Midweek update

David Ermer

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

Midweek update

David Ermer–CDC, Congress, COVID-19 vaccine, Rx coverage, Telehealth, U.S. Healthcare–
Photo by Manasvita S on Unsplash

From Capitol Hill, STAT News reports that Senate leaders have reached an agreement to extend a Medicare pay bump for health care providers through 2021, a major lobbying win for hospitals.”

The Wall Street Journal reports two Senate confirmations in healthcare positions:

The Senate [today] confirmed Dr. Rachel Levine as assistant health secretary, making her the first openly transgender federal official approved by the Senate.

The vote was 52 to 48, largely along party lines, with GOP Sens. Lisa Murkowski of Alaska and Susan Collins of Maine joining all 50 Democrats.

The pediatrician and former Pennsylvania secretary of health helped steer the state’s response to Covid-19. She has also worked to increase awareness of equity issues that the LGBT community faces and is a professor of pediatrics and psychiatry at Penn State College of Medicine. 

and

Yesterday, the Senate approved Vivek Murthy, President Biden’s pick for surgeon general, by a 57-to-43 vote, marking his second stint in the post, which he held from 2014 through 2017. Dr. Murthy, who was co-chairman of Mr. Biden’s Covid-19 advisory board, has said he would use his position to provide science-based guidelines for ending the coronavirus pandemic.

From the COVID vaccine front, Medscape informs us that

White House officials said at a briefing Wednesday they are still anticipating updated vaccine data from AstraZeneca, after federal officials called Tuesday’s release of interim phase 3 data from the company “outdated information.”

“Right now, AstraZeneca is getting back with the Data and Safety Monitoring Board and will likely come out with an updated statement,” said Anthony Fauci, MD, a top COVID-19 official and chief of the National Institute of Allergy and Infectious Diseases, the agency that complained to the pharmaceutical company that their current information was “incomplete.”

Andy Slavitt, senior White House adviser for COVID-19 response, added: “Our takeaway is the importance of transparency and trust…. I would urge us not to focus on the process of the last couple days, but instead to focus on what really matters, which is what happens when these applications for these candidates are submitted to the FDA.”

FLASH — The Washington Post reported at 10:30 pm Wednesday night that

An updated company analysis of the coronavirus vaccine developed by AstraZeneca and the University of Oxford showed that the two-shot regimen was robustly effective — 76 percent at preventing symptomatic illness — according to a news release from the drugmaker late Wednesday.

The finding, only slightly lower than results announced days earlier, underscores that the vaccine being widely used by many countries appears to be a powerful tool to help end the pandemic. No severe cases of illness were reported in study volunteers who received the vaccine. Among people 65 and older, the vaccine was 85 percent effective, the company reported.

Yesterday, the FEHBlog watched a Wall Street Journal interview with Mr. Slavitt as part of the WSJ’s Health Forum. The FEHBlog really enjoyed this WSJ video featuring reporter Joanna Stern with a COVID vaccine hunter from New Jersey. It’s certainly worth five and half minutes of your day.

HR Dive reports that

Employers should offer paid sick leave to employees with “signs and symptoms” following COVID-19 vaccination, according to guidance updated March 16 by the Centers for Disease Control and Prevention.

Employers should consider on-site vaccination programs if they have a large workforce with predictable schedules and enough space to run a clinic that meets social distancing requirements, CDC said. Employers that choose to offer vaccinations should record each offer and employees’ decisions. Employers should consider off-site vaccination if they are a small- or medium-sized organization lacking the resources to host a vaccination clinic, it said.

The agency also said that whether an employer may require COVID-19 vaccinations is a matter of state or other applicable law but noted that exemptions may apply: Medical exemptions for people who are at risk for an adverse reaction because of an allergy to one of the components used in the vaccine or a medical condition; and religious exemptions for people who reject being vaccinated because of their religious beliefs.

In healthcare business news, Fierce Healthcare lets us know that

Uber is ramping up its prescription delivery business by teaming up with software company ScriptDrop. The ride-share giant will be the default delivery service for ScriptDrop pharmacies in 37 states and will eventually expand to others.

ScriptDrop works with some of the top grocery chains, pharmacy chains and health systems in the U.S., including Albertsons, Jewel-Osco, Safeway and Vons. Through the tie-up with Uber, those pharmacies will be able to leverage the company’s technology to deliver more prescriptions to more customers.

From the report front, the FEHBlog noticed

Finally March 22 to 28, 2021, is National Drug and Alcohol Facts Week. “Held since 2010, NDAFW brings teens and scientific experts together to discuss the scientific facts about drugs, as well as their potential health effects on teen bodies and brains. ”

Tuesday Tidbits

David Ermer–ACA, Congress, COVID-19, COVID-19 vaccine, U.S. Healthcare, Uncategorized–

The FEHBlog was wondering today whether the clinical trial review board had given AstraZeneca a heads up about its concerns with the company’s press release before making the midnight press release on that topic. The New York Times reports that

“Only hours after AstraZeneca announced encouraging news about the effectiveness of its Covid-19 vaccine on Monday, a group of medical experts charged with monitoring the company’s clinical trial made a highly unusual accusation: AstraZeneca had essentially cherry-picked data to make its vaccine look better.

The accusation, in a two-page letter sent Monday to the company and federal officials, was a fresh blow to the credibility of a vaccine whose low price and relatively easy storage have made it critical to the global fight against the coronavirus pandemic.”

In other words, AstraZeneca, which is partnering with the University of Oxford, knew about the credibility concerns yet didn’t pull back the press release in the face of such criticism. The company’s failure to respond lead to a “sharply worded” statement  from the the National Institute of Allergy and Infectious Diseases [issued] on Tuesday shortly after midnight, disclosing the panel’s concerns.

The New York Times explains that

The fight is about the degree of effectiveness of a vaccine that is considered highly safe and effective.

While AstraZeneca said on Monday that its vaccine appeared to be 79 percent effective at preventing Covid-19, the panel of independent experts said the actual number may have been between 69 percent and 74 percent. The mass availability of a vaccine with even a 69 percent efficacy rate could help the world conquer the coronavirus.

But the public airing of a conflict between a pharmaceutical company and a board overseeing a clinical trial is almost unheard-of. It is certain to trigger extra scrutiny of the vaccine by the Food and Drug Administration and other regulators if, as expected, AstraZeneca seeks their authorization to use it on an emergency basis in the United States.

This is a sad state of affairs.

And now for some tidbits

  • The Department of Health and Human Services announced today its decision to the extend the Affordable Care Act marketplace special enrollment period for an additional three months. The last day to enroll will be August 15 instead of May 15, 2021.
  • Fierce Healthcare reports that “The Senate is likely to consider a bill this week that would extend a moratorium on 2% cuts to Medicare payments, according to the American Hospital Association. The extension is a major priority for hospital and doctor groups that say providers are still suffering financially due to the COVID-19 pandemic.”
  • In a piece of good news, Healthcare Dive informs us that

After cancer screenings for breast and colon cancers plummeted at the outset of the COVID-19 pandemic, they rebounded by the end of July, according to a new report in the Journal of General Internal Medicine that analyzed the private insurance claims of 6.8 million people ages 45 to 64.

In fact, the rate of women seeking mammograms was higher by the end of July than in the months leading up to the pandemic. Prior to mid-March, or when the public health crisis began, the median weekly rate of mammogram screenings were 87.8 women per 10,000 beneficiaries. That figure improved to 88.2 screenings per 10,000 beneficiaries by the end of July.

However, the rate of colonoscopies did not return to pre-pandemic levels, but returned to near normal, according to the researchers. In the months leading up to the crisis, median weekly colonoscopy rates were 15.1 per 10,000 beneficiaries and later rebounded to only 12.6 per 10,000 beneficiaries.

  • The Federal News Network reports on the Postal Service’s long awaited ten year business plan which was released today.
USPS aims to hit break-even year by 2023 under 10-year infrastructure plan

Monday Roundup

David Ermer–Congress, COVID-19, COVID-19 vaccine, Electronic health records, Mental health care, OPM–
Photo by Sven Read on Unsplash

The big news today is Astra Zeneca’s announcement that its two dose COVID-19 vaccine “demonstrated statistically significant vaccine efficacy of 79% at preventing symptomatic COVID-19 and 100% efficacy at preventing severe disease and hospitalisation.

This interim safety and efficacy analysis was based on 32,449 participants accruing 141 symptomatic cases of COVID-19. The trial had a 2:1 randomisation of vaccine to placebo.

Vaccine efficacy was consistent across ethnicity and age. Notably, in participants aged 65 years and over, vaccine efficacy was 80%.

The vaccine was well tolerated, and the independent data safety monitoring board (DSMB) identified no safety concerns related to the vaccine. The DSMB conducted a specific review of thrombotic events, as well as cerebral venous sinus thrombosis (CVST) with the assistance of an independent neurologist. The DSMB found no increased risk of thrombosis or events characterised by thrombosis among the 21,583 participants receiving at least one dose of the vaccine. The specific search for CVST found no events in this trial.

Ann Falsey, Professor of Medicine, University of Rochester School of Medicine, US, and co-lead Principal Investigator for the trial, said: “These findings reconfirm previous results observed in AZD1222 trials across all adult populations but it’s exciting to see similar efficacy results in people over 65 for the first time. This analysis validates the AstraZeneca COVID-19 vaccine as a much-needed additional vaccination option, offering confidence that adults of all ages can benefit from protection against the virus.”

Mene Pangalos, Executive Vice President, BioPharmaceuticals R&D, said: “These results add to the growing body of evidence that shows this vaccine is well tolerated and highly effective against all severities of COVID-19 and across all age groups. We are confident this vaccine can play an important role in protecting millions of people worldwide against this lethal virus. We are preparing to submit these findings to the US Food and Drug Administration and for the rollout of millions of doses across America should the vaccine be granted US Emergency Use Authorization [EUA”].”

Typically these trial result announcements have been made a week or two submission of the EUA application to the FDA and then the FDA takes two to three weeks to approve the application. Consequently, it appears that a fourth COVID-19 vaccine will be online in mid-to-late April.

CAVEAT: Bloomberg reports Tuesday morning that

AstraZeneca Plc may have released outdated information about its Covid-19 vaccine trial, giving an “incomplete” view of the efficacy of the shot, said the leading U.S. agency on infectious diseases.

The Data and Safety Monitoring Board, charged with ensuring the safety and accuracy of AstraZeneca’s vaccine trial, has expressed concerns to the National Institute for Allergy and Infectious Diseases that the information released about the testing results included outdated information.

This “may have provided an incomplete view of the efficacy data,” the agency said in a statement early Tuesday, without elaborating.

“We urge the company to work with the DSMB to review the efficacy data and ensure the most accurate, up-to-date efficacy data be made public as quickly as possible,” said the group headed by Anthony Fauci, the top U.S. infectious disease official.

Astra Zeneca needs this news like it needed a hole in the head as one of the FEHBlog’s grandmothers would say.

The Centers for Disease Control offers guidance on how to talk about COVID-19 vaccines with friends and family. The FEHBlog’s general advice is simply get it. The key consideration is that all three available vaccines as well as the Astra Zeneca vaccine have 100% efficacy on preventing severe hospitalization or death from COVID-19.

The Hill reports that the Senate confirmed by a 68-29 vote the President’s nomination of Boston Mayor Marty Walsh to be Secretary of Labor. This is an important position with respect to the Affordable Care Act and ERISA as well as labor affairs.

EHR Intelligence discusses the growing role of state run health information exchanges in achieving health information interoperability.

The CMS interoperability rule addresses admission, discharge, and transfer (ADT) notifications. Providers need to fulfill a CMS condition of participation that will require all healthcare facilities to send outbound event notifications by May 2021.

All healthcare facilities must send direct electronic notifications to a patient’s provider once the patient is admitted, discharged, or transferred from another facility.

Health information exchanges are in a prime position to help prepare their clients accordingly.

This is a nifty idea, but why not give electronic notice to the health plan too?

In its latest call letter for FEHB carrier benefit and rate proposals, OPM encouraged carriers to pay attention to controlling low value care. Health Payer Intelligence discusses a relevant JAMA Open Network study finding that “there are at least 13 areas of low-value care in which Medicare Advantage and Medicare alike are not reducing healthcare spending,” among them, “antibiotics for acute upper respiratory infection, antibiotics for influenza, anxiolytic, sedative, or hypnotic medication, benzodiazepine for depression, an opioid for headache, an opioid for back pain, nonsteroidal anti-inflammatory drug (NSAID) for hypertension, heart failure, or kidney disease, radiograph for back pain, and MRI or CT for back pain or for headaches.”

From the healthcare innovation front —

  • Health IT Analytics informs us that “Statistical suicide risk prediction models could be implemented cost-effectively in healthcare organizations and may help save many lives each year, according to a study published in JAMA Psychiatry.”
  • mHealth Intelligence reports that “Researchers at the University of Cincinnati are developing a small drone, that, equipped with telehealth tools, can enter a house to facilitate virtual visits, drop off or pick up supplies, even survey living conditions.”

From the “Big Bowl of Wrong” front, the Wall Street Journal reports that “Hospitals that have published their previously confidential prices to comply with a new federal rule have also blocked that information from web searches with special coding embedded on their websites, according to a Wall Street Journal examination.” Yet, nn the bright side “After the Journal approached hospitals about its findings, the search-blocking code was removed from sites including those of HCA, Penn Medicine and Beaumont, and of South Dakota-based Avera Health, Tennessee-based Ballad Health, Maine’s Northern Light Health and Gundersen Health System in Wisconsin.” Good job Journal.

Weekend update

David Ermer–ACA, AHRQ, Congress, COVID-19, COVID-19 vaccine–
Photo by Mark Tegethoff on Unsplash

The House of Representatives is engaged in committee work this week which will be followed by three weeks of district work. The Senate will engage in a floor voting, including a confirmation vote on the Secretary of Labor nominee Martin Walsh tomorrow, as well as committee work.

Healthcare Dive reports that

  • The House passed a bill Friday to extend the pause on Medicare sequester cuts until Dec. 31. The cuts have been on hold for a year but are set to go back into effect at the end of March.
  • The bill passed on a 246-175 bipartisan vote and also exempts the latest $1.9 trillion pandemic relief bill from budget rules that would have imposed additional cuts on Medicare payments to providers.
  • “We now look forward to working with the U.S. Senate to achieve relief from the pending Medicare sequester cuts before they go into effect,” the American Hospital Association said in a Friday statement.

Medicare sequester cuts tend to boomerang on private sector health plans, including FEHB plans.

Following up on Friday’s Stats and More, the FEHBlog compared new weekly COVID-19 cases and deaths per 100,000 by age groups as of January 2, 2021, and last Wednesday March 17, 2021.

This chart has a left axis measured in hundreds
This chart’s left axis ranged from zero to sixteen.

Because the March 17 new deaths rates are not visible in this chart, here are those numbers that the FEHBlog copied from the CDC’s website for last week’s new death statistics by age group

 Week ended 3-17-202118-2425-3435-5455-6465-7980+
New Deaths  per 100,000 00000.010.03

That, my friends, illustrates the work of the COVID-19 vaccines over the past two and half months. The Wall Street Journal reports today

Both the production and administration of shots have picked up in recent weeks. Now, some 2.5 million people in the U.S. are vaccinated daily on average, up from about 500,000 in early January, though many who want a vaccine still can’t get it.

The increased output should be enough to fully vaccinate 76 million people in the U.S. in March, another 75 million in April and then 89 million more in May, according to estimates from Evercore ISI analysts. The Pfizer-BioNTech and Moderna vaccines require two doses.

By midsummer, 75% of Americans 12 years old and above should be vaccinated, according to Morgan Stanley. The vaccines aren’t currently authorized for anyone younger than 16, but companies may have results this spring for studies of the shots in adolescents 12 and older, which, if positive, could lead to vaccinations for that age group. The companies are also starting to test the vaccines in children younger than 12, but results of those studies aren’t expected until late this year. 

Keep your sunny side up.

In other healthcare news:

  • Katie Keith in the Health Affairs Blog informs us that the impact of American Rescue Plan’s new ACA marketplace subsidies will be made known to consumers on April 1, 2021.

Enhanced subsidies are available for the entire 2021 plan year to anyone who qualifies and enrolls in marketplace coverage. This includes individuals who enrolled during the 2021 open enrollment period (and have had coverage since January 2021), individuals who enrolled before the American Rescue Plan was enacted (during special enrollment periods in 2021), and individuals who will enroll during the rest of 2021.

Consumers will be able to see the availability of the enhanced subsidies at HealthCare.gov beginning on April 1. But the process to “claim” these enhanced subsidies will look slightly different for new consumers versus existing consumers. (This process will also vary for consumers in states with their own marketplaces, which may adopt policies and timelines that differ from those for HealthCare.gov.)

Just like any other year, individuals can choose to receive all or some of the enhanced PTC in advance (i.e., have it paid to the insurer on their behalf each month) or wait to receive PTC at tax time in 2022 (i.e., while paying full premiums to the insurer each month). Because the cost of health insurance is so high for so many people, most marketplace enrollees opt for advance PTCs to reduce the amount they owe in monthly premiums.

The federal ACA marketplace and many state ACA marketplaces are in the middle of a special Open Season that run until May 15, 2021.

  • The HHS Agency for Healthcare Research and Quality’s Director concluded Patient Safety Week with reflections available at this link. Among the observations were the following:

The quest to learn more about what contributes to diagnostic inaccuracies and delays has already been a focus area for AHRQ. We began investing in diagnostic safety and quality research in 2007 and have helped build interest around the topic. Diagnostic error harms too many and costs too much .  

When I think about options for tackling the issue of diagnostic safety, I’m reminded of the progress we’ve made with our successful Healthcare-Associated Infections (HAI) Program. AHRQ’s HAI Program is dedicated to understanding the problems that can harm patients, identifying what works to prevent infections, and then developing, testing, and refining tools to put that knowledge into practice on the front lines of care. AHRQ has achieved a great deal working alongside clinicians, patients, and other stakeholders focused on HAI prevention throughout government and the private sector.

Cybersecurity Saturday

David Ermer–Cybersecurity, Uncategorized–

Happy first day of Spring. Bloomberg reports that

As the U.S. reels from major cyber-attacks by suspected Russian and Chinese hackers, officials are looking to implement new technologies that would allow the federal government to respond more effectively.

The National Security Agency and the Department of Homeland Security believe they have part of the answer within the Domain Name System, or DNS, often referred to as the phone book of the internet. They are encouraging government agencies and high-risk companies to embrace a system known as Protective DNS, in which a private security firm would monitor and filter web traffic.

The payoff could be enormous, officials say. PDNS blocked connections to malicious websites millions of times in a recent test involving five U.S. defense contractors. After it was installed in the U.K., the system blocked nearly 60 million connections to suspect sites in 2018 alone, including 450,000 related to the infamous WannaCry strain of ransomware, according to a report issued by the National Cyber Security Centre.

Here’s a link to the NSA / CISA’s March 4, 2021 cybersecurity information sheet, “Selecting a Protective DNS Service.” This publication details the benefits of using a Protective Domain Name System (PDNS), which criteria to consider when selecting a PDNS provider, and how to effectively implement PDNS.”

Bankinfosecurity.com adds

In light of the SolarWinds supply chain attack and the ongoing hacking of unpatched Microsoft Exchange on-premises email servers, organizations need to rethink how they use threat intelligence to block malicious domains and other malicious activity, says Oliver Tavakoli, CTO at security firm Vectra AI. PDNS services can play an important role, he says.

“Having PDNS in place allows for quick leverage of threat intel to actively block access, and it also allows relatively easy retrospective analysis to see if the organization was affected,” Tavakoli says.

Adopting PDNS services and improving security of the aging DNS protocol can help reduce common internet security problems, says Roger Grimes, data-driven defense evangelist at the security firm KnowBe4.

“A far more safe and secure internet can easily be designed. It would not take magic. It would take a few dozen people who control the internet’s future sitting in a room, designing a few global services, like Protective DNS, but on a global level, and agreeing on a few dozen values in a few database tables, and we could do it,” Grimes says. He notes, however that “it’s hard to get people in your own family to agree on something, much less all of the people in the world.”

On March 17, the FBI’s Internet Crime Complaint Center released its annual report.

The 2020 Internet Crime Report includes information from 791,790 complaints of suspected internet crime—an increase of more than 300,000 complaints from 2019—and reported losses exceeding $4.2 billion. State-specific statistics have also been released and can be found within the 2020 Internet Crime Reportand in the accompanying 2020 State Reports.

The top three crimes reported by victims in 2020 were phishing scams, non-payment/non-delivery scams, and extortion. Victims lost the most money to business email compromise scams, romance and confidence schemes, and investment fraud. Notably, 2020 saw the emergence of scams exploiting the COVID-19 pandemic. The IC3 received over 28,500 complaints related to COVID-19, with fraudsters targeting both businesses and individuals.

TechRepublic adds that “A report released Wednesday [March 17] by Unit 42, the threat intelligence team at Palo Alto Networks, looks at how ransomware has evolved and provides advice on how to protect your organization. To create its “2021 Ransomware Threat Report,” Unit 42 worked with Palo Alto Networks’ Crypsis incident response team to analyze ransomware based on their collective data across the U.S., Canada and Europe.”

Finally, Cyberscoops offers an interesting perspective on the recent Verkada security camera breach.

Friday Stats and More

David Ermer–COVID-19–

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 11th week of this year (beginning April 2, 2020, and ending March 17, 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 March 17, 2021):

These charts are moving in the right direction, fingers crossed. Here is a COVID-19 vaccinations chart for the past three months which also uses Thursday as the first day of the week:

As of today just over 67% (2/3s) of the U.S. population over 65 and 30% of the vaccination eligible U.S. population has received at least one dose of a COVID-19 vaccination. 2.5 million doses were administered yesterday.

Nevertheless,. the Wall Street Journal reports today that

Federal officials this week warned that the U.S. may be on track for another surge in Covid-19 cases, trailing Europe by a few weeks in a pattern that has been seen throughout the pandemic.

European countries now implementing new lockdowns amid a resurgence in infections each took an upward trend after disregarding known mitigation strategies, said Centers for Disease Control and Prevention head Dr. Rochelle Walensky, noting it was a warning sign for the U.S.

France on Friday imposed a monthlong lockdown in Paris and other parts of the country. Italy earlier this week implemented new restrictions.

The U.S. in general has followed the European Union by a few weeks in the dynamics of the outbreak, Dr. Anthony Fauci said this week. In Europe, cases came down, plateaued and then countries pulled back on mitigation methods and had a rebound in cases, he said in a conversation with The Wall Street Journal.

“They are in the process of a rebound now, which is really something we absolutely want to avoid,” Dr. Fauci said. He added that given the current level of community infection in the U.S., it is risky to pull back on all the preventive modalities.

The U.S. pace of COVID-19 vaccination is much quicker than Europe’s. Yet, the Journal article concludes as follows:

The majority of Americans who have been fully vaccinated are ages 50 and up, according to CDC data.

But with the U.S. choosing to prioritize a limited number of vaccines for older or vulnerable adults—who are at greater risk for serious complications and death from Covid-19—it means that those who are perhaps more likely to move about the community are going to be vaccinated later, according to both Dr. [Emily] Martin and Dr. {Yonatan] Grad.

“It makes sense, if your goal is to reduce deaths, to focus on vaccinating those at highest risk of dying if infected,” Dr. Grad said, adding, “there are some contexts where you would want to vaccinate those who are at highest risk of transmitting to get cases down, in order to reduce deaths.”

The FEHBlog assumes that those other contexts which Dr. Grad has in mind involve situations where the risk of rapid death from the disease is low. Before long the U.S. will be adequately vaccinated from the aged to the younger groups.

Thursday Miscellany

David Ermer–AHRQ, Congress, Telehealth–
Photo by Juliane Liebermann on Unsplash

In the wake of yesterday’s announcement that Amazon is breaking into the employer sponsored plan telehealth market, there was plenty of news today about telehealth.

STAT News reports that

“The market for virtual care is still massively underpenetrated,” wrote Cowen analysts Charles Rhyee, Calvin Sternick, James Auh, and Gwen Shi in a research note Wednesday. While Teladoc expects to provide 10 million visits in the U.S. in 2021, each year the country sees roughly 850 million outpatient visits, plus 300 million additional visits specific to mental health, according to the Cowen analysts. “This is not a zero sum game by any stretch,” they added.

Med City News effectively seconds this point of view as follows:

Amazon will need to build out relationships with health plans and health systems, so it can have a referral network for patients who need to see a specialist.   Teladoc, for example, says it has partnerships with more than 50 health plans and 600 health systems, perhaps implying that it’s not going to be that easy.

“New entrants to virtual care will continue to confront many of the challenges Teladoc Health has overcome over the past decade as we have built worldwide capabilities to deliver, enable and empower whole-person virtual care,” a Teladoc spokesperson wrote in an email.

While that may well be true, what Teladoc and Amwell encountered and overcame was low utilization — something that Amazon won’t have to contend with given that Covid-19 has ramped up utilization and adoption sky-high.

It will be interesting to see the jockeying for market share, but no matter which company wins, telehealth has already come out on top.

In that regard, Healthcare Dive reports that “Virtual behavioral health visits surged in the first half of 2020 as the COVID-19 pandemic exacerbated mental health needs, according to a new analysis by Milliman and Well Being Trust.”

Healthcare IT News cautions us that “Telehealth experienced sudden and massive growth starting a year ago, but it didn’t happen everywhere. A new report from the RAND Corporation suggests that the biggest upticks in virtual care availability occurred in more affluent and metropolitan communities, and that telemedicine services were mostly enjoyed by patients with private insurance.”

Healthcare Dive offers an interview with Health Affairs editor in chief Alan Weil that features a discussion of telehealth.

In healthcare equity news

  • Health Payer Intelligence reports that “Blue Shield of California has enhanced its provider network to expand COVID-19 vaccine access in underserved communities.”
  • Fierce Healthcare reports that

The Blue Cross Blue Shield Association (BCBSA) is teaming with Feeding America for COVID-19 vaccine outreach in vulnerable communities.

Clinical information and educational materials highlighting the safety and efficacy of the vaccines will be made available at Feeding America’s 200 food banks, which reach 40 million people. BCBSA will provide physical handouts as well as social media posts with information from the Centers for Disease Control and Prevention and its own clinicians.

The materials will be available in both English and Spanish, BCBSA said, and aim to “dispel common myths” that may prevent people from getting vaccinated.

In other healthcare industry news

  • Healthcare Dive reports that the Senate confirmed the President’s nomination of Xavier Becerra to be Health and Human Services Secretary by a 50-49 vote. “Becerra has the support of payer and provider groups including the American Hospital Association and American Medical Association.”
  • Also coming out of Congress,

Senators Dianne Feinstein (D-Calif.) and Chuck Grassley (R-Iowa) and Representatives Scott Peters (D-Calif.) and John Curtis (R-Utah) today introduced the Methamphetamine Response Act, a bill declaring methamphetamine an emerging drug threat which would require the Office of National Drug Control Policy (ONDCP) to develop, implement and make public a national plan to prevent methamphetamine addiction and overdoses from becoming a crisis.

 “In a single year we’ve seen psychostimulant-related overdose deaths, which include meth, spike by 42 percent,” said Feinstein. “The meth available on our streets is pure, potent and cheap and law enforcement is seizing more of the drug than ever. Two of the largest seizures on record occurred in California last year and in just a five month period, U.S. Customs and Border Protection seized more than 75,000 pounds of methamphetamine. Clearly we are in the midst of a meth crisis and we must implement a national, comprehensive plan to address this threat before it claims even more American lives.”

No bueno.

In further celebration of Patient Safety Awareness Week and because the FEHBlog believes that communication plays an important role in patient safety here’s an AHRQ article on using better communication to improve drug safety / avoid medication errors.

Midweek Update

David Ermer–COVID-19 testing, HSA, OPM, Telehealth–
Photo by Manasvita S on Unsplash

Happy St. Patricks Day to all.

Congress in a recent appropriations law sought a report from the National Academy for Public Administration on the Trump Administration’s proposal to break up the Office of Personnel Management. The Federal Times reports that “A better federal workforce policy will require the Office of Personnel Management to become a more independent and authoritative agency, rather than being broken apart into other departments, a long-awaited National Academy for Public Administration study determined March 17. ”

“We strongly recommend that a central personnel agency continue to exist, and that organization is an independent, enterprise-wide human capital agency and a steward of the merit system principles,” said Terry Gerton, president and CEO of NAPA, said at a press briefing on the report. “But that organization, OPM as we know it today, really needs to build its staff capacity, encourage innovation and adopt a more data-driven, accountable and forward-looking capital management approach.”

In other federal agency news, the Federal News Network informs us that

The IRS is moving this year’s April 15 tax filing season deadline back to May 17, citing ongoing challenges from the COVID-19 pandemic. IRS Commissioner Chuck Rettig said in a statement Wednesday that the new deadline would give the public more time to take stock of their finances, while also giving agency employees more time to implement new responsibilities under the American Rescue Plan.

The Department of Health and Human Services announced today that the agency

will invest $10 billion from the American Rescue Plan to ramp up screening testing to help schools reopen, $2.25 billion to scale up testing in underserved populations, and provide new guidance on asymptomatic screening testing in schools, workplaces, and congregate settings. These measures are part of President Biden’s strategy to increase COVID-19 testing nationwide as vaccinations increase.

“COVID-19 testing is critical to saving lives and restoring economic activity,” said HHS Acting Secretary Norris Cochran. “As part of the Biden Administration’s National Strategy, HHS will continue to expand our capacity to get testing to the individuals and the places that need it most, so we can prevent transmission of the virus and defeat the pandemic.”

The U.S. Preventive Services Task Force announced yesterday a proposed B grade recommendation “on screening for prediabetes and type 2 diabetes. The Task Force recommends screening adults between ages 35 to 70 years old who are overweight or obese for prediabetes and diabetes.” The current minimum age for this screening recommendation is 40 years old. NBC News reports that

We know the rates of prediabetes and diabetes are increasing in people who are younger,” said Dr. Chien-Wen Tseng, a task force member and a professor of family medicine at the University of Hawaii’s John A. Burns School of Medicine. “Our main reason for dropping the age is to match the screening with where the problem is: If diabetes and prediabetes are occurring at a younger age, then we should be screening at a younger age.”

The Affordable Care Act requires health plans to cover USPSTF A and B recommended preventive services without member cost sharing when an eligible member receives the service in-network. If the USPSTF finalizes this recommendation later in 2021, then the ACA health plan coverage mandate for this screening would expand to people in the age 35 to 40 age group in 2023. Here is a link to background on the USPSTF’s sixteen members.

In other health industry news —

Healthcare Dive reports that

Amazon is expanding its virtual care pilot program, Amazon Care, to employees and outside companies nationwide beginning this summer in a major evolution of its telehealth initiative, as the COVID-19 pandemic continues to drive unprecedented demand for virtual care.

Amazon will also offer its on-demand primary care service to other Washington state-based companies and plans to expand its in-person service to Washington, D.C., Baltimore and other cities in the following months, the e-commerce behemoth announced Wednesday.

Employee Benefit News offers a Chief Financial Offer’s advice on health savings account funding.

Tuesday Tidbits

David Ermer–AHRQ, CDC, COVID-19 vaccine, U.S. Healthcare, Uncategorized–
Photo by Patrick Fore on Unsplash

Fortune offers an insightful story about CVS Health’s CEO Karen Lynch.

Smart Brief discusses news from last week’s AHIP National Policy Conference.

The Society for Human Resource Management offers a helpful list of American Rescue Plan Act provisions impacting employers.

Medscape encouragingly reports that

Vaccination of about 88% of Americans who received the first dose of Pfizer/BioNTech or Moderna’s COVID-19 vaccines was complete, a study of over 12 million people by the U.S. Centers for Disease Control and Prevention (CDC) showed. * * * According to the analysis, about 3% of people in the United States who received the first dose of either vaccine did not get the second dose needed to complete vaccination. The agency said 8.6% had not received the second dose, but were still within the allowable interval to receive it.

As of today, 64.6% of the U.S. population over age 65 has received at least one dose of the COVID-19 vaccine and 36.6% of that group (including the FEHBlog) are fully vaccinated.

Healthcare Dive informs us that “Independent primary care docs more financially stable, but fed up with vaccine exclusion.” The FEHBlog heard today that vaccine distribution will open to more sites of care, including physician offices, once the Food and Drug Administration gives full marketing approval to the COVID-19 vaccines. The FEHBlog, however, could not find a projected date for that action, but he will keep looking.

Healthcare Dive also reports that “Virtual care company Doctor on Demand and clinical navigator Grand Rounds have announced plans to merge, creating a multibillion-dollar digital health firm.” The companies’ joint press release explains

The new company will combine Grand Rounds’ data-driven clinical navigation platform and patient advocacy tools with Doctor On Demand’s preeminent virtual care offering to provide an unparalleled member experience. It will accelerate the adoption of virtual care in key areas including primary care, specialty care, chronic condition management, and behavioral health. Owen Tripp, CEO of Grand Rounds, will serve as the CEO of the expanded business. Both companies will continue to operate under their existing brands for the time being.

“No one has done this before, combining navigation and virtual care delivery. We think it’s the future,” said Owen Tripp, co-founder and CEO of Grand Rounds. “People make unguided healthcare decisions every day, often with higher costs and worse outcomes. Now, with Doctor On Demand, we’ll offer them coordinated support on all fronts—physical, behavioral, financial, administrative—and we’ll do it for everything from acute issues to life-long health. This is truly complete care, and it’s what we all need.”

“We’re building a next-generation virtual care company with a nationwide practice of diverse, dedicated providers and a multidisciplinary care team,” said Hill Ferguson, CEO of Doctor On Demand. “By fully integrating medical and behavioral healthcare with clinical navigation, we’re impacting healthcare where it actually happens—between a patient and their provider—and ensuring that experience is seamless, personalized, and can follow the patient wherever they go.”

In continuing recognition of Patient Safety Awareness Week, here are links to the Agency for Healthcare Research and Quality’s blog post on accelerating progress in patient safety and an AHRQ article on the importance of good communication skills to achieving patient safety.

Monday Roundup

David Ermer–AHRQ, CMS, COVID-19, COVID-19 vaccine–
Photo by Sven Read on Unsplash

“The ides of March are come.
Soothsayer: Ay, Caesar; but not gone.” Wm. Shakespeare

From the COVID-19 vaccine front —

The Centers for Medicare and Medicaid Services (“CMS”) announced today that

Effective for COVID-19 vaccines administered on or after March 15, 2021, the national average payment rate for physicians, hospitals, pharmacies and many other immunizers will be $40 to administer each dose of a COVID-19 vaccine. This represents an increase from approximately $28 to $40 for the administration of single-dose vaccines, and an increase from approximately $45 to $80 for the administration of COVID-19 vaccines requiring two doses. The exact payment rate for administration of each dose of a COVID-19 vaccine will depend on the type of entity that furnishes the service and will be geographically adjusted based on where the service is furnished.  

CMS, along with the Departments of Labor and Treasury, is requiring that most private health plans and issuers cover the COVID-19 vaccine and its administration, both in-network and out-of-network, with no cost sharing during the public health emergency (PHE). Current regulations provide that out-of-network rates must be reasonable, as compared to prevailing market rates, and reference the Medicare reimbursement rates as a potential guideline for insurance companies. In light of CMS’s increased Medicare payment rates, CMS will expect commercial carriers to continue to ensure that their rates are reasonable in comparison to prevailing market rates.

Medscape reports that “AstraZeneca Plc is preparing to file for U.S. emergency use authorization (EUA) for its COVID-19 vaccine later this month or early April after accumulating enough data to judge the inoculation’s efficacy, sources with knowledge of the ongoing clinical trial told Reuters on Friday.” STAT News in its article titled the “Curious Case of the AstraZeneca’s COVID-19 vaccine” concludes

The U.S. study, started last September and including 30,000 patients, is, like the studies for the Moderna and Johnson & Johnson vaccines, being run with the U.S. National Institutes of Health. It’s the best hope for settling any questions or concerns about the AstraZeneca vaccine once and for all.

STAT News also informs us that Biden Administration is about to embark on a $1.5 billion public relations campaign to convince Americans to receive the COVID-19 vaccine. “Much of the project’s funding comes from the sweeping $1.9 trillion Covid-19 relief bill Biden signed last week. The administration has also already pledged over $500 million in additional funds to address vaccine uptake, health literacy, and equity in the vaccine distribution, including $250 million to fund local health literacy projects and another $255 million for the CDC to fund local government efforts to focus on equity and confidence in underserved communities.”

The Federal Times reports that “Washington, D.C. Mayor Muriel Bowser released an updated vaccination timeline March 15 that outlines when, among other essential professions, federal government and Postal Service employees can expect to become eligible for a COVID-19 vaccine. * * * Just under seven percent of federal employees are located in Washington, D.C.”

Also, Fierce Healthcare offers UnitedHealthcare scientist and Healthcare Dive offers hospital executive reflections on the first anniversary of the great hunkering down.

The HHS Office of Inspector General has unveiled a new website about the agency’s oversight of COVID-19 response and recovery. The website calls attention to the agency’s updated list of COVID-19 scams.

During this Patient Safety Awareness Week, HHS’s Agency for Healthcare Research and Quality calls attention to its Chartbook on Patient Safety. “This Patient Safety chartbook is part of a family of documents and tools that support the National Healthcare Quality and Disparities Report (QDR). The QDR includes annual reports to Congress mandated in the Healthcare Research and Quality Act of 1999 (P.L. 106-129). This chartbook includes a summary of trends across measures of patient safety from the QDR and figures illustrating select measures of patient safety.”