FEHBlog

Tuesday’s Tidbits

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

Roll Call discusses the status of the $3.5 trillion budget reconciliation bill as “Senate Democrats begin to tweak the House package.” Federal News Network provides a broader perspective on the varied issues facing Congress this month.

From the Delta variant front

  • The Department of Health and Human Services” (HHS) Vaccination Community Corps has updated its resources list.
  • Yesterday, HHS “transitioned from a direct ordering process to a state/territory-coordinated distribution system * * * for the distribution of monoclonal antibody drugs (“mAbs”) [to treat COVID-19 particularly in unvaccinated people].  State and territorial health departments know best where product is needed in their areas. Transitioning to a state/territory-coordinated distribution system gives health departments maximum flexibility to get these critical drugs where they are needed most.” Makes sense.  
  • Healthcare Dive reports that “Just as patients started returning for care they delayed throughout the COVID-19 pandemic, hospitals are again having to put non-emergency procedures on hold to free up resources for patients hospitalized with the delta variant of the coronavirus. Salt Lake City-based Intermountain Healthcare is the latest system to announce it’s postponing elective procedures starting Wednesday at 13 of its hospitals, and expects the pause to last several weeks, CEO Marc Harrison said during a Friday press conference.”
  • JDSupra offers a useful and in the FEHBlog’s opinion accurate legal analysis of the President’s vaccination programs for federal contractors and private employers. Bloomberg expresses concern that “The U.S. may not have enough tests to keep pace with the Biden administration’s tightened workplace Covid-19 mitigation measures.”

In the tidbits department

  • The Mercer consulting firm announced that ‘[a]s the pandemic continues to unfold, the ability of employers to have a positive impact on employee health and resiliency cannot be understated and is one of the most important findings of the latest Mercer “Health on Demand” survey released today.” Since the onset of COVID-19, when employers stepped up to provide essential support, it made a difference. Employees who say they received good support from their employers are much less likely to view their personal experience of the pandemic as mostly or entirely negative compared to those who received little or no support – 25% vs. 49%. And almost half (45%) of those receiving good support say they are less likely to leave their job as a result.
  • The FEHBlog noticed a Modern Healthcare article discussing how employers are incorporating virtual substance abuse programs in their provider networks. As an example the article pointed to Ria Health which describes itself as an evidence based alcohol additional treatment program.
  • The American Medical Association’s President (appropriately in the FEHBlog’s view) is urging physicians and patients to reengage. “As life takes steps to return to normal, it’s urgent that patients and physicians prioritize health screenings and regular procedures.”

Monday Roundup

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

On the OPM front, Govexec informs us that

The Office of Personnel Management on Monday announced that it agrees with the vast majority of recommendations posed by a recent study on the future of the agency and is incorporating much of that report’s findings into its strategic plan and budget requests.

In March, the National Academy of Public Administration released its long-awaited report on how to modernize OPM * * * .

OPM said that many of NAPA’s recommendations have already been incorporated into the agency’s fiscal 2022-2026 strategic plan and will be used as the agency develops its fiscal 2023 budget request, which is due to the Office of Management and Budget in October. The new strategic plan will not be public until February 2023, coinciding with the release of President Biden’s fiscal 2023 budget proposal.

In a statement, OPM Director Kiran Ahuja said she will ensure the agency is focused on implementing policies that reaffirmed OPM as a strong and independent leader in governmental human resources.

Good luck with that effort. It seems like yesterday that OPM released its last five year strategic plan.

On the Delta variant front, The Wall Street Journal reports today that

A surge in Covid-19 deaths caused by the highly contagious Delta variant is hitting working-age people hard while highlighting the risks for people who remain unvaccinated.

Federal data show Covid-19 deaths among people under 55 have roughly matched highs near 1,800 a week set during last winter’s surge. These data show weekly tallies for overall Covid-19 deaths, meanwhile, remain well under half of the pandemic peak near 26,000 reached in January. * * *

Older Americans still account for the most Covid-19 deaths, but their higher vaccination rates have helped hold down the numbers. About 54% of the overall U.S. population and 63% of eligible people ages 12 and above are fully vaccinated, while the average among nursing homes is 84% for their residents, federal data show.

On the COVID vaccination front —

  • David Leonhardt in the New York Times offers helpful information for folks who have received the one dose Johnson & Johnson vaccine.
  • Medscape tells us that “Pfizer’s COVID-19 vaccine could be authorized for ages 5-11 by the end of October, according to Reuters.”

On the Biden Administration’s vaccine mandate front —

Federal News Network reports that

Federal employees have until Nov. 22 to be fully vaccinated in accordance with the president’s new mandate, the Biden administration said Monday.

The Safer Federal Workforce Task Force, led by the White  House COVID-19 Response Team, the Office of Personnel Management and General Services Administration, offered up a few more details on what agencies and employees should expect from the president’s new vaccine executive order.

“Federal executive branch employees must be fully vaccinated, except in limited circumstances where an employee is legally entitled to a reasonable accommodation,” the task force said in a series of updated “model safety principles” released Monday. “Agencies must work expeditiously so that their employees are fully vaccinated as quickly as possible and by no later than Nov. 22, 2021.”

The task force said it’s preparing additional guidance on how agencies should implement the president’s new executive order and will issue it “soon.”

Govexec tells us that “The U.S. Postal Service is not committing to implementing any COVID-19 vaccine mandate—full or partial—for its workforce, with an agency spokesman saying officials will first need to see the fine print of new requirements President Biden has issued.”

On the health equity front —

  • Healthcare Finance News reports that seventeen national healthcare organizations sent a letter “urging Department of Health and Human Services Secretary Xavier Becerra to move forward on alternative payment models as part of its strategy to achieve health equity. [T]he groups [letter] underscored how APMs routinely leverage multidisciplinary approaches to care, assess social risk, partner with community organizations to increase access to nonmedical services and leverage data to improve disparities in patient outcomes.”
  • Health IT Analytics discusses the value including social determinants of health data in artificial intelligence applications. “According to New York University researchers, machine learning can accurately predict cardiovascular disease and guide physicians to select treatment options. However, by factoring social determinants of health into the equation, providers can better serve diverse groups.”

In other healthcare news —

  • HHS’s “Substance Abuse and Mental Health Services Administration (SAMHSA) is awarding more than $123 million in funding through six grant programs to provide multifaceted support to communities and health care providers as the Nation continues to combat the overdose epidemic.”

Policymakers have introduced proposals to combat high and rising hospital prices, but focusing on high-concentration markets likely misses the mark.

The majority of high-price hospitals are active in markets that meet federal definitions of low or moderate concentration, according to a recently published commercial claims review.

As such, price regulation policy proposals that specifically target concentrated hospital markets would only impact a minority of hospitals charging the highest prices for their services, Harvard-affiliated researchers wrote in Health Affairs.

Policymakers would instead be more effective if they focused their interventions directly on limiting high provider prices without regard to a hospital’s surrounding market, researchers wrote.

“Policymakers could start with modest approaches, such as capping the highest prices, tracking outcomes and gradually pushing the caps downward, and monitoring trade-offs between savings and any unintended consequences for access or quality,” they wrote.

Weekend Update

David Ermer–CMS, Congress, COVID-19, COVID-19 vaccine, Rx coverage–
Photo by Dane Deaner on Unsplash

The U.S. House of Representative both will be engaged in committee work through Wednesday this week until Yom Kippur begins on Wednesday evening. The Senate also will be engaged in floor voting for the same period. Committee work principally will focus on the details of the $3.5 trillion budget reconciliation bill and a related Plan B measures including a stopgap extension of federal funding past September 30 and addressing the debt ceiling.

On the Delta variant front

The Wall Street Journal explains that epidemiologists no long think that COVID-19 can be eradicated. We have a good shot at the virus becoming endemic / a routine treatable illness.

When or even whether Covid-19 settles into that status depends on how many more people get vaccinated and how soon, said Adolfo Garcia-Sastre, director of the Global Health and Emerging Pathogens Institute at the Icahn School of Medicine at Mount Sinai in New York.

For Covid-19 to become mild, most people will need some immunity, which studies have shown reduces the severity of the disease. Infections provide some immunity, but at risk of severe illness, death and further spread of the virus, compared with vaccines. People could become vulnerable to SARS-CoV-2 if that immunity erodes or is weak, or if the virus mutates.

“The more people who are vaccinated, the less problems there are going to be,” Dr. Garcia-Sastre said.

The Journal’s Numbers columnist explains why COVID-19 vaccination boosters will be necessary.

“We’re fortunate with tetanus, diphtheria, measles and vaccinia,” Dr. [Mark] Slifka [from the Oregon Health & Science University] said. “We have identified what the threshold of protection is. You track antibody decline over time, and if you know the threshold of protection, you can calculate durability of protection. With Covid, we don’t know.”

Complicating things further, viruses and bacteria that mutate to escape the body’s immune response are harder to control.

Measles, mumps, rubella and chickenpox hardly mutate at all, but at least eight variants of SARS-CoV-2, the virus that causes Covid-19, have been found, according to the British Medical Journal.  

“It does make it more complicated for the vaccine to work,” Dr. Slifka said. “You’re chasing multiple targets over time. Flu also mutates. With flu, we’ve adjusted by making a new flu vaccine each year that as closely as possible matches the new strain of flu.”

The FDA’s Vaccines Advisory Committee meets on the topic of COVID-19 boosters this Friday September 17. The CDC’s Advisory Committee on Immunization Practices has scheduled a complementary meeting for September 29.

The FEHBlog ran across this interesting WebMD article titled “Monoclonal Antibodies vs. Vaccines vs. COVID-19: What to Know.” “‘As hospitalizations go up nationwide, we have a therapy here that can mitigate that,’ says William Fales, MD, medical director of the Michigan Department of Health and Human Services Division of EMS and Trauma. Getting monoclonal antibodies is one of ‘the best things you can do once you’re positive.’” However, the vaccine’s protection against COVID-19 has a much longer duration than this treatment. “There are two authorized uses for monoclonal antibodies: To treat or stop COVID-19’s progression in a high-risk person who tests positive, and to prevent COVID-19 in a high-risk person who’s been exposed.” The treatment is administered while hospitalized or while outpatient at an infusion center.

In RX news, Managed Healthcare Executive reports

The FDA has approved 30 biosimilars and 21 have been launched. But it won’t be till biosimilars for some of the more widely prescribed biologics are on the market before biosimilars really start to have a major impact on American healthcare and its cost, according to a top-ranking executive at OptumRx.

“We’re still a few years away from the point at which the most widely-utilized … products in the U.S. today will be available as biosimilars,” Savitha Vivian, senior vice president of clinical and formulary Services for OptumRx, said in an interview with Managed Healthcare Executive®. “And that’s really what we’re looking for, because that’s going to enable a more sizable and impactful bottom-line savings.”

Ms. Vivian expects Humira to hit the bio-similar market in 2023.

“Another significant biosimilar launch that is still two to three years away from one for Novo Nordisk’s insulin aspart injection (Novolog), a “highly utilized medication, especially in the outpatient setting,” noted Vivian.Biosimilars for Genentech’s Actemra (tocilizumab), a medication for rheumatoid arthritis and other forms of arthritis, and Stelara (ustekinumab), Janssen’s immunosuppressive drug for plaque psoriasis and psoriatic arthritis, are also two or three years away.”

Patient and provider comfort with biosimilars is still a “critical barrier” to the adoption of biosimilars, she said.

Switching therapies in patients who are stable on the biosimilar’s reference product to the biosimilar is not typically recommended, according to Vivian. “So from a clinical perspective, we need to be cautious in implementing strategies that force these types of switching.”Instead, she said, “what we really need is data showing that there’s really no additional risk from switching therapies in these hard-to-treat or hard-to-control chronic diseases. That’s going to really increase the confidence for prescribers to start using biosimilars in … those stable patients.”

Another barrier is a lack of interchangeability in biosimilars, with notable exception of Semglee (insulin glargine-yfgn), which was FDA-approved as biosimilar to, and interchangeable with Lantus (insulin glargine) this summer. In order to demonstrate interchangeability, studies must show there is no additional risk or reduced efficacy if a patient switches back and forth between the interchangeable biosimilar and the reference product.

Cybersecurity Saturday

David Ermer–Cybersecurity–
September 11, 2020

From the ransomware front, Bleeping Computer reports today that “The REvil ransomware gang has fully returned and is once again attacking new victims and publishing stolen files on a data leak site.” REvil was responsible most recently for the JBS meat packing plant and the Kayesa hacks. Following the Kayesa hack, the gang went into virtual hiding.

After their shutdown, researchers and law enforcement believed that REvil would rebrand as a new ransomware operation at some point. However, much to our surprise, the REvil ransomware gang came back to life this week under the same name.

Also here is a link to Bleeping Computer’s the Week in Ransomware.

ZDNet offers an interesting article on ransomware targets.

On Monday, KELA published a report on listings made by ransomware operators in the underground, including access requests — the way to gain an initial foothold into a target system — revealing that many want to buy a way into US companies with a minimum revenue of over $100 million. * * *

Ransomware groups such as Blackmatter and Lockbit may cut out some of the legwork involved in a cyberattack by purchasing access, including working credentials or the knowledge of a vulnerability in a corporate system. 

* * * Roughly half of the ransomware operators will, however, reject offers for access into organizations in the healthcare and education sector, no matter the country. In some cases, government entities and non-profits are also off the table. * * *

[T{here are preferred methods of access. Remote Desktop Protocol (RDP), Virtual Private Network (VPN)-based access prove popular. Specifically, access to products developed by companies including Citrix, Palo Alto Networks, VMWare, Cisco, and Fortinet.  

ZDNet further reports that

All the time spent ticking boxes in cybersecurity training sessions seems to be paying off after all: according to a new report, about a third of emails reported by employees really are malicious or highly suspect, demonstrating the effectiveness of the well-established maxim “Think before you click”.  

IT security company F-Secure analyzed over 200,000 emails that were flagged by employees from organizations across the globe in the first half of 2021, and found that 33% of the reports could be classified as phishing.

On the zero trust front, FCW informs us that “The push to convert federal networks, systems and devices to a zero trust security architecture is accelerating, with the release of three new draft guidance documents as part of the White House administration’s push to improve the nation’s cybersecurity” and the Wall Street Journal provides us with a Deloitte produced guide to zero trust cybersecurity.

For those with a law enforcement orientation, the Wall Street Journal tells us that the secret vulnerability of cybercrime gang is the burnout of their foot soldiers. The reporters had interviewed scores of lower level cybercrime workers, among other investigative techniques. Their conclusions:

[W]hen authorities targeted the support staff—the labor force that the cybercrime industry depends on—with a few arrests and made their jobs even more miserable than usual through coordinated shutdowns of server networks, the effect was much greater. This is not unlike putting pressure on a mafia accountant, as opposed to arresting crime bosses. 

In our research, we saw that when authorities attacked the cybercrime infrastructure this way, the services became unreliable and their customers thought they were being scammed, flooding their chat channels with complaints. When servers went down, so did the business of all the criminals who were renting that infrastructure. Cyberattacks declined.

Conventional wisdom suggests that disrupting the infrastructure of cybercrime services by taking down their servers is merely a game of Whac-A-Mole, with these groups able to set up new systems fairly quickly. But that doesn’t take into account the effect on cybercrime workers: We found that these takedowns were extremely frustrating for the people working behind the scenes. We even began to see people quitting the business, burned out from the stress of having to provide round-the-clock customer service and system administration under increasing scrutiny from the police.

Friday Stats and More

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

Based on the Centers for Disease Control (CDC) constantly improving COVID data tracker website, here are charts of new weekly COVID-19 cases and deaths using Thursday as the first day of the week. As you can see, new cases trended down last week. Per the CDC, “The current 7-day moving average of daily new cases (136,558) decreased 12.7% compared with the previous 7-day moving average (156,341).” Moreover, “The current 7-day moving average of new deaths (1,077) has decreased 11.3% compared with the previous 7-day moving average (1,214).”

Here are links to the COVID hospitalization statistics and the CDC’s weekly interpretation of its COVID data. Per the CDC, “The current 7-day daily average for September 1–September7, 2021, was 11,754 This is a 4.1% decrease from the prior 7-day average (12,251) from August 25–August 31, 2021.”

Here is chart of weekly COVID vaccines distributed and administered from the time administration began last December through the 36th week of this year (ending September 8, 2021):

New vaccinations have levelled out at a rate of roughly 5 million per week for the past two months. Per the CDC, “As of September 9, 2021, 92.6% of people ages 65 years or older have received at least one dose of vaccine and 82.2% are fully vaccinated. Over three-quarters (75.3%) of people ages 18 years or older have received at least one dose of vaccine and 64.5% are fully vaccinated. For people ages 12 years or older, 73.4% have received at least one dose of vaccine and 62.5% are fully vaccinated.”

The Food and Drug Administration today released this bulletin about the status of making available a COVID vaccine for young children.

The FDA is working around the clock to support the process for making COVID-19 vaccines available for children. As outlined above, this process is complex and relies on robust manufacturer trials and data, and while we cannot offer a specific date or timeline for when it may be completed for the various manufacturers’ vaccine candidates, we can assure the public we are working as expeditiously as possible to meet this critical public health need and we very much hope to have pediatric COVID-19 vaccines available in the coming months.

The New York Times reports

Federal health officials released new data showing that unvaccinated Americans are 11 times as likely as vaccinated people to die of Covid-19.

Three large studies, published on Friday by the Centers for Disease Control and Prevention, also highlighted the effectiveness of the shots at preventing infection and hospitalizations with the virus.

The research underscored a deep conviction among scientists that vaccine hesitancy and refusal have prolonged the pandemic. The administration’s new plan should stem the flood of infections and return the country to some semblance of normalcy in the long term, several experts said in interviews.

With respect to the President’s vaccination mandates, Gov Exec tells us that

The U.S. Postal Service is not committing to implementing any COVID-19 vaccine mandate—full or partial—for its workforce, with an agency spokesman saying officials will first need to see the fine print of new requirements President Biden has issued. 

Biden’s executive order mandating the vaccines for the federal workforce took a somewhat narrow definition of agencies that carved out USPS, which employs more than 640,000 people. The president on Thursday also announced the Labor Department would put forward a rule directing all employers with more than 100 workers to require their staff to either be vaccinated or submit to weekly COVID-19 testing. USPS said on Friday it was still determining whether the rule would apply to the agency.

From the No Surprises Act front, HHS has issued its proposed rule implementing the Consolidated Appropriations Act 2021 Division BB provisions on air ambulance reporting, health insurer / plan broker compensation reporting and HHS enforcement of the law. Here is a link to a fact sheet on the proposal. The public comment deadline is October 18.

HHS also announced today that its “Health Resources and Services Administration (HRSA), is making $25.5 billion in new funding available for health care providers affected by the COVID-19 pandemic. This funding includes $8.5 billion in American Rescue Plan (ARP) resources for providers who serve rural Medicaid, Children’s Health Insurance Program (CHIP), or Medicare patients, and an additional $17 billion for Provider Relief Fund (PRF) Phase 4 for a broad range of providers who can document revenue loss and expenses associated with the pandemic.” The American Hospital Association was pleased with the news.

Federal News Network has interviewed many current and former federal employees about their memories of September 11, 2001. Check it out as the interviews include two OPM officials. Of course, never forget.

Busy Thursday

David Ermer–Uncategorized–

Earlier today the President announced a comprehensive list of executive measures intended to stem the Delta variant of COVID-19 in our country. Here’s a Medscape article on this action.

One of the new measures replaces the President’s July 28 vaccination screening program for federal employees and federal government contractors with a vaccination mandate program described in this Federal News Network article. Here are links to the Executive Order for the federal employees program and the separate Executive Order for the federal government contractors program.

The Health and Human Secretary Xavier Becerra announced the Administration’s plan to lower prescription drug costs. In the FEHBlog’s view, the proposals build price controls on top of existing price controls. The president of PhRMA, the prescription drug manufacturer’s trade association, commented that

“What was released today is a laundry list of old partisan ideas and not a serious plan to address what patients pay out of pocket for prescription drugs. What it leaves out is any attempt to fix a broken insurance system that discriminates against sick patients and does nothing to hold insurers and middlemen accountable for pocketing savings from our companies that should go to patients to lower their costs.
 
“It’s hard to ignore the irony that this is being released the same day the White House is unveiling a separate plan meant to regain control of the Covid-19 pandemic. The biopharmaceutical industry is continuing to work around the clock against this pandemic while this same White House is trying to make it more difficult for our industry to continue the fight against this pandemic and plan for future health crises.” 

Alternatively and perhaps even worse for PhRMA, according to STAT News, “[S]everal advocates and lobbyists told STAT this week that lawmakers in the U.S. Senate] were zeroing in on the idea of setting prices based on the maximum price drug makers can charge several military health programs, including the VA’s, known as the Federal Ceiling Price. That price is calculated by reducing the average price paid by non-governmental wholesalers by roughly one-quarter.” This drug cost reduction initiative in its final form would be included in the $3.5 trillion budget reconciliation bill.

Yesterday, the actuarial consulting firm WillisTowersWatson released its 2021 Benefits Trend Survey.

More than two-thirds of respondents (69%) say integrating employee wellbeing into the benefit package will be the top strategic benefit objective over the next two years. Most employers (86%) cite employee emotional wellbeing as their top priority over the next two years, followed by physical wellbeing (68%) and financial wellbeing (67%).

According to the survey, employers are taking steps to support their employees’ health and wellbeing in four main areas:

Physical: Over three in four employers (77%) have added or enhanced online and virtual medical services, and over half (53%) plan to add more or enhance them in the next two years.

Emotional: 73% of employers plan to boost their support for mental health (stress, burnout and depression).

Financial: Nearly half of employers (47%) plan to add or enhance their support for financial wellbeing (savings, budgeting, loans and counseling).

Social: More than a quarter of employers (29%) plan to add or enhance support for social wellbeing (charitable donations, volunteer opportunities and social recognition).

The survey also revealed less than three in 10 employers (28%) believe their benefit programs enhance employee appreciation of the employment deal, and many are taking steps to boost support and communication. Over one-third (34%) are planning or considering the use of digital tools and technology to help employees feel connected and be productive; over half (52%) are planning or considering the use of personalized communication to specific segments of the workforce.

he Wall Street Journal”The coming flu season is on track to be much worse than the last cycle, according to health experts, who fear an influx of cases could further strain hospitals already overwhelmed by the Delta surge. The season could also strike earlier and more severely than usual, doctors and researchers said, because many people haven’t been able to build up their natural immune defenses while working from home and avoiding strangers.”

The Wall Street Journal reports that

The coming flu season is on track to be much worse than the last cycle, according to health experts, who fear an influx of cases could further strain hospitals already overwhelmed by the Delta surge.

The season could also strike earlier and more severely than usual, doctors and researchers said, because many people haven’t been able to build up their natural immune defenses while working from home and avoiding strangers [and children are back in school].

The FEHBlog got his flu shot today.

Today’s WSJ Future of Everything article informs us that

A sports injury or trauma to cartilage around the knee, hip or shoulder joint can lead to osteoarthritis later in life—or, worse yet, the need for a new joint. So can the wear and tear that comes with age. One day, new drugs and stem-cell therapies may stop the degeneration before it starts.

Researchers are developing new techniques to protect, repair and regrow articular cartilage, the layer of connective tissue that covers the ends of bones and enables joints to move smoothly, to stop the progression of osteoarthritis and curb the need for joint replacement surgery.

Now that could reduce healthcare spending.

Midweek Update

David Ermer–ACA, HIPAA Privacy and Security Rules, Telehealth, U.S. Healthcare–
Photo by Tomasz Filipek on Unsplash

Yesterday was the deadline for submitting public comments on the first No Surprises Act (“NSA”) interim final rule. The first IFC concerns the surprise billing protections afforded to consumers in emergency case, out of network care at in-network facilities and air ambulance care.

Here is potpourri of pertinent articles from Becker’s Payer Issues (about AHIP’s comments), the American Hospital Association, and Health Leaders Media (MGMA’s comments). When the same tri-agencies issued interim final rules implementing the Affordable Care Act (“ACA”) in 2011, those agencies did not issue “final final” rules until four or five years later.

While the NSA law is narrower in scope than the ACA, it poses much more complicated administration issues than those ACA provisions. Consequently the final final NSA rules may be accelerated. Sensibly, AHIP suggests that the tri-agencies create a good faith safe harbor for health plans and insurers during 2022 and 2023 to allow them to come into full compliance with this complex law.

In other healthcare news

  • A friend of the FEHBlog called his attention to the September 2021 issue of NIH in the News which may provide useful article for health plan newsletters to members.
  • The Journal of AHIMA breaks down the ICD-10 diagnosis code changes that will take effect on October 1, 2021, under the HIPAA transactions and code sets rule.
  • NCQA has made available a kidney health toolkit.
  • Fierce Healthcare reports that “Anthem is teaming up with The Clinic by Cleveland Clinic to offer virtual second opinions to members. The Clinic is a digital health joint venture from Cleveland Clinic and Amwell that provides video consultations, digital record collection and concierge service to insurers, providers, employers and patients. Through the partnership, eligible members can seek online second opinions from the health system’s 3,500 physicians. Anthem will initially make these consults available to its large employer clients, with the potential to expand to other employers and other insurance programs, according to the announcement.”
  • Health Payer Intelligence tells us that “In 2020, the prevalence of employer-sponsored health plan coverage fell during the coronavirus pandemic even as employment rebounded, according to a recent study published in the JAMA Health Forum. * * * In 2021, the data forms a clearer picture. Employer-sponsored healthcare coverage declined even as employment levels recovered, potentially indicating a shift to Affordable Care Act marketplace or Medicaid plans.” That is hardly surprising given the enormous funding that Congress has provided to the ACA marketplace.

Finally, the Wall Street Journal’s the Future of Everything series today discusses how

Researchers around the world are trying to turn the humble cough into an inexpensive tool to diagnose and stop respiratory-disease killers like tuberculosis and Covid-19. They’re collecting recordings of millions of the explosive sounds from patients and consumers on smartphones and other devices. And they’re training artificial intelligence to find patterns to try to identify the type and severity of disease from the cough itself. 

“We call it acoustic epidemiology,” says Peter Small, a tuberculosis expert and chief medical officer of Hyfe Inc., a Delaware-based company with two free smartphone apps—one for consumers, another for researchers—that use AI to detect and track how often someone coughs.

Tuesday’s Tidbits

David Ermer–CDC, Congress, COVID-19, COVID-19 vaccine, Federal employment benefits, Rx coverage, Telehealth, U.S. Healthcare–
Photo by Patrick Fore on Unsplash

On the Delta variant front and acccording to the CDC’s COVID Data Tracker, the United States reached two data points today — the number of COVID cases now exceeds 40 million and the percentage of Americans aged 18 and over who have received at least one dose of a COVID-19 vaccine reached 75%.

At the end of 2020, the number of cases according to the CDC stood at 20 million. In his blog, National Institutes of Health Director Francis Collins discusses a recent Nature study estimating that “the true number of [COVID] infections by the end of 2020 at more than 100 million [1]. That’s equal to just under a third of the U.S. population of 328 million. This revised number shows just how rapidly this novel coronavirus spread through the country last year. It also brings home just how timely the vaccines have been—and continue to be in 2021—to protect our nation’s health in this time of pandemic.” It also suggests to the FEHBlog that we may to closer to effective herd immunity in some areas of the U.S. than generally thought.

Also David Leonhardt in today’s New York Times tells us about another way to look at the situation.

The C.D.C. reported a terrifying fact in July: Vaccinated people with the Delta variant of the Covid virus carried roughly the same viral load in their noses and throats as unvaccinated people.

The news seemed to suggest that even the vaccinated were highly vulnerable to getting infected and passing the virus to others. Sure enough, stories about vaccinated people getting Covid — so-called breakthrough infections — were all around this summer: at a party in Provincetown, Mass.; among the Chicago Cubs; on Capitol Hill. Delta seemed as if it might be changing everything.

In recent weeks, however, more data has become available, and it suggests that the true picture is less alarming. Yes, Delta has increased the chances of getting Covid for almost everyone. But if you’re vaccinated, a Covid infection is still uncommon, and those high viral loads are not as worrisome as they initially sounded.

How small are the chances of the average vaccinated American contracting Covid? Probably about one in 5,000 per day, and even lower for people who take precautions or live in a highly vaccinated community. * * *

I will confess to one bit of hesitation about walking you through the data on breakthrough infections: It’s not clear how much we should be worrying about them. For the vaccinated, Covid resembles the flu and usually a mild one. Society does not grind to a halt over the flu.

In Britain, many people have become comfortable with the current Covid risks. The vaccines make serious illness rare in adults, and the risks to young children are so low that Britain may never recommend that most receive the vaccine. Letting the virus continue to dominate life, on the other hand, has large costs.

“There’s a feeling that finally we can breathe; we can start trying to get back what we’ve lost,” Devi Sridhar, the head of the global public health program at the University of Edinburgh, told The Times.

Well put, Mr. Leonhardt, as usual.

From the federal employee benefits front, OPM posted on the Federal Register website today a notice of changes to Federal Group Life Insurance premium rates for “Employee Basic Insurance, Option A (most age bands), Option B (most age bands), Option C (most age bands), and Post-Retirement Basic Insurance. These rates will be effective the first pay period beginning on or after October 1, 2021.”

From the tidbits department

  • Federal News Network reports that “The White House is proposing billions of dollars in supplemental funding for disaster relief and other programs, which it’s asking Congress to attach to a short-term continuing resolution that will be critical toward avoiding a government shutdown at the end of the month. ‘With the end of the fiscal year rapidly approaching, it’s clear that Congress will need to pass a short term continuing resolution to provide more time for the fiscal 2022 process to unfold,’ Shalanda Young, the Office of Management and Budget’s acting director, said Tuesday in a blog post.” 
  • Fierce Healthcare informs us that “The American Medical Association [“AMA”] released updates to its medical codes for 2022 with many tied to new technology services and the administration of COVID-19 vaccines. The AMA made 405 changes in the 2022 Current Procedural Terminology code set, including 249 new codes, 63 deletions and 93 revisions. The changes will take effect Jan. 1. ” The CPT is recognized as a HIPAA electronic transaction code set.
  • AP News reports that “Four companies in the drug industry said Saturday that enough states had agreed to a settlement of lawsuits over the opioid crisis for them to move ahead with the $26 billion deal. An announcement from the three largest U.S. drug distribution companies and a confirmation from drugmaker Johnson & Johnson, which had previously announced that it would move ahead, came Saturday. That was the deadline for the companies to decide whether there was enough buy-in to continue the settlement plan. * * * Together, the settlements are likely to represent the biggest piece of a string of settlements between companies in the drug industry and state and local governments over the addiction and overdose epidemic in the U.S.”
  • Healthcare Dive tells us that “The use of telehealth for patient visits seems to have leveled off at 20% or fewer of all appointments, more than a year and a half after COVID-19 first spurred an unprecedented jump in utilization, according to a new survey from KLAS Research and the Center for Connected Medicine.”
  • The AMA discusses “what doctors wish patients knew about a prediabetes diagnosis,” which of course is a fairly common diagnosis in our country.
  • The Wall Street Journal continues its series on the Future of Everything in healthcare with an article about sensor studded smart clothes. “From a prescription bra that signals cardiac arrest to a mosquito-proof textile, startups and scientists are developing garments for healthier living.”

Labor Day Roundup

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

The Senate remains on a State work break while the House of Representatives will engage in limited Committee business later this week.

The FEHBlog ran across two stories which seek to answer questions which have puzzled him lately.

  • The Wall Street Journal discusses why FDA approval of a COVID-19 vaccine for children “is taking so long.” Of note, “Pfizer-BioNTech trial results for 5- to 12-year-olds could come by the end of this month, which could mean shots aren’t authorized for use until October or November, months after they were cleared for adolescents. Data for younger children could come in October. Moderna Inc. expects to seek emergency use for 6- to 12-year-olds by the end of this year, and early next year for children 6 months to less than 6 years, a company spokeswoman said.”
  • The National Institutes of Health reports on a large genomic study that “illuminates the origins of lung cancer in never-smokers.” “’What we’re seeing is that there are different subtypes of lung cancer in never smokers that have distinct molecular characteristics and evolutionary processes,’ said epidemiologist Maria Teresa Landi, M.D., Ph.D., of the Integrative Tumor Epidemiology Branch in NCI’s Division of Cancer Epidemiology and Genetics, who led the study. * * * A future direction of this research will be to study people of different ethnic backgrounds and geographic locations, and whose exposure history to lung cancer risk factors is well described. “We’re at the beginning of understanding how these tumors evolve,” Dr. Landi said. This analysis shows that there is heterogeneity, or diversity, in lung cancers in never smokers.” Stephen J. Chanock, M.D., director of NCI’s Division of Cancer Epidemiology and Genetics, noted, “We expect this detective-style investigation of genomic tumor characteristics to unlock new avenues of discovery for multiple cancer types.”

The Wall Street Journal continues its series on the future of healthcare with an article about how thanks to the pandemic routine physical exams have gained a remote aspect which will expand over time. “In five to 10 years, says Michael Blum, a cardiologist and chief digital transformation officer at University of California San Francisco, ‘I’ll be able to do the same quality of physical exam out of the office as if you were right in front of me in the office.’” More convenient for the doctor and patient no doubt but will this transition lower costs?

Labor Day Sunday

David Ermer–Uncategorized–
Thanks to Alexandr Hovhannisyan for sharing their work on Unsplash.

OPM published in the September 3, 2021, Federal Register an Interim Final Rule extending FEHB coverage to 125 Indian tribal “297 grant” schools as required by the Consolidated Appropriations Act, 2021 (“CAA”). This CAA provision “is expected to make FEHB accessible to approximately 4,328 tribal employees of [the newly] entitled schools.”

This CAA provision expanded an Affordable Care Act (“ACA”) provision that offered Indian tribal employers the opportunity to enroll their employees in FEHB.

Tribal employers began purchasing FEHB for their employees on March 22, 2012 with coverage effective on May 1, 2012. As of April 2021, 125 tribes participate in the FEHB Program, and there are 32,178 tribal employees for a total of 64,208 covered lives.

The FEHBlog was interested to read that OPM already has contracted with some of the newly entitled schools.

Four eligible tribally controlled schools elected to begin purchasing FEHB coverage for their tribal employees on May 1, 2021 with an insurance coverage effective date of May 1, 2021. As of July 2021, 7 tribally controlled schools have enrolled in the FEHB Program

Smooth sailing. The public comment deadline on the interim final rule is November 2, 2021.

From the holiday weekend miscellany department

  • Healthcare Finance News reports that “Aetna has agreed to team up with Autism Comprehensive Educational Services to establish an Institute for Quality targeted toward individuals and families impacted by autism spectrum disorder, among other special needs. Through the new national agreement, effective August 1, Aetna members now have access to value-based autism care from ACES clinical providers.” Smart move.
  • The American Hospital Association offers some reassuring words about the No Surprises Act. The FEHBlog expects that the law will protect consumers without disrupting healthcare networks but will increase administrative costs at least for 2022 as the out-of-network providers test the independent dispute resolution (“IDR”) system. Other CAA Division BB provisions scheduled for implementation after 2022, e.g., transitional care, provider non-discrimination rule making, do pose risks to provider networks.
  • On the technology front, Fierce Healthcare discusses Apple’s plans for its health app and the Wall Street Journal tells us that “The next frontier of at-home health tracking is flush with data: the toilet.” In nothing sacred?

Have a restful Labor Day.