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–COVID-19–

Fiere Biotech reports that Abbott Laboratories has launched a COVID-19 antibody blood test. “The company plans to distribute 4 million tests in the next two weeks as it ramps up production to 20 million tests per month beginning in June for both the Architect and Alinity systems.” The test will help public health authorities better understand the spread of the disease and help members of the public learn whether they have gained immunity against the disease.

Fierce Pharma offers insights on a presser’s interview with drug manufacturer GSK CEO Emma Walmsley. The article explains that

In all, there are 71 preclinical vaccine programs underway, while six projects have reached phase 1 and one is in phase 2, according to a tracker from the Vaccine Centre at the London School of Hygiene & Tropical Medicine.

China’s CanSino Bio recently moved to phase 2, while Moderna, Inovio and others have started early human testing, according to the tracker. As for Big Pharma, many of the industry’s top companies are involved. Johnson & Johnson, Sanofi, Pfizer and GSK and are among those putting resources into the hunt for a vaccine.

Ms. Walmsley expects that more than one group will succeed in this vitally important development process. “We’re all hoping and we believe the world is going to need more than one vaccine as part of the solution.”

Medium writer Robert Roy Britt discusses the course of the COVID-19 illness. It’s not a 48 hour bug which is important to understand.

Healthcare Dive reports that telehealth network vendor

Teladoc expects volume in the quarter ending March 31 to be above 1.8 million visits, up more than 70% from 1.06 million visits during the same period last year. That’s a significant jump, though analysts said they expected utilization to be even higher. More than 60% of visits are new users looking to check potential COVID-19 symptoms or treat non-respiratory conditions as they shelter in place.

It will be interesting to see if the telehealth trend survives the pandemic. The FEHBlog expects that it will become a routine part of health care.

Govexec.com looks at the Postal Service’s COVID-19 issues and provides and exchange of fairly recent correspondence between a group of U.S. Senators and the Postal Services (last paragraph of the article).

Tuesday Tidbits

David Ermer–COVID-19–

A friend of the FEHBlog recommended this National Review podcast in which former Food and Drug Administrator Scott Gottlieb is interviewed about the COVID-19 emergency. It’s quite informative.

Also today the FEHBlog ran across this Castlight.com COVID-19 test site finder. He checked it out on his own locality. It strikes the FEHBlog as a valuable resource at this time when testing resources still are expanding.

Diabetes Forecast offers a Q&A on diabetes and COVID-19.

First, the good news: If your blood glucose is well managed, your risk for serious complications from COVID-19 is the same as people without diabetes.

However, blood glucose that’s not in your target range does raise your chance of getting very sick from the virus, just as it would if you were sick with the yearly flu.

The Boston Globe’s STAT warns that the country may be in for more healthcare problems later this year if people with chronic conditions don’t receive proper routine care during the great hunkering.

Monday Musings

David Ermer–Congress, COVID-19, OPM, SCOTUS–

Becker’s Hospital Review provides a helpful update of today’s top seven COVID-19 news items.

Healthleaders Media interviews “Karen Murphy, PhD, RN, executive vice president and chief innovation officer at Geisinger, and founding director of the Steele Institute” for Health Innovation about COVID-19 and lessons for the future.

HL: Is telehealth among the initiatives that should be expanded? What else?

Murphy: Virtual care is one thing that I think will transform the healthcare industry. And, we’re looking at what we need in terms of infection control. How do we change our practices?

Federal News Network reports on legislative ideas coming from the majority leadership of the House Oversight and Reform Committee. With regard to the FEHBP, the leaders

recommended allowing federal employees to change or opt into new insurance plans during a health emergency like the current pandemic.

Currently, FEHB participants have one chance a year, usually a four-week “open season,” to make changes to their health insurance plan.

In addition, the chairmen suggested allowing employees to extend eligibility for their federal health, dental and vision benefits to qualifying dependents for an additional year. Some children, for example, may age out of their family’s current health plans during the coronavirus pandemic, they said.

The FEHBlog recalls that approximately 15% of FEHBP eligible employees decline FEHBP coverage in favor of taking coverage under his or her spouse’s employer sponsored coverage. We the rapid employment loss due to the great hunkering down, it would make sense for OPM to remind federal employees that losing other health coverage is a qualifying life event that allows them to rejoin the FEHBP for themselves and their eligible family members. OPM prominently notes that “Generally, if you choose to make a change to your enrollment, you must make the change within 60 days of the event.”

Today, the U.S. Supreme Court, which had cancelled its March and April oral arguments, rescheduled ten of those cases for telephonic oral argument in May. “The Court anticipates providing a live audio feed of these arguments to news media.” Normally the press desiring live feeds would have listen to the oral argument in person at the Court. Transcripts of the oral argument come later.

Weekend Update

David Ermer–Congress, COVID-19–

Congress is on a State / district work period at least until April 20 as a form of social distancing. Congress nevertheless can take action by unanimous consent measures from afar. The Wall Street Journal reports on bumpy bi-partisan efforts to craft a fourth COVID-19 relief bill.

The Affordable Care Act regulators have issued FAQ 42 on concerning “implementation of the Families First Coronavirus Response Act (the FFCRA), the Coronavirus Aid, Relief, and Economic Security Act (the CARES Act), and other health coverage issues related to Coronavirus Disease 2019 (COVID-19).” The FAQs cover COVID-19 coverage issues for group and individual health plans as well as employee assistance plan and telehealth issues.

The Wall Street Journal helpfully wrote about how to obtain healthcare for issues other than COVID-19 during this emergency.

Don’t assume doctors are too busy for you. Doctors are converting their practices to telemedicine quickly to address more ailments, so there is no need to suffer in silence. Call your doctor and together make a plan that addresses both your medical need and your concern for protection from the coronavirus.

“Doctors have switched their business model on the fly,” says Fred Feuerbach, a cardiologist and assistant attending physician and clinical instructor of medicine at NewYork-Presbyterian/Weill Cornell Medical Center, who is monitoring some patients through daily phone calls and FaceTime visits. “Patients should know doctors are available,” he says.

According to the article, the same approach applies to seeking dental care. The article also discusses women’s health care, vision care, orthopedics, and allergy and vision care during the great hunkering down. The across the board advice is to avoid emergency rooms now.

The Wall Street Journal reports on the expansion of serological / blood testing for COVID-19 antibodies.

“To date, we have had no clue how many people have been infected,” said Eran Bendavid, an infectious-disease physician at Stanford University. “This could be an extraordinarily important piece of how we’re going to get over this epidemic.”

In the U.S., the Food and Drug Administration granted the first emergency authorization for one of the blood tests last week, and the Centers for Disease Control and Prevention said it has started using its own test. The U.S. could have a “rather large number of tests” available within a week, provided extra checks show them to be accurate, Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told CNN.

Reason Magazine discusses a serological test study conducted in a German hot spot.

Over the last two weeks, German virologists tested nearly 80 percent of the population of Gangelt for antibodies that indicate whether they’d been infected by the coronavirus. Around 15 percent had been infected, allowing them to calculate a COVID-19 infection fatality rate of about 0.37 percent. The researchers also concluded that people who recover from the infection are immune to reinfection, at least for a while.

This preliminary study illustrates the promise of these serological tests in gauging the lifting of the great hunkering.

The FEHBlog noted recently about a new rapid COVID-19 test development by Abbott Labs. According to this Wall Street Journal article, the federal government bought a boatload of the machines and distributed them among the States and other U.S. jurisdictions. However, Abbott has experienced a backlog in manufacturing the test cartridges to be read on the machines, notwithstanding producing 50,000 cartridges daily. On the bright side,

Detroit, was able to buy and deploy a large number of Abbott’s rapid tests shortly after the company got approval from the FDA on March 27. The quick results helped reshape the city’s response to the virus.

Since the start of the month, Detroit has administered more than 1,000 tests, initially focusing on first responders and bus drivers who had been in quarantine, said John Roach, a spokesman for the mayor. The city has already purchased 4,000 additional tests from Abbott and recently said that rapid tests would be used at nursing homes and homeless shelters.

Well done, Detroit.

Friday Stats and More

David Ermer–CDC, COVID-19–

So the FEHBlog was wrong in promoting the fact that the COVID-19 death rate was stable for two days this week. After the period of stability the death rate rose from 3.23% to 3.61%. In other words, the plateau has not yet been reached. Here are the CDC Cases in U.S. Stats for the four Fridays:

COVID-193/203/274/34/10
Cases10,44285,356239,279459,165
Deaths15012465,44216,570
Deaths over Cases1.44%1.46%2.37%3.61%

Please note that the CDC numbers close at 4 pm on the previous day. The much loved John Hancock COVID-19 site is simply too much for the FEHBlog to handle.

Today, the CDC released its latest COVIDView and its final FluView for the 2019-20 flu season. Thanks heavens for small miracles.

The FEHBlog was overjoyed by a sentence from the following HHS press release that the FEHBlog has placed in bold print:

The Trump Administration is committed to ensuring that Americans are protected against financial obstacles that might prevent them from getting the testing and treatment they need from COVID-19.As announced in early April, a portion of the $100 billion Provider Relief Fund will be used to reimburse healthcare providers, at Medicare rates, for COVID-related treatment of the uninsured.
As a condition, providers are obligated to abstain from “balance billing” any patient for COVID-related treatment.
The Families First Coronavirus Response Act requires private insurers to cover an insurance plan member’s cost-sharing payments for COVID-19 testing. President Trump has also secured commitments from private insurers, including Humana, Cigna, UnitedHealth Group, and the Blue Cross Blue Shield system to waive cost-sharing payments for treatment related to COVID-19 for plan members.

Here’s the rub. How will health plans know that a particular provider is barred from balance billing for COVID-19 care?

It is admirable that UnitedHealthGroup is helping HHS promptly distribute this CARES Act funding to providers.

Person using a laptop

Thursday Miscellany

David Ermer–CDC, COVID-19, HIPAA Privacy and Security Rules, Rx coverage–

As the FEHBlog discussed COVID-19 death rates yesterday, it’s only meet and right to post STAT’s story which seeks to put COVID-19 death projections into perspective.

On the flip side, STAT reports on Pfizer’s decision to accelerate by three months human testing on a potential treatment for COVID-19 and local WTOP news reports on COVID-19 vaccine development efforts by a company in the Maryland suburbs of D.C., Novovax. Best of luck.

Healthleaders Media discusses a Guidehouse study finding

A major factor hampering the financial situation for rural providers is the migration of patients to care options outside of the community, with over 75% of patients bypassing local hospitals to receive care elsewhere. These levels are much higher compared to the outmigration patterns of suburban and urban patients.

More than 350 rural hospitals [one in four], accounting for $8.3 billion in total patient revenue, are at the greatest financial risk of closure, according to Guidehouse. The five states most likely to be impacted by hospital closures include Tennessee, Oklahoma, Mississippi, Alabama, and Kansas, according to the analysis.

Guidehouse adds that “Of these hospitals, 81%, or 287 hospitals, are considered highly essential to the health and economic well-being of their communities.” What is really troubling about this study is that it was conducted before the COVID-19 emergency which must be exacerbating these financial problems.

The Centers for Medicare and Medicaid Services today issued additional guidance loosening the regulatory reins on healthcare providers so that “so that hospitals, clinics, and other healthcare facilities can boost their frontline medical staffs” necessary to treat COVID-19 patients and others. Among other steps,

Doctors can now directly care for patients at rural hospitals, across state lines if necessary, via phone, radio, or online communication, without having to be physically present. Remotely located physicians, coordinating with nurse practitioners at rural facilities, will provide staffs at such facilities additional flexibility to meet the needs of their patients.

Similarly, the HHS Office for Civil Rights which enforces the HIPAA Privacy and Security Rules promised not to impose HIPAA penalties on good faith rule violations that occur at COVID-19 testing sites.

Drug Channels offers an interesting take on the CMS actuary’s recent healthcare spending projections for the U.S. Adam Fein observes that ” The coronavirus is upending our healthcare system and putting enormous pressure on hospitals. Despite increased costs of treatment, I expect that spending [that CMS estimated before the COVID-19 emergency] will be lower than the CMS projections.”

On the technology front, the federal government’s cybersecurity authorities released a detailed alert on a variety of cyberscams that have arisen during the COVID-19 emergency.

Midweek update

David Ermer–CDC, COVID-19, Uncategorized–

As you know, the FEHBlog tracks the daily COVID-19 cases in the U.S. posted by the Centers for Disease Control. Here are the statistics for this week so far:

COVID 19 Statistics4/54/64/74/8
Cases304,826330,891374,329395,011
Deaths7,6168,91012,06412,754
Deaths over Cases2.50%2.69%3.22%3.23%

We tragically have experienced more COVID-19 deaths so far this week than the approximately 3,000 Americans who died at Pearl Harbor (or on September 11). However, the relatively high death rate (particularly compared to the flu) was flat for the past two days. We will see on Friday whether this encouraging trend continues.

The flattening occurred because the number of deaths stopped increasing proportionally faster than the number of cases. The more rapidly increasing number of COVID-19 cases must be due at least in part to the expansion of COVID-19 testing as discussed in this Healthcare Dive article and this HHS announcement that licensed pharmacists now are authorized to order COVID-19 tests.

Fierce Healthcare reports on the development of a new COVID-19 portal called “The National Response Portal that will provide vital information to healthcare providers, policymakers and the general public as a ‘one-stop-shop’ for all health data related to COVID-19, which is caused by the novel coronavirus, according to the organizations.” The new portal is gathering information now and is expected to go live next week.

It’s World Health Day

David Ermer–CDC, COVID-19, Medicare, OPM–

The World Health Organization has declared today World Health Day appropriately honoring nurses and midwives. U.S. HHS Secretary Alex Azar commented

“This year’s theme for World Health Day, ‘Celebrating Nurses and Midwives,’ is also an important reminder of the work being done by frontline healthcare workers every day, around the world, to save lives. Preparing for and responding to outbreaks that can cross borders is one of the most important contributions we can make to support our healthcare workers, and we applaud the heroic work they have been doing to battle the global pandemic

The FEHBlog heartily agrees. Now, how about some Tuesday Tidbits?

  • Yesterday, as Health Payer Intelligence reports, the Centers for Medicare and Medicaid Services “finalized its Medicare Advantage and Part D rates, including finalizing the disputed Medicare Advantage end-stage renal disease (ESRD) payment rule without changes.” HPI adds that CMS anticipates a slight uptick (1.66 percent) in revenue as a result of the new rate announcement, based on its changes to the reimbursement methodologies for Medicare Advantage organizations, PACE organizations, and Part D sponsors. The uptick does not account for the adjustments related to the underlying coding trend, which CMS anticipates will bump most risk scores by around 3.56 percent.” In the FEHBlog’s view, the extension of Medicare Advantage coverage to beneficiaries under age 65 with end stage renal disease could be disruptive to Medicare Advantage rates.
  • The Centers for Disease Control released yesterday a report on “Coronavirus Disease 2019 in Children — United States, February 12–April 2, 2020.” Here’s the summary

What is already known about this topic?

Data from China suggest that pediatric coronavirus disease 2019 (COVID-19) cases might be less severe than cases in adults and that children (persons aged <18 years) might experience different symptoms than adults.

What is added by this report?

In this preliminary description of pediatric U.S. COVID-19 cases, relatively few children with COVID-19 are hospitalized, and fewer children than adults experience fever, cough, or shortness of breath. Severe outcomes have been reported in children, including three deaths.

What are the implications for public health practice?

Pediatric COVID-19 patients might not have fever or cough. Social distancing and everyday preventive behaviors remain important for all age groups because patients with less serious illness and those without symptoms likely play an important role in disease transmission.

  • TechCrunch brings us up to date another potential COVID-19 vaccine is entering phase 1 human trials with Food and Drug Administration approval. This vaccine is being developed by Inovio Pharmaceuticals with financial backing from the Bill and Melinda Gates Foundation. Best of luck to Inovio and the other developers.
  • A friend of the FEHBlog found this online edited transcript of NYC pulmonologist David Price’s chat and Q&A on COVID-19 discussed in yesterday’s FEHBlog. Check it out.

Pulmonologist video

David Ermer–COVID-19–

Yesterday a friend called the FEHBlog’s attention this 56 minute long video of pulmonologist “Dr. David Price of Weill Cornell Medical Center in New York City sharing information in a Mar. 22 Zoom call with family and friends on empowering and protecting families during the COVID-19 pandemic.” The FEHBlog watched the video this morning. Dr. Price engages in a monologue for the first 30 minutes. In the monologue he beautifully ties together all of the government’s current guidance on how to deal with COVID-19. Dr. Price answers questions in the last 26 minutes. It’s worth watching if you haven’t already seen it.

For example, Dr. Price explains that the likeliest path to catching COVID-19 is to touch an infected person or object and then touch your face. That’s why it’s important to clean your hands frequently and not touch your face. Dr. Price explained that the COVID-19 virus is a wimp that virtually all disinfectants can kill. He said a drop of Purell would do the trick. He explained that the principal purpose of a cloth face mask is to protect your face from unprotected touching by your own hands, which makes sense.

Weekend update

David Ermer–COVID-19, HIPAA Privacy and Security Rules, OPM–

Congress remains on a State / district work period this week with the exception of one Senate Armed Services Committee hearing. The Wall Street Journal reports that

The [coming] week will be “the hardest and saddest week of most Americans’ lives,” Surgeon General Jerome Adams said on Fox News Sunday, drawing comparisons with the 1941 attack on Pearl Harbor and the Sept. 11, 2001, terrorist attacks.

Officials again urged Americans to stay home. “This is the moment to not be going to the grocery store, not going to the pharmacy, but doing everything you can to keep your family and your friends safe,” coronavirus response coordinator Deborah Birx said at a White House news briefing over the weekend.

HHS’s Office for Civil Rights, which enforces the HIPAA Privacy and Security Rules, called attention today to the Federal Bureau of Investigation’s guidance “on defending against video-teleconferencing (VTC) hijacking (referred to as ‘Zoom-bombing’ when attacks are to the Zoom VTC platform). Many organizations and individuals are increasingly dependent on VTC platforms, such as Zoom and Microsoft Teams, to stay connected during the Coronavirus Disease 2019 (COVID-19) pandemic.” This guidance is applicable to both business and personal users of these virtual meeting platforms.

And as this is the FEHBlog, not the COVIDblog, the FEHBlog wants to call attention to this FEDSmith article on how federal employees and annuitants can extend their FEHBP coverage post-mortem to their surviving spouses and children (under age 26 except in the case of total disability.) This unique federal employment benefit should be a top consideration in estate planning for federal employees and annuitants. Here is a link to the OPM website’s discussion of continued FEHB coverage for survivor annuitants. Here are OPM’s survivor annuity websites for the federal government’s legacy retirement system CSRS and its current retirement system, FERS.

Hang in there, my friends.