The FEHBlog just watched on C-SPAN the House of Representatives join the Senate in adopting the CARES Act (H.R. 748) so the $2 trillion COVID-19 emergency relief bill heads to the President for his expected signature later today.
The Centers for Medicare Services plans to start a new pilot program known as ET3 that allows certain ambulance companies to take traditional Medicare patients who call 911 to less acuity health care facilities than the usual hospital emergency room.
Under the ET3 Model, Medicare will pay participating ambulance suppliers and providers to:
Transport a beneficiary to an alternative destination (such as a primary care doctor’s office or an urgent care clinic), or
Initiate and facilitate treatment in place by a qualified health care practitioner, either in-person on the scene or via telehealth.
Upon arriving on the scene of a 911 call, participating ambulance suppliers and providers may triage Medicare beneficiaries to one of these Model’s interventions.
The ET3 program will begin later this year for a two year period.
One of OPM’s heaviest weighted HEDIS measures turns on whether a pregnant woman visits her obstetrician in the first trimester of her pregnancy. Interestingly, Health Affairs Blog explains that
Prenatal care has been largely left out of the growing national conversation about the rise in maternal morbidity and mortality and the stark racial disparities in maternal health outcomes. This notable absence may be a consequence of how little is understood about the content and quality of prenatal care services and their relationship to maternal and infant health. Increased understanding of what happens during labor, delivery, and the postpartum period is essential to improving outcomes: the Centers for Disease Control and Prevention (CDC) estimates that roughly two-thirds of maternal deaths occur during childbirth and the first year thereafter. The remaining third of deaths occur during pregnancy. Prenatal care—spanning most of a year and consuming substantial time and resources from patients and providers alike—may represent an important opportunity to prevent these deaths, as well as to identify and mitigate risks of subsequent mortality or morbidity.
There are three primary impediments to rigorous research in this area:
Reliance on blunt quality metrics that do not reflect important dimensions of care;
Limited access to data on what occurs during prenatal care; and
Empirical challenges to evaluating the impact of prenatal care on maternal and infant outcomes.
In other words, it’s complicated.
Fierce Healthcare reports on a survey about the extent to which patients lie to their physician and offers tips to doctors on how to encourage their patients to be truthful. If patients lie to their doctors, then members may well lie to their health plan too so the tips in the article should be generally helpful.
The Hill reports that “[House of Representatives] Speaker Nancy Pelosi (D-Calif.) said Thursday that the House will move quickly on Friday to approve the Senate’s massive, $2 trillion coronavirus relief package [the CARES Act, H.R. 748] through the lower chamber and on to President Trump, who has vowed to sign it immediately.” NPR has provided a link to the text of the bill that the Senate passed unanimously at 11:17 pm last night.
Federal News Network reports tonight that “The White House has tapped Michael Rigas, the newly-appointed acting director of the Office of Personnel Management [and Senate confirmed OPM Deputy Director], to serve concurrently as the acting deputy director for management at the Office of Management and Budget.” This means that Margaret Weichert is leaving the federal government for a consultancy. Ms. Weichert who was the Senate confirmed OMB Deputy Director for Management served as OPM Acting Director between Senate confirmed yet temporary OPM Directors Jeff Pon and Dale Cabaniss.
The President and the entire Senate leadership have agreed on a third COVID-19 relief bill known as the CARES Act (H.R. 748). Senator Charles Grassley, the Senate Finance Committee Chair, has released a summary of the bill’s taxation and unemployment insurance provisions and summary of its health provisions. The key health provisions affecting federal employees benefits are the following:
Sec. 3701. Health Savings Accounts for Telehealth Services
This section would allow a high-deductible health plan (HDHP) with a health savings account (HSA) to cover telehealth services prior to a patient reaching the deductible, increasing access for patients who may have the COVID-19 virus and protecting other patients from potential exposure.
Sec. 3702. Over-the-Counter Medical Products without Prescription
This section would allow patients to use funds in HSAs and Flexible Spending Accounts for the purchase of over-the-counter medical products, including those needed in quarantine and social distancing, without a prescription from a physician.
The FEHBlog mistakenly stated on Sunday that that the House of Representatives would be back on Capitol Hill yesterday. In fact, as the Wall Street Journal explains, House members remain on recess this week. Should the Senate as anticipated pass the CARES Act today, the House leadership is expected to seek approval by a unanimous consent motion. A single member of Congress can block such a motion so a lot rides on entire House leadership support for the bill. According to the Wall Street Journal, House Speaker Nancy Pelosi wants the unanimous consent to clear the House. This motion could be brought to the House floor on tomorrow or Friday. The Journal further reports that the President is ready to sign the bill into law.
The FEHBlog has found a link to a COVID-19 statistics site, The COVID-19 Tracking Project, that displays aggregated lab results from COVID-19 testing, U.S. state by state, where available.
Today is the tenth anniversary of President Obama signing the Patient Protection and Affordable Care Act into law. The FEHBlog is tempted to muse on the law but since he has been writing in this space since 2006, he concluded no need exists for another such musing.
Be sure to check out at least the transcript for this week’s Econtalk interview with Dr. Azra Raza, a veteran oncologist who wrote a book on the human cost of cancer treatment. She explained that the benefit of early detection of cancer lies in the fact that at that point the body has fewer cancer cells that must be killed. She also touted tobacco cessation. She further explained that the new fangled CAR-T drug therapy has a weakness. CAR-T activates the body’s T cells which wind up killing healthy and cancerous tissue in a particular organ. Consequently CAR-T therapy is not used for example on liver cancer because the cure would kill the liver. Cancer is a very complicated disease.
On the COVID-19 front —
The House and the Senate will be in session this coming week working on a third COVID-19 relief bill. The House returns from a district work week on Tuesday while the Senate cancelled its state work week which had been scheduled for this week.
On the COVID-19 front —
| COVID-19 Cases | March 6 | March 13 | March 20 |
| Travel | 36 | 138 | 290 |
| Person to Person | 18 | 239 | 310 |
| Cause of Infection Under Investigation | 110 | 362 | 9,842 |
| Total Cases | 164 | 1629 | 10,442 |
| Total Deaths | 150 |
These statistics are drawn from Centers for Disease Control’s COVID-19 Situation Summary in the U.S. website. The CDC indicates that there statistics may be understated. The FEHBlog is using the CDC’s website in the interest of consistency and reliability.
The COVID-19 virus is present in all 50 states with the highest concentration of case in New York State, California, and Washington State.
From the CDC’s latest Fluline (March 14),
In other news,
On the COVID-19 front —
Finally, here’s a link to the Politico article that broke the story about Dale Cabaniss’s resignation as OPM Director on Tuesday. The FEHBlog is disturbed that a federal agency director would resign over personal differences with White House officials in the midst of a national emergency. Can’t we all get along?