Friday Stats and More

David Ermer

I am an attorney who practices law in Washington DC. My practice has involved the Federal Employees Health Benefits Program since 1983.

Friday Stats and More

David Ermer–CDC, COVID-19, COVID-19 vaccine, OPM, Patient safety, U.S. Healthcare–

Based on the Centers for Disease Control’s COVID-19 Data Tracker website, here is the FEHBlog’s chart of new weekly COVID-19 cases and deaths over the 14th week of 2020 through 18th week of this year (beginning April 2, 2020, and ending May 5, 2021; using Thursday as the first day of the week in order to facilitate this weekly update):

and here is the CDC’s latest overall weekly hospitalization rate chart for COVID-19:

The FEHBlog has noticed that the new cases and deaths chart shows a flat line for new weekly deaths  because new cases greatly exceed new deaths. Accordingly here is a chart of new COVID-19 deaths over the period (April 2, 2020, through May 5, 2021):

The Wall Street Journal observes and the charts evidence that

The U.S. may finally have turned a corner in the Covid-19 pandemic, according to epidemiologists and public-health officials.

Newly reported coronavirus cases have declined for three straight weeks, and the seven-day average of Covid-19 PCR tests that returned positive is hovering around 4%, one of its lowest points in the pandemic. Hospitalizations have been declining and reported deaths have fallen every week since late March.

The decrease in nearly every key metric comes as the U.S. meets a benchmark in its vaccination campaign. More than 40% of the adult population is now fully vaccinated, which many public-health experts say is an important thresholdwhere vaccinations gain the upper hand over the virus.

Here is a weekly COVID-19 vaccinations chart over the period December 17, 2020, through May 5, 2021, which also uses Thursday as the first day of the week:

The Centers for Disease Control observes

Following a rapid acceleration in vaccination rates, we are now seeing U.S. vaccination progress slow. This is not surprising considering the prior focus on vaccinating people at increased risk. Also, people eager to be immunized when they became eligible may have already secured their vaccine in line with increased supply. While more than 8 in 10 people 65 years and older have received at least one dose of vaccine, only around 1 in 3 people ages 18-29 have. All age groups currently eligible for the vaccine can benefit from the protection it provides themselves and others, especially as more states are easing prevention measures. 

Also from the COVID-19 vaccination front:

  • The Society for Human Resources Management provides helpful guidance to employers on how to help achieve herd immunity.
  • The CDC’s Advisory Committee on Immunization Practices will vote on Wednesday May 12 on whether to extend Pfizer’s emergency use application for its COVID-19 vaccine to children ages 12-15.
  • The Wall Street Journal reports that “AstraZeneca PLC could skip asking the Food and Drug Administration for emergency-use authorization for its Covid-19 vaccine, according to people familiar with the matter—and instead pursue the more time-intensive application for a full-fledged license to sell the shot.”
  • Law professor Richard Epstein weighs in on the hot topic of “Intellectual Property and the COVID-19 vaccines.”

From the healthcare business front

  • Healthcare Dive reports on Cigna’s 1st quarter 2021 results. The health insurer “beat Wall Street expectations in the quarter, and increased its forecast for the full year, signaling optimism for the remainder of 2021 despite the ongoing uncertainty.”
  • Fierce Healthcare reviews several health insurers’ first quarter 2021 results.

In other news —

  • The FEHBlog understands why according to Becker’s Payer Issues, 95% of insurers “are worried about meeting No Surprises Act requirements by [the January 1, 2022] deadline. Congress created an overcomplicated law. Hopefully the regulators can straighten it out in time.
  • The American Hospital Association questions the Lown Institute report on low value hospital care that the FEHBlog mentioned earlier this week.
  • Health Payer Intelligence brings us up to date on electronic attachments to HIPAA standard claims transactions, the one HIPAA requirement that HHS has not been able to tackle successfully.
  • Strangely, a British website helpfully summarizes the path of Kiran Ahuja to become OPM Director. “At her hearing, Ahuja said: “I believe people are, and should be, at the centre of all policy decisions, and… I would carry forward this guiding principle while working in service to the American public.” It remains to be seen whether the Senate, in a time of division, accepts that Ahuja can be the unifier the US public service needs.” My bet remains on confirmation.

Thursday Miscellany

David Ermer–COVID-19, COVID-19 vaccine, Telehealth, U.S. Healthcare, Uncategorized–
Photo by Juliane Liebermann on Unsplash

Today is the first day of National Nurse’s Week. The well-deserved celebration begins each year on May 6th and ends on May 12th, Florence Nightingale’s birthday. What a marvelous profession.

Meanwhile Healthcare Dive reports that

  • Last year marked a historic shift in the organization of medicine, with fewer than half of U.S. doctors working in a private practice, according to the latest American Medical Association Physician Practice Benchmark Survey. And among those private practices that continue to operate, many are trending toward a larger size.
  • According to the report, 50.2% of physicians were employees, up from 47.4% in 2018 and 41.8% in 2012. The proportion of doctors working in a private practice was 49.1% last year.
  • Hospitals are one of the largest employers of physicians, with the proportion increasing nearly 50% between 2012 and last year. And with the vast majority of doctors under the age of 40 now employees rather than employers, it suggests the trend will continue over the long term.

The Raleigh (NC) News-Observer reports that

CVS [Health] announced Wednesday it’s joining the list of pharmacies offering people the coronavirus vaccine without requiring an appointment, spokesperson Matt Blanchette told McClatchy News. Same-day scheduling as soon as one hour ahead of time is also available.  Walk-ins are available at 8,300 CVS locations across the country, Blanchette said. The company has more than 9,900 locations across 49 states, Washington, D.C., and Puerto Rico. 

The New York Times adds that “Chains like Walmart, Walgreens, Safeway and Stop & Shop have said that they are now offering vaccines to walk-in clients at some locations or in mobile clinics. Other pharmacies preceded the president’s announcement. Rite Aid said that it would accommodate walk-ins on a limited basis last week, for example.” Let’s go.

Forbes reports that Pfizer-Biontech and Moderna will apply for full FDA marketing approval of their respective COVID-19 vaccines later this month.

The FDA authorized the Moderna vaccine under an EUA on Dec. 18, after granting the same authorization to the Pfizer Covid-19 vaccine. The FDA can grant emergency use authorizations when a panel of experts determine the “known and potential benefits outweigh the known and potential risks,” and when the secretary of Health and Human Services determines a health crisis deems emergency use of unapproved products “appropriate.” Pfizer announced Monday it would file for full FDA approval, and it’s likely Johnson & Johnson, manufacturers of the only other Covid-19 vaccine authorized for emergency use in the U.S., will file for full FDA approval as well. Emergency use authorizations can be revoked when public health crises subside, and FDA approval would allow companies, like Moderna and Pfizer, to directly market their vaccines to consumers. 

FLASH: Politico reports that Pfizer/BioNTech applied for full FDA approval on Friday May 7.

Errata: The FEHBlog included in a post last month an erroneous report that Moderna had filed for FDA approval. He had understood that the application was overdue. Whoops.

Forbes further informs us

Moderna announced Wednesday its booster shot showed a positive immune response against the Covid-19 variants found in South Africa and Brazil. Moderna is testing booster shots in individuals who already received their two-dose Moderna vaccine regimen. [Moderna CEO Stephane] Bancel has said he expects booster shots will be necessary, and Pfizer CEO Albert Bourla said it’s “likely” vaccinated individuals will need a booster within a year of being fully vaccinated. 

From the healthcare business front —

  • According to the Wall Street Journal “Walmart Inc. said Thursday it purchased telehealth provider MeMD and plans to offer nationwide virtual healthcare services, another sign of the retail behemoth’s healthcare ambitions. The acquisition will allow Walmart to expand its Walmart Health service around the country, the company said. The retail giant didn’t disclose the financial details of the transaction.
  • The Journal further reports that ‘The MeMD deal opens another front in which Walmart and Amazon will compete, as Amazon recently announced plans to provide its telehealth service, Amazon Care, to its nearly 1 million U.S. employees by summer. Amazon Care, which now serves company workers in Washington state, will also be offered to other employers.” STAT News informs us that “Amazon Care signed its first enterprise customer this week, a significant milestone as the virtual-first health care platform looks to expand its footprint. The client, Precor, is a fitness business that was recently acquired by fitness technology company Peloton for $420 million in cash. Although small financially, the deal is a significant opener for Care.”
  • Healthcare Dive adds that “Nearly two out of three healthcare leaders say they’re currently prioritizing investment in telehealth as the pandemic continues, but that could change over the next few years, when investing in artificial intelligence shoots up the list of priorities, according to a new report from health tech giant Philips.”

Midweek Update

David Ermer–ACA, COVID-19, Mental health care, OPM, Telehealth–
Photo by Thought Catalog on Unsplash

OPM has released the 2020 highlights of its FEHB Plan Performance Assessment System. With this system, the 2020 plan scores which are based on 2019 data are used to determine the 2021 service charge for experience rated plans and the 2021 performance adjustment for community rated plans. 2020 was a tricky scoring year because the data was being gathered and analyzed just as the great hunkering down began in March 2020.

Reg Jones provide FEHB background for federal employees in Fedweek.

On the COVID-19 front, Bloomberg discusses the work of the federal government’s recently created COVID-19 Community Corps. The article discusses a Maine dairy farmer who set up a COVID-19 vaccination clinic for her employees and community members. “Organized in small teams that run the gamut from veterans and religious groups to progressive youth organizations and a Black LGBTQ group, the corps has been in the forefront of reaching the reluctant. The idea is that this wide demographic outreach will radiate, so that the friends and neighbors of the vaccinated follow suit.” Bravo.

WTOP, a local news radio station here in Washington DC reports that Pfizer “will seek [emergency] approval for use [of its COVID-19 vaccine] in children between 2 and 11 years old as early as September.

In other healthcare news

  • Mobihealth News reports that “On-demand behavioral health platform Ginger is now available as a health benefit for Cigna’s 14 million members, the companies announced [on April 28]. Members with Cigna’s employer-sponsored or individual and family insurance plans can now access Ginger’s behavioral health coaching, therapy and psychiatry services as an in-network benefit.” Smart move.
  • Healthcare Dive reports that “Telehealth utilization among the commercially insured fell 16% from January to February, the first month-to-month drop since September, according to a tracker from nonprofit Fair Health. The data suggests a potential slowdown in demand for virtual care services that spiked last year in the early months of COVID-19. Historically high levels of telehealth utilization spurred an unprecedented influx of cash into the digital health sector, but the sustainability of that boom depends in part on continued demand from consumers that could be waning as vaccinations increase and the pandemic wanes. Mental health conditions continued to top the list of diagnoses. However, COVID-19, which joined the top five diagnoses list in December, dropped from the list, likely reflecting the national decline in cases in February.”
  • Since Monday the FEHBlog has been looking at the Health Affairs blog to post here Katie Keith’s follow up post on the 457 page long second final ACA notice of benefit and payment parameters. It turns out that he had posted Prof. Keith’s follow up post on Monday and that the lead entry was made last Saturday May 1. Here are the links to Prof. Keith’s lead and follow up posts on that important ACA rule making. Considering it’s Cinqo de Maio, lo siento lectors.

The FEHBlog hasn’t mentioned the Econtalk podcast in a while but he does listen every week. This week the host Russ Roberts spoke with behavioral scientist Katy Milkman of the Wharton School at the University of Pennsylvania talks about her new book How to Change: The Science of Getting from Where You Are to Where You Want to Be.” Professor Milkman talks about soft commitment strategies [to achieve goals] and hard commitment strategies. An example of a soft commitment strategy involved a doctor posting a letter visible to patients committing to specific Choosing Wisely recommendations such as proper prescribing of antibiotics. As for hard commitments she notes this example, which was news to the FEHBlog, “websites like StikK and Beeminder that let you fine yourself if you’re not achieving your goals.” She also discusses the carrot strategy .”The carrot is, let’s actually figure out ways to make it more enjoyable in the moment, and that way your willpower won’t be needed to do the thing that’s good for you.” An example is binging junk TV while using the treadmill. Their discussion on self control is fascinating. Check it out.

Tuesday’s Tidbits

David Ermer–COVID-19, COVID-19 vaccine, Mental health care, OPM, U.S. Healthcare–
Photo by Patrick Fore on Unsplash

The Wall Street Journal reports

The Biden administration said it would begin reallocating some Covid-19 vaccine doses to states with higher demand for shots and direct pharmacies to offer walk-in vaccinations, as the president aims to get 70% of the adult population at least one dose by July 4.

President Biden said Tuesday he also wants 160 million U.S. adults to have the full course of the vaccine by that point, which he said would mean administering about 100 million shots over the next 60 days. The U.S. administered about 220 million shots in Mr. Biden’s first 100 days, but the pace of vaccinations has fallen in recent weeks, according to the Centers for Disease Control and Prevention. Roughly 56% of U.S. adults had received at least one dose as of Monday, according to the CDC.

Also from the COVID-19 front, the NIH Director Dr. Francis Collins offers a real world look at COVID-19 vaccines versus variants.

Healthcare Dive reports

  • CVS Health beat Wall Street expectations for earnings and revenue in the first quarter, reporting a topline of $69.1 billion, up 3.5% year over year due to growth across all major businesses.
  • The diversified healthcare behemoth brought in net income of $2.2 billion, compared to $2 billion at the same time last year in financial results released premarket Tuesday. 
  • Following the quarter, which saw a strong financial showing from all major U.S. payers, CVS raised its full-year earnings guidance, noting it expects normal utilization throughout 2021 and minimal effects from the COVID-19 pandemic. However, management did warn vaccine hesitancy could slightly hamper expected earnings growth.

In related CVS news —

  • NPR Shots informs us about how CVS Health is adding mental health therapists to its Minute Clinics and Health Hubs.
  • Drug Channels places CVS Specialty at the top of its list of top 15 specialty pharmacies.

In other healthcare business news

  • STAT News informs us that “Although the pharmaceutical industry argues that wholesale prices do not accurately reflect prescription drug costs, a new study finds that rising wholesale prices have, in fact, led to higher out-of-pocket expenses for roughly half of insured patients.” Shocking.
  • The Wall Street Journal reports that “Pfizer Inc. raised this year’s sales forecast for its Covid-19 vaccine to about $26 billion, a 73% increase that reflects the shot’s growing role in a long-term global vaccination campaign.” Thanks Pfizer.
  • Health Payer Intelligence reports

Gross margins and medical loss ratios from 2020 may confirm that payer profitability increased during the coronavirus pandemic, according to a brief from Kaiser Family Foundation.

The researchers leveraged data from the National Association of Insurance Commissioners (NAIC) to observe the pandemic’s effects on the profitability of four health insurance markets: Medicare Advantage, Medicaid managed care, the individual health insurance marketplace, and the fully-insured group health insurance marketplace.

“By the end of 2020, gross margins per member per month across these four markets remained relatively high and medical loss ratios were relatively low or flat compared to recent years,” the researchers discerned. “These findings suggest that many insurers remained profitable through 2020.”

Here are some additional healthcare tidbits —

  • The Lown Institute announced that “Every 80 seconds, a hospital in the U.S. delivers a low-value test or procedure to an older adult, putting hundreds of thousands at risk of harm, according to a new analysis from the Lown Institute, a health care think tank. The Institute today released a ranking of over 3,100 U.S. hospitals that examines success at avoiding the use of tests and procedures that offer little to no clinical benefit.”
  • The Congressional News Service released a helpful report titled “A Comparison of Tax-Advantaged Accounts for Health Care Expenses.”
  • The Department of Health and Human Services announced “the availability of nearly $1 billion to strengthen COVID-19 response efforts and increase vaccinations in rural communities. As part of the Biden Administration’s commitment to expanding access to vaccines and ensuring equity in the COVID-19 response, the Health Resources and Services Administration, a part of HHS, will increase the number of vaccines sent to rural communities, expand testing and other COVID-19 prevention services, and work to increase vaccine confidence by empowering trusted local voices with additional funding for outreach efforts in underserved communities.”

Last but not least here are some federal employment tidbits —

  • The Office of Personnel Management reminds us that “Each year Federal Executive Boards (FEBs) across the nation recognize federal employees who have made exceptional contributions in their community or the advancement of their agency’s mission. This year, OPM and the Partnership for Public Service are highlighting more than 300 awards winners from FY2020 and FY2021. To learn more about these recipients and their exemplary accomplishments, visit the FEB awards site.  “
  • Federal News Network reports that “Union leaders say staffing shortages are stretching their agencies thin.”
  • Govexec reports that “Some U.S. Postal Service employees will receive layoff notifications later this month, the mailing agency told workers in a memorandum this week. * * * USPS declined to specify how many positions would be eliminated, but said it aims to offer impacted workers opportunities for reassignment.”

Monday Roundup

David Ermer–CDC, CMS, COVID-19, OPM, U.S. Healthcare–
Photo by Sven Read on Unsplash

The Office of Personnel Management reminds us that this is Public Service Recognition Week. “Celebrated annually during the first week of May since 1985, Public Service Recognition Week (PSRW) (external link) is time set aside to honor the men and women who serve our nation as federal, state, county and local government employees.”

From the COVID-19 front:

The Food and Drug Administration is preparing to authorize use of the Pfizer-BioNTech Covid-19 vaccine in adolescents 12 to 15 years old by early next week, according to federal officials familiar with the agency’s plans, opening up the nation’s vaccination campaign to millions more Americans.

The news is highly anticipated: Eager parents have been counting down the weeks since Pfizer announced results from its trial in adolescents, showing the vaccine is at least as effective in that age group as it is in adults. Vaccinating children is also key to raising the level of immunity in the population and bringing down the numbers of hospitalizations and deaths.

The authorization could come as early as late this week, according to the federal officials, who did not give their names because they weren’t authorized to speak publicly. If it is granted, the Centers for Disease Control and Prevention’s vaccine advisory panel will likely meet the following day to review the clinical trial data and make recommendations for the vaccine’s use in adolescents.

  •  The Wall Street Journal informs us

Everyone who was desperate for a vaccine has gotten a shot, said Alexandra Simon, the California director of vaccines for Curative, a Covid-19 testing and health-services company administering vaccines across the country. The company is now seeing people with access issues, including questions about insurance or identification, and fears about being unable to take care of children because of side effects. Many people, she said, simply can’t take time off. Others only want an appointment on Thursday or Friday, or prefer a site with the vaccine from Pfizer Inc. and BioNTech SE, said Curative’s chief information officer, Isaac Turner.

But the fact that supply now exceeds immediate demand means getting vaccinated is a much easier process. That message may be getting across because over 3.3 million doses of COVID-19 vaccine were administered Sunday per the CDC.

  • The Wall Street Journal also hopefully reports that “The next generation of Covid-19 vaccines in development could come as a pill or a nasal spray and be easier to store and transport than the current handful of shots that form the backbone of the world-wide vaccination effort.”

Good advice from the American Medical Association (“AMA”)

  • The AMA offers six lifestyle changes that can prevent heart disease.
  • The AMA also recommends eight keys to ending the drug overdose crisis.

In healthcare business news, the Wall Street Journal reports that

The Blue Cross Blue Shield Association said it dropped a rule that limited competition among its member insurers, moving to implement a key aspect of an antitrust settlement the companies reached last year with customers. * * *

Previously, the rule was that two-thirds of a Blue licensee’s national net revenue from health plans and related services must stem from Blue-branded business.

The Blue Cross Blue Shield Association includes 35 insurers, each of which typically hold exclusive rights to the Blue Cross and Blue Shield brands within a certain territory, a setup that would remain intact under the antitrust settlement.

However, lifting the revenue cap could allow the Blue insurers to compete more against one another by expanding their non-Blue businesses, experts said. Dropping the limit “certainly should increase competition,” said Tim Greaney, a professor at the University of California Hastings College of the Law, though he said it isn’t clear how quickly it would have an effect.

Following up on a couple of items from Friday’s post:

  • The FEHBlog mentioned that a company called ClosedLoop.ai had won a million dollar healthcare artificial intelligence prize from the federal government. The FEHBlog couldn’t figure out what the prize winning invention did. STAT News tells us that ClosedLoop.ai “bested 300 rivals with a system capable of forecasting adverse health events by crunching an array of data on patients.” Nifty.
  • The FEHBlog also pulled the key tidbit from the 457 page long HHS second notice of 2022 benefit and payment parameters. Katie Keith in the Health Affairs blog provides much more detail for all those interested.

Weekend Update

David Ermer–Congress, COVID-19, COVID-19 vaccine, U.S. Healthcare–
Photo by Michele Orallo on Unsplash

This coming week, the House of Representatives is engaged in Committee business and the Senate is on a State work break.

From the COVID front, Bloomberg reports on a UK study finding that taking only one dose of the Pfizer OK may be sufficient for a person who has survived a COVID-19 infection but not for others.

The study appears to contrast with other research that has suggested the first dose of Pfizer’s shot provides a strong level of protection against Covid, including some variants. That’s in part because it examined the level of people’s immune responses, rather than real-world infection levels.

Still, the findings offer a warning for countries like the U.K., where the majority of vaccinated people have had only a single dose of inoculations like Pfizer’s that require two shots to offer full protection.

In other vaccination news, Precision Vaccinations explains that

The HPV vaccine was designed to prevent reproductive warts and cancers caused by the most common sexually transmitted infection in the United States. The FDA approved the vaccine for women in 2006 and expanded it to men in 2009.

Preventing cervical cancer was the primary focus at that time, so girls and women were more likely to hear about it from their pediatricians or OBGYNs. 

Yet oropharyngeal cancer, which occurs in the throat, tonsils, and back of the tongue, has now surpassed cervical cancer as the leading cancer caused by HPV.

Data indicates 80% of those diagnosed with oropharyngeal cancer are men.

“I don’t think that a lot of people, providers, and patients, are aware that this vaccine is a cancer-prevention vaccine for men as well as women,” Chen says. “But HPV-associated oropharyngeal cancer can impact anyone.”

“And there’s no good screening for it, which makes vaccination even more important.”

With respect to general preventive services, Fierce Healthcare informs us that

CVS Health is expanding its program to offer no-cost, community-based screenings to 14 more markets.

Project Health, which is now in its sixteenth year, offers a slew of free biometric screenings at CVS Pharmacy locations, including blood pressure, glucose levels and cholesterol. Patients can then meet with a nurse practitioner, who can provide additional guidance and referrals for treatment if needed.

New markets include Birmingham, Alabama; Phoenix; Jacksonville, Orlando and Tallahassee, Florida; Baton Rouge and New Orleans, Louisiana; Jackson, Mississippi; Charlotte, North Carolina; Cleveland, Ohio; Charleston and Columbia, South Carolina; and Knoxville and Memphis, Tennessee, CVS said in announcement provided first to Fierce Healthcare.

The program is also launching four new mobile units, CVS said, and anticipates providing 1,700 screening events across its 32 markets by the end of the year.

From the relevant history front, the Wall Street Journal’s Saturday Essay compares the 1957-58 flu pandemic with our current COVID-19 pandemic. In both cases, a rapidly developed vaccine was made available to the public.

From 1948 to 1957, Maurice Hilleman—born in Miles City, Mont., in 1919—was chief of the Department of Respiratory Diseases at the Army Medical Center (now the Walter Reed Army Institute of Research).

Early in his career, Hilleman had discovered the genetic changes that occur when the influenza virus mutates, known as “shift and drift.” It was this work that enabled him to recognize, when reading reports in the press of “glassy-eyed children” in Hong Kong, that the outbreak had the potential to become a disastrous pandemic. He and a colleague worked nine 14-hour days to confirm that this was a new and potentially deadly strain of flu.

Speed was of the essence, as in 2020. Hilleman was able to work directly with vaccine manufacturers, bypassing “the bureaucratic red tape,” as he put it. The Public Health Service released the first cultures of the Asian influenza virus to manufacturers even before Hilleman had finished his analysis. By the late summer, six companies were producing his vaccine.

It has become commonplace to describe the speed with which vaccines were devised for Covid-19 as unprecedented. But it was not. The first New York Times report of the outbreak in Hong Kong—three paragraphs on page 3—was on April 17, 1957. By July 26, little more than three months later, doctors at Fort Ord, Calif., began to inoculate recruits to the military.

Wait there’s more, according to his 2005 obituary, Dr. Hilleman invented vaccines for measles, mumps, rubella, Hepatitis A, Hepatitis B and pneumonia.

In closing here is an interesting Bloomberg interview with Shahid Jameel, director, Trivedi School of Biosciences, Ashoka University, which is located in the state of Haryana, India. The interview concerns the COVID-19 crisis in that country.

BG: What’s the biggest challenge now?

SJ: To bring things under control, you want to vaccinate more people on a daily basis than the number of new infections. Remember that a person who gets the first shot today will get the second shot in four to six weeks, and will need two more weeks to develop full immunity. So somebody who starts vaccination today will take two months to develop protective immunity.

This means the vaccination drive has to be sustained over months, many more doses daily than cases. Only then can we reverse the surge.

BG: Is the supply of vaccines sufficient to maintain that pace?

SJ: One of the critical errors we made was in vaccine procurement. In January, the government ordered only 11 million doses [from Serum Institute located in India]. Between Serum Institute and Bharat Biotech, we can currently produce roughly 90-100 million doses in a month. But they also have exports commitments, especially to the WHO’s COVAX program. 

Meanwhile, India has begun to accept vaccine registration from anyone aged 18 or older. In total, we’re talking about 800 million people, or 1.6 billion doses. It’s going to be a struggle.

The BBC offers more background on the Indian crisis. Needless to say, the world needs to help India.

Cybersecurity Saturday

David Ermer–Cybersecurity–

Cyberscoop reports that

The Justice Department is undertaking a four-month review of its approach to combatting a range of malicious cyber activity from foreign governments and criminals amid a spate of ransomware attacks and supply chain compromises.

“We need to rethink … and really assess are we using the most effective strategies” against such hacking, Deputy Attorney General Lisa Monaco said Friday at the Munich Cyber Security Conference.

In this regard —

  • Health IT Security discusses “Healthcare’s Biggest Cybersecurity Blind Spots and Misconceptions — While awareness of the threats facing the healthcare sector has improved, providers have inherent blindspots and misconceptions leaving them exposed to a host of cybersecurity risks.”
  • Health Leaders Media explains why “Medical Device cyber-vulnerability casts a cloud over growing use.”
  • ISACA asks whether there are ever can be normalcy in cyberspace? “The cycle of conducting hearings after hacks occur, followed by writing laws and spending money, is exhausting. In short, doing the same things yet expecting different results is senseless. Lawmakers must accept the fact, known universally by security practitioners, that all digital devices are vulnerable—they always have been and always will be. Cybersecurity is a technical risk and, for the foreseeable future, the goal must be to make cyberattacks costly for malicious actors.”

Here’s the latest on the SolarWinds hack from the American Hospital Association. (The ISACA article’s author adds “But to categorize SolarWinds as merely a hack is a disservice, as it is now understood to be a major cybercampaign involving an estimated 1,000 nation-state actors.”).

From the ransomware front —

  • The New York Times warns “Don’t Ignore Ransomware. It’s Bad.”
  • The International Foundation of Employee Benefit Plans sets forth “Five Ransomware Risk Mitigation Strategies” for benefit plan administrators. The FEHBlog adds encrypting data in motion and at rest to that list.

The National Institutes of Standards and Technology is seeking public comments on two cybersecurity documents:

Friday Stats and More

David Ermer–ACA, CMS, COVID-19, U.S. Healthcare–

Based on the Centers for Disease Control’s COVID-19 Data Tracker website, here is the FEHBlog’s chart of new weekly COVID-19 cases and deaths over the 14th week of 2020 through 17th week of this year (beginning April 2, 2020, and ending April 28, 2021; using Thursday as the first day of the week in order to facilitate this weekly update):

and here is the CDC’s latest overall weekly hospitalization rate chart for COVID-19:

The FEHBlog has noticed that the new cases and deaths chart shows a flat line for new weekly deaths  because new cases greatly exceed new deaths. Accordingly here is a chart of new COVID-19 deaths over the period (April 2, 2020, through April 28, 2021):

Finally here is a COVID-19 vaccinations chart over the period December 17, 2020, through April 28, 2021 which also uses Thursday as the first day of the week:

As of yesterday, 39% of the U.S. population over age 18 and 68.8% of those over age 65 have been fully vaccinated. The Centers for Medicare & Medicaid Services Office of Minority Health will host a May 13 webinar on building COVID-19 vaccine confidence. Register for the 12 p.m. ET webinar here. The FEHBlog already has done so.

The American Hospital Association reports that “The Centers for Medicare & Medicaid Services today released a second final notice of benefit and payment parameters to implement standards governing health insurance issuers and marketplaces for 2022 that were not finalized in the Jan. 19 final rule. CMS chose not to finalize the proposed premium adjustment percentage and instead finalized a lower percentage, resulting in lower maximum out-of-pocket costs for consumers ($8,700 for individuals and $17,400 for families) than originally proposed.” These are the 2022 out of pocket maximums on in-network cost sharing that apply to FEHB plans. Here’s a link to the HHS press release which promises even more guidance down the road.

The Centers for Medicare and Medicaid Services announced the winner and runner-up in its healthcare artificial intelligence competition today. “Out of more than 300 initial entries, ClosedLoop.ai was chosen as the grand prize winner and will receive up to $1 million in prize money. Based in Austin, Texas, the company is a leader in developing healthcare data science solutions. Challenge Runner-Up Geisinger, a non-profit healthcare system based in Danville, Pennsylvania [and the carrier of an FEHB plan], will receive up to $230,000 in prize money.” Congratulations.


Thursday Miscellany

David Ermer–CMS, COVID-19, COVID-19 vaccine, Federal employment benefits, OPM, Patient safety, Telehealth, U.S. Healthcare–
Photo by Mel on Unsplash

Today the U.S. Office of Personnel Management released guidance to federal agencies on American Rescue Plan Act “provisions authorizing emergency paid leave (EPL) for covered Federal employees in specified qualifying circumstances through special funds.” The Federal News Network offers information on how federal employees can apply for EPL.

From the COVID-19 front, the Wall Street Journal reports that Astra-Zeneca now expects to file an emergency use application for its COVID-19 vaccine with the Food and Drug Administration in the middle of next month.

“One especially time-consuming task has been compiling British data from almost four months of vaccinations in the U.K., including efficacy, virus-transmission and safety statistics, people close to the process say. That has added to the complexity of AstraZeneca’s submission and is expected to lengthen any FDA review. Other shots that the FDA has authorized had large-scale human trial data but little or none from real-world rollouts outside of controlled studies.”

No good deed, etc.

From the patients safety front, the Leapfrog Group released its Spring 2021 hospital safety grades yesterday. The two hospitals closest in proximity to the FEHBlog’s residence are graded A and B. Beckers Hospital Review helpfully points out the 27 hospitals with straight A scores and F scores. Meanwhile, Healthcare Finance reports that

The Centers for Medicare and Medicaid Services on Wednesday released the overall hospital quality star ratings that now include new methodology in five measure groups.

CMS rated over 4,500 hospitals from one to five stars, with five representing the highest quality rating.

Of 4,586 hospitals, 13.5%, or 455 hospitals, received five stars; 988 received four stars; 1,018 received three stars; 690 received two stars; and 204 received one star.

For more than a quarter of hospitals, 1,181, no information was available.

This compares to January 2020 data, when of the 5,340 hospitals listed, 396 received five stars; 1,132 received four stars; 1,108 got three stars; 710 received two stars; and 226 got one star. Another 1,761 had no rating information available.

Furthermore, the Centers for Disease Control released a new study setting a “Baseline to Measure Quality of Antibiotic Prescribing in U.S. Hospitals.”

Since 2015, when the prescribing data were collected, CDC has been working diligently with partners like the American Hospital Association and others to implement stewardship efforts and programs in acute care.

CDC will continue building on this progress and important work in the coming years as a part of the newly released Combating Antibiotic-Resistant Bacteria National Action Plan. Good luck with that effort.

In healthcare business news:

  • Healthcare Dive informs us that ” Virtual care powerhouse Teladoc reported a wider-than-expected net loss in the first quarter, but beat Wall Street estimates on revenue with a topline of $454 million, up 151% year over year, driven by growth in specialty offerings and multi-product contracts. * * * CEO Jason Gorevic contended he is unworried about mounting competition in the lucrative telehealth space, banking the company’s heft and variety of clinical services will fend off entrenched rivals and new entrants like Amazon.”
  • Fierce Healthcare advises “Do not expect the Biden administration to pull away from price transparency even though the administration wants to pull a requirement for hospitals to post Medicare Advantage rates, experts say. The proposal included in a hospital inpatient payment rule released late Tuesday is more aimed at easing administrative burdens for hospitals still struggling due to the pandemic, several experts said. “The repeal of this requirement more falls into the bucket of easing hospitals’ burden as opposed to the agency’s stance on hospital price transparency,” said Caitlin Sheetz, head of analytics and a director for the consulting firm ADVI, in an interview with Fierce Healthcare.
  • Fierce Healthcare also reports that “Anthem has completed its acquisition of home health benefits manager MyNEXUS, the insurer announced Thursday morning. MyNEXUS offers comprehensive home-based nursing management to health insurers, providing integrated clinical services to some 1.7 million Medicare Advantage beneficiaries in 20 states. The company’s platforms largely automate the visit and authorization, which allows members to access care more quickly, according to the announcement. MyNEXUS will be folded into Anthem’s Diversified business group.”

In benefit design news, Health Payer Intelligence offers a thoughtful article describing key considerations for implementing diabetes management programs.

Midweek Update

David Ermer–CDC, Congress, COVID-19, COVID-19 testing, COVID-19 vaccine, Federal employment benefits, Medicare, U.S. Healthcare–
Photo by Mark Tegethoff on Unsplash

Govexec reports that at the Senate Homeland Security and Governmental Affairs Committee’s business meeting today, the Committee advanced to the Senate floor the nominations of Kiran Ahuja to be OPM Director along party lines and the three nominations of Postal Service Governors with bipartisan margins. The FEHBlog expects these nominations to be brought to the Senate floor next month.

From the COVID-19 front:

  • The Wall Street Journal informs us that “Vaccines appear to be starting to curb new Covid-19 infections in the U.S., a breakthrough that could help people return to more normal activities as infection worries fade, public-health officials say. By Tuesday, 37.3% of U.S. adults were fully vaccinated against Covid-19, with about 2.7 million shots each day. * * * With the U.S. recently averaging at least 50,000 new daily cases, the pandemic is far from over. But the U.S. is nearing a nationwide benchmark of having 40% of adults fully vaccinated, which many public-health experts call an important threshold where vaccinations gain an upper hand over the coronavirus, based on the experience from further-along nations such as Israel.”
  • Today the Centers for Disease Control released a report on the mRNA vaccines. Here are the highlights which support the Journal’s report particularly as over 2/3s of Americans over age 65 are fully vaccinated.

Clinical trials suggest high efficacy for COVID-19 vaccines, but evaluation of vaccine effectiveness against severe outcomes in real-world settings and in populations at high risk, including older adults, is needed.

What is added by this report?

In a multistate network of U.S. hospitals during January–March 2021, receipt of Pfizer-BioNTech or Moderna COVID-19 vaccines was 94% effective against COVID-19 hospitalization among fully vaccinated adults and 64% effective among partially vaccinated adults aged ≥65 years.

What are the implications for public health practice?

SARS-CoV-2 vaccines significantly reduce the risk for COVID-19–associated hospitalization in older adults and, in turn, might lead to commensurate reductions in post-COVID conditions and deaths.

  • The Wall Street Journal also reports that “Covid-19 tests for people to use to get quick results at home are finally becoming available to buy at pharmacies and retailers. Yet an obstacle might stand in the way of regular use: cost. * * * The U.S. Food and Drug Administration recently cleared over-the-counter sales of two of these rapid at-home screening tests, one from Abbott Laboratories and another from Quidel Corp. 

Major pharmacies recently said they plan to sell a two-pack of Abbott’s test for nearly $24, while Walmart says it will charge just under $20. The price for Quidel’s test hasn’t been released, though Quidel has indicated it will be less than $30 for a pair.

“Twenty-five dollars for a Covid test, I think most people would pay that once. But would they pay it every week or every two weeks?” says Zoe McLaren, a health economist and an associate professor in the School of Public Policy at the University of Maryland, Baltimore County. “It’s not designed to be a one-time cost.”

Dr. McLaren and medical-testing experts expressed hope that prices would drop if more companies get clearance to sell paper-strip tests. * * * Public-health authorities say they are glad to see the tests in stores, and the tests will be valuable tools for checking symptoms or for specific occasions, such as traveling or visiting relatives.

From the Medicare front

  • The Centers for Medicare and Medicaid Services released yesterday a proposed fiscal year 2022 Medicare Part A inpatient prospective payment system rule. “The proposed increase in operating payment rates for general acute care hospitals paid under the IPPS that successfully participate in the Hospital Inpatient Quality Reporting (IQR) Program and are meaningful electronic health record (EHR) users is approximately 2.8 percent. This reflects the projected hospital market basket update of 2.5 percent reduced by a 0.2 percentage point productivity adjustment and increased by a 0.5 percentage point adjustment required by legislation.”
  • Healthcare Dive provides its perspective on the proposal which evidently was well received by the hospital industry. “[T]he American Hospital Association applaud[ed] the provision that removes the requirement that hospitals report privately negotiated rates with Medicare Advantage payers on Medicare cost reports and another that repeals market-based weight methodology for determining payments.”

On the FEHB front

  • FedSmith advises that “Federal employees facing a future with children aging out of TRICARE should consider enrolling in an FEHB policy. This is because FEHB plans provide coverage for children in the family option up to age 26. Additionally, the family FEHB premium for the employee, spouse, and children may be less than the cost of the TYA option for one individual. FEHB employees who are eligible for TRICARE and interested in having their children covered in an FEHB plan have to enroll during Open Season. Federal employees with TRICARE also need to enroll in a plan at least a year ahead of retirement for the FEHB plan to be continue in retirement.” Interesting.

On the artificial intelligence front, Forbes lists its top 50 AI companies to watch. Enjoy.