongoing: Cisplatin and carboplatin resupply dates are unknown, varied, backordered or anticipated in late 2023. The ongoing shortage is causing doctors to delay, modify or find alternative treatment plans.

Penicillin – a recent addition to the drug shortage list:

  • Overview: On Monday, June 12, Pfizer released a letter to clinicians stating that there is a “limited supply and impending stock out situation for select Bicillin L-A (penicillin G benzathine injectable suspension) and Bicillin C-R (penicillin G benzathine and penicillin G procaine injectable suspension) Prefilled Syringes.”
  • Why this is important: Bicillin L-A is the most effective antibiotic, as well as the only product available to treat pregnant patients with syphilis. Alternative treatments for syphilis, like doxycycline, can already be found on ASHP’s drug shortage list.
  • What you can do: To help CDC continue to monitor the situation, notify [email protected] of shortages or stock-outs of Bicillin L-A and report any shortages to the Pfizer Supply Continuity Team at 844-646-4398.

What you need to know about the potential UPS strike:

  • Overview: Unionized drivers and workers for UPS have voted to authorize a strike if they don’t secure a new contract by Monday, July 31. UPS Healthcare, the segment of the company focused on logistics for healthcare, is widely used by global healthcare companies.
  • Why this is important: Given UPS’s large healthcare footprint, a potential strike of UPS delivery drivers has major implications for delivery of healthcare products in the U.S. If the strike occurs, it is likely that deliveries of medical products, including pharmaceuticals, will be delayed. The severity of impacts on the healthcare supply chain is uncertain and depends on how long the strike lasts.
  • What you can do: If you are customer of UPS, you should build contingency plans for alternative distribution processes, especially for critical deliveries, in case a strike is called.

Study shows in-hospital delivery-related deaths have decreased

A large nationally representative study shows in-hospital delivery-related maternal mortality rates decreased 57% from 2008 to 2021. This study was conducted by the HHS Office on Women’s Health (OWH) and published in JAMA Open Network.

Key findings from the study:

  • In-hospital deaths decreased 57%, from 10.6 per 100,000 discharges in 2008 to 4.6 per 100,000 discharges in 2021 across the U.S.
  • Mortality rates decreased across all racial and ethnic groups during the study period:
    • American Indian women decreased 92%
    • Asian women decreased 73%
    • Black women decreased 76%
    • Hispanic women decreased 60%
    • Pacific Islander women decreased 79%
    • White women decreased 40%
  • The decline in deaths during delivery hospitalizations likely demonstrates the impact of national and local strategies to improve the quality of care by hospitals during delivery-related hospitalizations, including HHS quality improvement activities such as:
    • Perinatal Quality Collaboratives
    • Alliance for Innovation on Maternal Health
  • The study did find an increasing trend in severe maternal morbidity (SMM), which are serious pregnancy-related complications that have significant consequences to a women’s overall short and long-term health, in all racial and ethnic groups, from 146.8 per 10,000 discharges in 2008 to 179.8 per 10,000 discharges in 2021.
    • The highest overall rates of SMM were observed in Asian, American Indian and Pacific Islander women.

Read the full release from HHS.

AzHHA is proud to serve as a leader in the Arizona Alliance for Innovation on Maternal Health (AIM) Collaborative. Through this program, AzHHA helps hospitals and clinics in our state to implement maternal evidence-based practices and safety bundles. Learn more about the Arizona AIM Collaborative.


Friday, July 21 – 2023 Summer State of the State, Flagstaff Medical Center’s McGee Auditorium 
Register and receive $15 off registration with code azhha2023 at checkout. 

Thursday, Aug. 31 - Introduction to POLST  
Join physician orders for life-sustaining treatment paradigm (POLST) for their one-hour virtual workshops equipping healthcare professionals with knowledge and resources to begin using POLST in Arizona. The objectives are to describe what POLST is at the state and national level, explain why POLST is important, define the population for POLST, when to begin the conversation and who completes POLST, describe the process for completing, reviewing and updating POLST, and learn the process of submitting healthcare planning documents to the Arizona Healthcare Directive Registry. Register now.

Friday, Sept. 15 – AIM Collaborative Conference 
Register now for our second annual event focusing on AIM’s obstetric hemorrhage maternal health bundle. Hear from engaging speakers from around the state presenting on maternal health initiatives and integrating health equity into patient care. Attendees will include clinicians and executives from hospitals and birthing facilities, leaders from state agencies, community partners, not-for-profits, tribal healthcare and students. Sponsorship opportunities are available; contact [email protected]. 


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