Monday Roundup

David Ermer

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

Monday Roundup

David Ermer–Congress, COVID-19, COVID-19 testing, COVID-19 vaccine, Telehealth, U.S. Healthcare, Uncategorized–
Photo by Sven Read on Unsplash

The Wall Street Journal reports that

The House [of Representatives] looked on track to pass the latest version of the $1.9 trillion coronavirus relief package later this week, as liberal Democrats swallowed their frustration with the Senate’s changes and prepared to approve the bill for a second time.

The House is expected to narrowly pass the bill Tuesday or Wednesday, sending it to the White House for President Biden’s signature. House Majority Leader Steny Hoyer (D., Md.) had initially said the House would take its first procedural vote on the bill Monday, but processing the bill’s Senate paperwork pushed the vote slightly later in the week, aides said. 

In COVID-19 news

  • The Centers for Disease Control today released guidance for those who are fully vaccinated against the disease (meaning two weeks after the final dose).
  • The Biden Administration announced “an effort to invest $250 million to encourage COVID-19 safety and vaccination among underserved populations. The U.S. Department of Health and Human Services (HHS) Office of Minority Health (OMH) will offer the funding as health literacy grants to localities, who will partner with community-based organizations, to reach racial and ethnic minority, rural and other vulnerable populations. The new initiative – Advancing Health Literacy to Enhance Equitable Community Responses to COVID-19 – is expected to fund approximately 30 projects in urban communities and 43 projects in rural communities for two years. “
  • The Food and Drug Administration has given emergency use authorization for “the Cue COVID-19 Test for Home and Over The Counter (OTC) Use. The product is a molecular nucleic acid amplification test (NAAT) that is intended to detect genetic material from SARS-CoV-2 virus present in the nostrils. The test is the first molecular test authorized for at-home use without a prescription.” Here’s a link to the Cue Health website.

In other healthcare news —

  • Healthcare Dive reports that “for the first time since Fair Health started tracking monthly telehealth claims, COVID-19 became one of the top five diagnoses in the U.S. in December as cases surged, the nonprofit said in a report released Thursday. Overall, telehealth claim lines increased 2,817% year over year, rising from just 0.22% of all medical claim lines in December 2019 to 6.51% in December 2020. Mental health conditions continue to be the No. 1 telehealth diagnosis nationwide.” It’s the last sentence that caught the FEHBlog’s attention.
  • Benefits Pro writes about the important role that employers and their health plans can help in reducing employee obesity issues. “’Overweight and obesity, which require a comprehensive approach, are top health concerns for employers around the world,’ said Ellen Kelsay, president and CEO of Business Group on Health. ‘Employers play a major part in offering quality health care, understanding obesity’s inextricable link to mental health, lessening the stigma surrounding it and addressing some of the social determinants of health.’ By 2025, one in five adults worldwide will be affected by obesity, according to the organization’s new report, ‘The Global Landscape for Overweight and Obesity: A Guide for Employers.’ As overweight and obesity rates surge worldwide, large employers are positioned to address the chronic medical conditions on multiple fronts, the report said.”
  • The New York Times reports that “When the pandemic struck last year, many Americans rushed to stock up on alcohol, causing retail sales of wine, beer and liquor to surge across the country. But the uptick in sales was a worrying sign for health experts focused on cancer prevention. In recent years, a growing number of medical and public health groups have introduced public awareness campaigns warning people to drink with caution, noting that alcohol is the third leading preventable cause of cancer, behind tobacco and obesity. * * * [Consumer S]urveys continue to show that most people remain unaware of the risks. When the American Institute for Cancer Research surveyed Americans two years ago to gauge their awareness of different cancer risk factors, the results were striking: fewer than half were aware of the alcohol-cancer link.”

Weekend update

David Ermer–ACA, Congress, COVID-19 vaccine, U.S. Healthcare, Uncategorized–
Photo by JOSHUA COLEMAN on Unsplash

The House of Representatives and the Senate will be engaged in committee and floor work this coming week. Fierce Healthcare reports on healthcare provisions found in the Senate passed American Rescue Plan bill.

Insurers will likely be happy with a temporary boost to income-based subsidies for customers on the Affordable Care Act’s exchanges for 2021 and 2022.

Under current law, anyone making 400% above the federal poverty level are not eligible for subsidies to pay down the cost of insurance.

However, under the legislation, anyone making 400% above the poverty level won’t have to pay more than 8.5% of their income on health insurance.

The bill would also ensure that low-income customers won’t have to pay anything for their coverage.

Currently, those making 150% above the poverty level pay no more than 4.3% of their income on healthcare. But the legislation would make their coverage fully subsidized.

The legislation would also offer premium assistance to cover up to 100% of COBRA costs for eligible individuals and families through the end of September.

Another change in the Senate version from the House concerns the removal of a cap on the Medicaid drug rebate, changing the removal of the cap to 2024 instead of 2023. The removal of the rebate cap, which kicks in at 100% of a drug’s average manufacturing price, will lead to higher rebates for Medicaid drugs.

The Wall Street Journal informs us that

The $1.9 trillion Covid-19 relief bill returns to the House of Representatives this week, where lawmakers will gear up for a vote as soon as Tuesday on the package following narrow approval Saturday by the Senate that came only after concessions to moderate Democrats.

The Senate changes to the bill, which first passed the House Feb. 27 with more generous unemployment provisions, mean House Speaker Nancy Pelosi must hold together her slim majority caucus for a second House vote to send President Biden’s top legislative priority to his desk.

The House is expected to hold a procedural vote on the bill Monday night, with final passage slated for Tuesday. 

Speaking of the Affordable Care Act marketplace, Katie Keith updates on the successful first two weeks of the ongoing marketplace special enrollment period.

In other healthcare news

  • Bloomberg reports on developing approaches to overcome COVID-19 hesitancy. “To do that, officials must make the process of getting shots easier, and fight misinformation about the vaccines, concerns about the speed of development and distrust of government and health-care institutions.” As of today, 23% of the eligible U.S population has received at least one dose of the COVID-19 vaccine. The FEHBlog noticed today that the Johnson & Johnson single dose vaccine is now being administered at the Maryland mass vaccination sites in Baltimore and Waldorf. It strikes the FEHBlog that the single dose vaccine will be more attractive to the hesitant.
  • NPR Shots offers a physician’s take on five types of medical visits that you should stop putting off. “Emerging evidence tells us that the health threats from postponing some tests and exams — including those for cancer and heart disease, but other crucial appointments too — outweigh the risk of running into the coronavirus at a doctor’s visit, even if the virus is prevalent in your community.”

Cybersecurity Saturday

David Ermer–Cybersecurity–

FCW reports that

Rep. Michael McCaul (R-Texas) announced that he and Rep. Jim Langevin (D-R.I.), both members of the House Homeland Security Committee are working on a bill that would establish the Cybersecurity and Information Security Agency as a kind of 911 for breach notification. McCaul said his legislation is designed to protect companies from repercussions in the market by removing sources and methods and company names out of reporting. “It would just simply send a threat information itself to CISA so that they could deal both industrywide and federal government wide and state, the threat information they would need to address it on a larger scale,” McCaul said at a joint hearing of the House Committee on Oversight and Reform and the House Homeland Security Committee on Feb. 26.

Speaking of CISA, last Wednesday March 3, CISA issued an emergency directive 21-02 “requiring federal civilian departments and agencies running Microsoft Exchange on-premises products to update or disconnect the products from their networks until updated with the Microsoft patch.” According to the Wall Street Journal this action stems from

A cyberattack on Microsoft Corp.’s MSFT 2.15% Exchange email software is believed to have infected tens of thousands of businesses, government offices and schools in the U.S., according to people briefed on the matter.

Many of those victims of the attack, which Microsoft has said was carried out by a network of suspected Chinese hackers, appear to be small businesses and state and local governments. Estimates of total world-wide victims were approximate and ranged broadly as of Friday. Tens of thousands of customers appear to have been affected, but that number could be larger, the people said. It could be higher than 250,000, one person said.

While many of those affected likely hold little intelligence value due to the targets of the attack, it is likely to have netted high-value espionage targets as well, one of the people said.

Cyberscoops informs us that

The White House is moving forward with an executive order to encourage software developers to build more security into their products as the investigation of a suspected Russian supply chain compromise continues, a top security official said Friday [March 5]. The upcoming directive “will focus on building in standards for software, particularly software that’s used in critical areas,” Anne Neuberger, the deputy national security adviser for cyber and emerging technology, said at the SANS Institute’s ICS Security Summit. “The level of trust we have in our systems has to be directly proportional to the visibility we have. And the level of visibility has to match the consequences of the failure of those systems.”

Cyberscoop further discloses that

Microsoft and FireEye on Thursday [March 4] revealed three more malware strains associated with the suspected Russian perpetrators who breached SolarWinds’ Orion software and used its update to infect federal agencies and major companies. FireEye named one strain Sunshuttle in a blog post. In a separate blog post, Microsoft dubbed two more strains GoldFinder and Sibot, and labeled the strain FireEye called Sunshuttle as GoldMax Microsoft said the strains join the previously known SolarWinds hacker tools Sunburst and Teardrop.

Fortune discusses the nascent use of contact tracing in cybersecurity processes.

A concept called Sightings has been gaining traction in the security community, largely at the academic level, for the past few years. The idea is for organizations to be able to share details of how they were attacked and what was targeted—the who, what, and when—as quickly as possible with other organizations. 

This concept could help organizations identify breaches sooner and remediate faster and more effectively. Through sharing, attack techniques could be more thoroughly understood, and with the right reporting mechanism, the resulting threat intelligence could be shared to help more organizations avoid a breach in the first place. MITRE, a leading not-for-profit research organization, is working on incorporating Sightings concepts into a security reporting process that would let breach victims share appropriate data in a secure, anonymized way to benefit the wider community.

Beyond this threat intelligence application, organizations could use this sort of contact tracing approach for their own internal investigations. Data contact tracing can dramatically reduce the time it takes to discover how far into their networks an attacker has penetrated, and identify where related systems in their supply chains, customers, and partner networks have also been compromised.

Finally, Health IT Security reports that

Cyberattacks on healthcare more than doubled in 2020, with ransomware accounting for 28 percent of all attacks. COVID-19 response efforts, including personal protective equipment and the vaccine supply chain were the largest focus of these targeted campaigns, according to the latest IBM X-Force report.

Nearly one out of four of overall cyberattacks last year were ransomware, while the increase in data extortion efforts enabled just one of these ransomware hacking groups to make over $123 million in profits in 2020.

The annual report is generated through insights and observations from monitoring more than 150 billion security events per day in more than 130 countries. Researchers also gathered and analyzed data from multiple sources within IBM, including data from Quad9 and Intezer.

Friday Stats and More

David Ermer–COVID-19, COVID-19 testing, 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 9th week of this year (beginning April 2, 2020, and ending March 3, 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 3, 2021):

Finally here is a COVID-19 vaccinations chart since mid-December 2020 which also uses Thursday as the first day of the week:

These are all encouraging charts. The CDC reports that as of today 21.7% of eligible Americans (over age 18) have received at least one dose of the COVID-19 vaccine and 11.2% of received two doses.

The CDC’s FluView continues to report that “Seasonal influenza activity in the United States remains lower than usual for this time of year.”

The Wall Street Journal informs us that

A new study on the topic in JAMA Cardiology is based on the screening of 789 professional athletes who tested positive for Covid-19 between May and October in Major League Baseball, Major League Soccer, the National Hockey League, National Football League, and the men’s and women’s National Basketball Association. 

The paper shows that 0.6% of those athletes ultimately had findings suggestive of inflammatory heart disease. Five athletes were held out of competition because of their cardiac results. Three had myocarditis, which is heart inflammation, and two had pericarditis, which is swelling of the tissue that surrounds the heart. All had had moderate cases of Covid.

The findings suggest that long-term heart complications in non-severe Covid cases are unlikely—and that sports leagues are still likely to continue with cardiac screenings during the pandemic.

Govexec offers an interesting interview with National Institutes of Health Director Dr. Francis Collins.

Thursday Miscellany

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

Roll Call reports that the Senate continues to move forward its modified version of the American Rescue Plan which the House of Representatives passed last week. Here’s a link to the Congressional Budget Office’s report on the Senate bill.

The Senate Homeland Security and Governmental Affairs Committee held a confirmation hearing today on the President’s nominations of Shalanda D. Young to be Deputy Director, Office of Management and Budget, and Jason S. Miller to be Deputy Director for Management, Office of Management and Budget. Federal News Network sums up the hearing as follows: “President Joe Biden’s picks to serve in top positions at the Office of Management and Budget vowed on Thursday to remove hurdles from federal hiring, improve employee morale and help agencies keep their workforces safe during the pandemic.”

David Leonhardt of the New York Times does a great job putting the three current COVID-19 vaccines in perspective:

It’s the latest case of vaccine alarmism.

Many Americans are worried that Johnson & Johnson’s Covid-19 vaccine is an inferior product that may not be worth getting. Gov. Doug Burgum of North Dakota recently told The Washington Postthat he was now seeing not only “vaccine hesitancy” but also “the potential for brand hesitancy.”

The perception stems from the headline rates of effectiveness of the three vaccines: 72 percent for Johnson & Johnson, compared with 94 percent for Moderna and 95 percent for Pfizer. But those headline rates can be misleading in a few ways.

The most important measure — whether the vaccine prevents serious illness — shows the Johnson & Johnson vaccine to be equally effective as the other two. All work for nearly 100 percent of people. The picture is murkier for mild cases, but they are not particularly worrisome.

In promising news, STAT News reports that

Eli Lilly said Thursday that a study showed its experimental diabetes drug, tirzepatide, reduced patients’ blood sugar and body weight more than a rival medicine, Novo Nordisk’s Ozempic. The study compared three doses of tirzepatide — 5 mg, 10 mg, and 15 mg — to a 1 mg dose of Ozempic. Both drugs were given as injections. Tirzepatide reduced A1C, a measure of blood sugar levels, by 2.09% at the 5-mg dose, 2.37% at the 10-mg dose, and 2.46% at the 15-mg dose. For Ozempic, there was a 1.86% reduction. Patients were followed for 40 weeks.

Patients who received tirzepatide also saw their body weight decline by more than those who received Ozempic. They lost an average of 7.8 kilograms, or 8.5% of their body weight at the lowest dose, 10.3 kg, an 11% decrease, on the middle dose, and 12.4 kg, a 13.1% decrease, on the highest dose. For patients on semaglutide, the decrease in body weight was 6.2 kilograms, or 6.7%.

The differences were all statistically significant.

Lilly plans to virtually present the full trial results at the American Diabetes Association’s annual scientific conference in late June 2021.

In concerning news, the Centers for Disease Control informs us that “a new paper from CDC, in partnership with the University of Utah, estimates that the national healthcare costs associated with infections from six multidrug-resistant pathogens can be substantial at more than $4.6 billion annually.   This is one of the largest studies to estimate the cost associated with high-priority antibiotic-resistant pathogens. Issues highlighted in the study align with data and threats in CDC’s 2019 Antibiotic Resistance (AR) Threats Report. This includes the impact of resistant infections in the community, which can put more people at risk, make spread more difficult to identify and contain, and threaten the progress made to protect patients in healthcare.”  

Finally, Fierce Healthcare lets us know that

Greater liquidity, a stable payer mix and higher-acuity patients helped major hospital chains end 2020 with massive profits despite a financial roller coaster caused by the pandemic.

The latest earnings reports from several for-profit and not-for-profit hospital chains come as patient volumes continue to drift below pre-pandemic levels and as major hospital groups have raised the alarm about financial hardship faced by many hospitals around the country. 

And while plenty of health systems around the country are struggling, experts say many of the largest health systems around the nation have remained profitable.

[However] Rural and more independent and smaller facilities already operate on narrower profit margins which have been exacerbated by the pandemic. These financial headwinds could cause more consolidation among such facilities.

Midweek Update

David Ermer–Congress, COVID-19 vaccine–
Photo by Manasvita S on Unsplash

Roll Call has laid its hands on the Senate’s version of the House’s American Rescue Plan bill and it reports on the differences between the two bills. In the healthcare realm

Another key health care change would fully subsidize health insurance premiums under the federal law known as COBRA for workers who leave their jobs. The House-passed bill and earlier Senate drafts would have required workers to chip in 15 percent of their premiums, while subsidizing the remainder.

Healthcare Dive reports that

The Senate Finance Committee voted along party lines Wednesday morning to send California Attorney General Xavier Becerra’s nomination as HHS secretary to the Senate for a full vote. After a 14-14 tie vote, the nomination will move forward but now requires debate and two floor votes. All Republicans on the committee voted against the nominee, citing his lack of healthcare-specific experience and support for abortion rights. The date for a full vote is not yet set, but Becerra is still likely to be confirmed.

Fierce Healthcare informs us that at yesterday’s House Energy and Commerce Committee hearing on the future of telehealth:

House [Energy and Commerce] health subcommittee chair Rep. Anna Eshoo said  it’s time to make telehealth flexibilities enacted during the COVID-19 pandemic permanent to help close gaps in care.

The Centers for Medicare & Medicaid Services (CMS) waived many telehealth payment policies during the public health emergency, which helped open up access to virtual care. It drove 10.6 million Medicare beneficiaries to use telehealth visits by the end of July, Eshoo said during a Committee on Energy and Commerce health subcommittee hearing.

“The wide adoption of telehealth has been a bright spot during a very dark time in our country,” she said. “For the first time, we’ve had substantiative data on the quality and the use of telehealth at scale.”

America’s Health Insurance Plans and the Blue Cross Blue Shield Association announced today the creation of the Vaccine Community Connectors pilot initiative. Participation in the initiation is open to all health insurers.

[The initiative] aims to enable the vaccination of 2 million seniors age 65+ in America’s most at-risk, vulnerable and underserved communities – such as African American and Hispanic communities. Insurance providers will focus on their members and the communities they serve. They are working to reach this important goal quickly, depending upon the increasing availability of vaccine supply. 

Bravo.

On the federal employment front —

  • Govexec reports on the latest Postal Service reorganization. “The Postal Service now has about 500,000 career employees, down nearly 300,000 from its peak near the turn of the century. USPS has grown its non-career workforce dramatically in that time, which now numbers more than 100,000.”
  • Federal News Network reports that “Far fewer federal employees retired in 2020 compared to previous years, and for some, the pandemic and new telework arrangements have played a prominent role in their decisions to delay and their views about their jobs. A total of 92,008 federal employees retired in 2020, the fewest in nearly 10 years, according to a Federal News Network analysis of monthly data from the Office of Personnel Management. By contrast, OPM processed 101,580 retirements in 2019 and 107,612 in 2018.”

Tuesday Tidbits

David Ermer–COVID-19, COVID-19 testing, COVID-19 vaccine, Rx coverage, Telehealth, U.S. Healthcare–
Photo by Patrick Fore on Unsplash

The Wall Street Journal reports this evening that “President Biden said the U.S. would have enough Covid-19 vaccines for all American adults by the end of May, two months earlier than he had previously said, after regulators authorized the one-shot Johnson & Johnson vaccine and Merck & Co. agreed to help produce it.” That is very encouraging news.

Politico reports that the President has agreed to comply with Neera Tanden’s request that he withdraw her nomination as Office of Management and Budget Director. “Biden’s statement indicated that he expects Tanden to serve in another role in his administration.”

And here are some tidbits for you —

  • The House Energy and Commerce Committee held a future of telehealth hearing today. “It is critical to the health, safety and equitable access of our patients to ensure we can continue to provide telehealth services after the end of the public health emergency,” said Megan Mahoney, M.D., chief of staff at Stanford Health Care, who testified at the hearing.
  • Medpage Today reports that ” Insufficient evidence exists to support any strategy where patients either delay their second dose or only receive one dose of COVID-19 mRNA vaccines [Pfizer and Moderna], even if they have been previously infected with the virus, CDC staff told the agency’s Advisory Committee on Immunization Practices (ACIP) at its Monday meeting. And ACIP committee members seemed to agree * * *.”
  • Fierce Pharma reports on two recent Food and Drug Administration emergency use authorizations of at home COVID-19 tests.
  • A friend of the FEHBlog pointed him to this STAT News article written by HHS Office of Inspector General Officials discussing the “importance of adding patients’ diagnoses to their prescriptions.” For example, [d]iagnosis information on prescriptions could help pharmacists identify safety issues,” and electronic prescription systems can accommodate diagnosis information.
  • CMS, which enforces the HIPAA electronic transaction rules, issued a factsheet on savings available to healthcare providers who use those electronic transactions. “According to data from the 2020 CAQH Index, 16% of medical plans and 36% of dental plans do not fully use electronic HIPAA standard transactions to conduct eligibility and benefits inquiries and responses. The CAQH Index estimates that medical and dental providers could save approximately $7 billion per year by completing eligibility and benefits checks using the HIPAA standard.” Health plans should share this information with their recalcitrant network providers.
  • Healthcare Dive informs us about four healthcare anti-trust issues to watch in 2021.
  • Health Payer Intelligence reports that “Blue Cross and Blue Shield of Illinois (BCBSIL) is tackling maternal care disparities in its state by financially supporting community-based interventions that focus on increasing education among new mothers and providing in-person and digital support. ‘By taking a holistic approach to supporting prenatal care that considers the social and economic factors impacting the health of mothers and newborns, we are working to help create an environment that fosters access to affordable benefits, equitable care delivery and wherever possible, better health outcomes,’ said Anita Stewart, MD, medical director at BCBSIL.” Well done.

Monday Roundup

David Ermer–Congress, U.S. Healthcare–
Photo by Sven Read on Unsplash

The Wall Street Journal reports this evening that “The Senate prepared to move ahead this week with Democrats’ sweeping coronavirus relief proposal without an increase in the minimum wage, after a backup plan to raise the wage through tax penalties and incentives fizzled over the weekend.” The Journal of Accountancy helpfully has summarized the tax and non-tax provisions of the House bill. The FEHBlog was surprised to find that the House bill displayed on Congress.gov (H.R. 1319) does not extend the COBRA continuation coverage subsidy to the analogous FEHB’s temporary continuation of coverage program. See page 114 of H.R. 1319.

Pennsylvania-based Blue Cross licensee Highmark announced

today [March 1] that its affiliation unveiled in June 2020 with [fellow Blue Cross licensee] HealthNow New York Inc. has become effective. 

 “We look forward to bringing our resources, tools and advanced technologies to Western and Northeastern New York,” said Deborah Rice-Johnson, president of Highmark Inc. “With this affiliation, we begin our path forward to enhance customer and clinician engagement, create better health outcomes, control costs and improve affordability for members in Western and Northeastern New York.”

In the coming months, the newly affiliated organization will be rebranded Highmark Blue Cross Blue Shield of Western New York and Highmark Blue Shield of Northeastern New York.

From the healthcare studies front:

  • Fierce Healthcare reports that “Giving patients discounts for choosing providers that bundle expensive procedures like knee surgeries together resulted in significant savings, a new study finds. The study, published Monday by RAND Corporation, comes as value-based care models have grown in popularity in Medicare but not as much in commercial insurance. The study examined a program that negotiates a preferred price with certain providers to cover an entire episode of care within a 30-day period and waives cost sharing for patients.
  • The RAND Corporation also has released a report on factors that contribute to COVID-19 vaccine hesitancy in the Black community and how those factors can be addressed.
  • Health Payer Intelligence informs us that

While payers have been focusing justifiably on diminishing healthcare spending for chronic conditions, rare disease healthcare spending may exceed chronic disease healthcare spending, according to the National Economic Burden of Rare Disease study.

The survey on which this study was founded received responses from nearly 1,400 individuals regarding costs related to 379 rare diseases in 2019.

“This primary survey was specifically designed and administered for this study to deepen the understanding of the full spectrum of rare disease (RD) impact,” the study explained.

“The survey was able to collect detailed data on a broad set of indirect and non-medical costs of RD that were previously unavailable, especially the impact of RD on unpaid caregivers. This survey was one of the largest surveys conducted so far covering multiple RD communities.”

These diseases impacted 15.5 million people and cost $966 billion. This number exceeds even chronic disease cost estimates including the most expensive chronic diseases driving healthcare spending in the US such as diabetes, cancer, and heart disease.

Weekend Update

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

Congress is session this week for committee and floor business. On Tuesday morning the House Energy and Commerce Committee will hold a hearing on “The Future of Telehealth: How COVID-19 is Changing the Delivery of Virtual Care”

The Wall Street Journal reports that

The task of passing a coronavirus relief package now rests with the Senate, where Democrats must grapple with emerging divisions over some components of the plan, including a minimum-wage increase. The House early Saturday morning passed [largely along party lines] President Biden’s $1.9 trillion package, which would fund vaccine distribution, enhance and extend federal unemployment benefits, and send direct checks of $1,400 to many Americans and $350 billion to state and local governments.

As mentioned in last Thursday’s post, the Democrat leadership in Congress is trying to figure out a way for the Senate to pass the entire bill under budget reconciliation which requires all fifty Democrat senators plus the Vice President. The $15 minimum wage provision found in the House bill remains a wild card in the Senate.

The President officially sent Kiran Ahuja’s nomination to be OPM Director to the Senate last Wednesday. Federal News Network forecasts six “challenges” that Ms. Ahuja will need to address once confirmed.

In most excellent news, the Food and Drug Administration gave emergency use authorization to the single dose Johnson and Johnson vaccine yesterday and the Centers for Disease Control seconded this action today. This means that health plans, including FEHB plans, become liable for reimbursing administration costs for the Johnson and Johnson vaccine without member cost sharing in 15 days / March 15, 2021. Per CNN with the blessing of these two agencies

[T]he federal government may then begin distributing the 3.9 million available doses of the vaccine, perhaps as soon as Monday.”I just want to state explicitly how very grateful I am that we now have three highly effective vaccines,” said ACIP member Dr. Matthew Daley of the Institute for Health Research with Kaiser Permanente Colorado.

The company has pledged to have 20 million doses available by the end of March and 100 million doses by summer.The vaccine, made by Johnson & Johnson’s Janssen vaccine arm, can be kept at regular refrigerator temperatures, which experts said would make it much easier to distribute than vaccines made by Moderna and Pfizer/BioNTech.

The Wall Street Journal sums it up for us as follows:

The pandemic has opened a new era for vaccines developed with gene-based technologies, techniques that have long stumped scientists and pharmaceutical companies, suggesting the possibility of future protection against a range of infectious disease.

Johnson & Johnson’s Covid-19 vaccine, which was authorized Saturday for use in the U.S., is at the vanguard of a class of shots designed to mobilize a person’s immune defenses against the disease. It will be the first Covid-19 vaccine administered in the U.S. that uses viral-vector technology, which employs an engineered cold virus to ferry coronavirus-fighting genetic code to the body’s cells.

J&J’s vaccine is the third to be authorized in the U.S. after ones from Pfizer Inc. and its partner, BioNTech SE, and Moderna Inc. In a late-stage trial, J&J’s single-shot vaccine was 66% effective in preventing moderate to severe cases of the disease that has killed more than 500,000 people in the U.S. and about 2.5 million world-wide.

“This is one of those giant leap moments for us. These are fundamental shifts in how we will build vaccines for the future,” said C. Buddy Creech, director of Vanderbilt University’s vaccine research program. “I think this really ushers in a golden age of vaccinology.”

By the way the Centers for Disease Control has created its own COVID-19 vaccine finder website. According to the CDC’s COVID-19 data tracker website, currently nearly 20% of the eligible U.S. population has received at least one dose of the vaccine and 10% have received both doses.

Finally, the Choosing Wisely campaign is offering a information and a webinar that address one of the points in OPM’s recent call letter for 2022 benefit and rate proposals from carriers:

In Building A Better Health Care System Post-Covid-19: Steps for Reducing Low-Value and Wasteful Care, Corinna Sorenson, PhD, Duke-Margolis Center for Health Policy, and colleagues outline the impact of the pandemic on low-value care, and the potential opportunities it presents to create a better health care system post COVID-19. She elaborates further on this topic in her January 2021 Choosing Wisely webinar recording.

Cybersecurity Saturday

David Ermer–Congress, Cybersecurity–

On Tuesday February 23, the Senate Select Committee on Intelligence held a hearing on the SolarWinds hack. FCW and CyberScoop report on the hearing here and there. Per CyberScoop

More than two months after the hack became public, the wide-ranging Senate Select Committee on Intelligence hearing committee demonstrated that the U.S. government, the private sector and digital incident responders still are wrestling with the ramifications of an suspected Russian espionage campaign that leveraged the federal contractor SolarWinds. 

A number of big questions remain: SolarWinds still hasn’t determined how the hackers originally got into its systems, nobody has fully settled debates on whether the incident amount to espionage, or something worse, and suspicions abound that more victims remain unrevealed.

“It has become clear that there is much more to learn about this incident, its causes, its scope and scale, and where we go from here,” said Senate Intelligence Chairman Mark Warner, D-Va.

The House Oversight and Reform Committee held its own SolarWinds hack hearing yesterday. “The hearing examine[d] the role of the private sector in preventing, investigating, and remediating these attacks, as well as the need for Congress and the Executive Branch to implement a strategy to strengthen cybersecurity across federal government networks and improve information-sharing with the private sector.”

In other SolarWinds hack related news, CyberScoop reports that

Microsoft is offering up the tool it used to track down potential indicators of compromise in the sweeping SolarWinds breach, the company announced Thursday.

Microsoft is releasing the so-called CodeQL queries it used to investigate its source code, in an effort to help other organizations mitigate the risk from the cascading cyber-espionage campaign involving a breach at the U.S. federal contractor SolarWinds. Microsoft is aiming to help firms pinpoint code-level indicators of compromise (IoCs), Microsoft’s Security Team said in a blog. 

By digging into their own code, organizations can assess if they have been compromised by the hack, in which suspected Russian hackers laced malicious software in a SolarWinds product’s software update, Microsoft said. The company has described the campaign as “Solorigate.”

  • CyberScoops reports that on Wednesday February 24, “President Joe Biden signed an executive order on Wednesday directing federal agencies to conduct a review of supply chain security risks in industries including information technology. * * * Specifically, the order directs reports within one year from the the secretaries of Agriculture, Defense, Energy, Health and Human Services and Transportation — along with a joint Commerce/Homeland Security report — that include an assessment of cyber risks within key industry sectors that could disrupt the U.S. supply chain.”

In other cybersecurity related news —

  • Bleeping Computer discusses at reasonable length the Zero Trust security model that the FEHBlog referenced in a recent post. “The National Security Agency (NSA) and Microsoft are advocating for the Zero Trust security model as a more efficient way for enterprises to defend against today’s increasingly sophisticated threats. The concept has been around for a while and centers on the assumption that an intruder may already be on the network, so local devices and connections should never be trusted implicitly and verification is always necessary. Cybersecurity companies have pushed the zero-trust network model for years, as a transition from the traditional security design that considered only external threats.”
  • Bitglass, a cloud security vendor, released its seventh annual healthcare data breach report.

Key Findings [from the company’s announcement]

  • The average cost per breached record increased from $429 in 2019 to $499 in 2020. With 26.4 million records exposed in 2020, data breaches cost healthcare organizations $13.2 billion.
  • Outside of hacking and IT incidents, the remaining breach categories exposed the personal details of about 2.3 million people, exposing victims to identity theft, phishing, and other forms of cyberattacks. 
  • This year, breach numbers were up across the board, with 37 out of 50 U.S. states suffering more breaches than they did in 2019. California had the most healthcare breaches in 2020 with 49 incidents–surpassing last year’s leader, Texas, which suffered 43 breaches in 2020. 
  • In 2020, the average healthcare firm took about 236 days to recover from a breach. 
  • The FEHBlog recently noticed that the Office of Personnel Management has posted its 4th Quarter 2020 report on the implementation of its FEHB Master Enrollment Index.