Tinnitus From COVID Vax? Docs Replaced by NPs, PAs; Ambulance Bills Still Surprise

Welcome to the latest edition of Investigative Roundup, highlighting some of the best investigative reporting on healthcare each week.

Tinnitus From COVID Vax?

There is mounting evidence from scientific studies and case reports that COVID-19 vaccines might be connected to rare cases of severe tinnitus, but some experts remain skeptical, National Geographic reports.

Several companies and organizations have acknowledged that tinnitus -- a common symptom of about 200 different disorders affecting more than 25 million Americans -- could be linked to the vaccine.

Last year, the European Medicines Agency warned that tinnitus could be a potential adverse effect of the AstraZeneca vaccine, and Australia updated the Novavax label to include tinnitus as a potential adverse effect.

In the U.S., more than 16,000 people reported experiencing tinnitus after receiving a dose of the COVID-19 vaccine, according to NatGeo. Some have reported experiencing it within hours of receiving the dose, while others reported developing it days or weeks later.

Still, some remain skeptical of the potential association. Paul Offit, MD, of the Children's Hospital of Philadelphia, told NatGeo that "[a]s a general rule, side effects associated with vaccines are associated with the immune response to the vaccine."

Martha Sharan, a spokesperson for the CDC, said the agency does "not have sufficient evidence from our surveillance to justify launching an epidemiologic study," the article stated.

However, Sharan said the CDC is "not dismissing it, and we'll continue to monitor it, but there's nothing that shows us that there's a safety problem between COVID-19 [vaccine] and tinnitus."

Staffing Group Replaces Doctors With NPs, PAs

One physician contract management group is reducing costs by replacing doctors with nurse practitioners and physician assistants, according to a report by KHN.

Hospitals like Tennova Healthcare in Clarksville, Tennessee have been outsourcing their emergency departments to medical staff management groups, which are in turn employing fewer physicians as a way to cut costs and increase earnings, according to a confidential company document obtained by KHN.

American Physician Partners took over the staffing of Tennova's emergency department in 2019. The confidential company document explains the strategy to replace physicians with NPs and PAs, who often perform many of the same responsibilities as physicians, generate similar revenue for the company, and receive "less than half the pay," according to KHN.

The document states that American Physician Partners "has numerous cost saving initiatives underway as part of the Company's continual focus on cost optimization." Those initiatives reportedly include a "shift of staffing" from doctors to NPs and PAs.

American Physician Partners told KHN that their staffing strategy is a way to ensure all emergency departments remain fully staffed. They also told KHN that this "blended model" allows physicians, NPs, and PAs "to provide care to their fullest potential."

Critics say this strategy saves money at the expense of care quality. American Physician Partners is 50% owned by private equity firm BBH Capital Partners.

Patients Still Not Protected From Surprise Ambulance Bills

Despite a recent federal law that banned most surprise medical bills, patients are still not protected from surprise bills for ambulance trips, according to STAT.

Roughly 85% of all emergency ambulance trips are considered to be out-of-network, which can cost between $500 and $750 for one ride at a minimum, STAT reported. Patients who need an ambulance are not in a position to shop for those services, leaving most people without a means to avoid those surprise out-of-network bills.

Despite recent action on other forms of surprise medical billing, STAT found "no traction" for more legislation to address this issue in Congress in the near future. While the No Surprises Act did create an ambulance advisory committee designed to further study patient billing and make recommendations, that committee has still not held its inaugural meeting.

Patricia Kelmar, of the consumer advocacy group U.S. PIRG and a member of the federal ambulance advisory committee, told STAT that it's "really troubling" that patients continue to receive these surprise ambulance bills with "no recourse."

One the reasons that addressing surprise ambulance bills is difficult is that the U.S. has a "patchwork system of ambulances," the article stated. While research has shown that local fire departments and municipalities operate the majority of the country's ambulances, private equity companies operate up to 10% of all ambulances.

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