FEHBlog

Monday Roundup

David Ermer–COVID treatment, COVID-19, COVID-19 testing, COVID-19 vaccine, Medicare, No Surprises Act, Telehealth–
Photo by Sven Read on Unsplash

From the COVID vaccination front, the CDC’s COVID Data Tracker indicates that over two-thirds of the U.S. population over five years old in fully vaccinated.

The American Medical Association’s column about “What Doctors Wish Patient Knew” explains

A Kaiser Family Foundation poll found that one-third of parents say they planned to get their children vaccinated right away. Yet other parents are taking a wait-and-see approach to COVID-19 vaccination for kids. But with the Delta-Omicron variant tag team, widespread vaccination is an essential tool for preventing COVID-19 deaths, hospitalizations and illnesses.

To help parents move from that “wait-and-see” mentality and calm their fears, two physicians shared what to know about COVID-19 vaccine safety for children.

Check it out.

From the Omicron treatment front, the Food and Drug Administration announced today that the agency has

revised the authorizations for two monoclonal antibody treatments – bamlanivimab and etesevimab (administered together) and REGEN-COV (casirivimab and imdevimab) [which are made by Eli Lilly & Co. and Regeneron Pharmaceuticals Inc.] – to limit their use to only when the patient is likely to have been infected with or exposed to a variant that is susceptible to these treatments.

Because data show these treatments are highly unlikely to be active against the omicron variant, which is circulating at a very high frequency throughout the United States, these treatments are not authorized for use in any U.S. states, territories, and jurisdictions at this time. In the future, if patients in certain geographic regions are likely to be infected or exposed to a variant that is susceptible to these treatments, then use of these treatments may be authorized in these regions. 

Monoclonal antibodies are laboratory-made proteins that mimic the immune system’s ability to fight off harmful pathogens such as viruses, like SARS-CoV-2. And like other infectious organisms, SARS-CoV-2 can mutate over time, resulting in certain treatments not working against certain variants such as omicron. This is the case with these two treatments for which we’re making changes today. * * *

Importantly, there are several other therapies – Paxlovid, sotrovimab, Veklury (remdesivir), and molnupiravir – that are expected to work against the omicron variant, and that are authorized or approved to treat patients with mild-to-moderate COVID-19 who are at high risk for progression to severe disease, including hospitalization or death. Healthcare providers should consult the NIH panel’s COVID-19 treatment guidelines and assess whether these treatments are right for their patients.

From the COVID vaccination mandate front, Federal News Network reports that

Last week’s court injunction that blocked the Biden Administration’s vaccine requirement for federal employees will put a temporary halt to disciplinary actions in federal agencies. But it won’t be of much help to feds who’d already been disciplined or fired for refusing the vaccine prior to last Friday.

That’s according to new guidance the administration’s Safer Federal Workforce Task Force issued Monday. The four-page document answers some basic questions on exactly how agencies should deal with the federal employee mandate now that a Texas judge has temporarily barred its implementation and enforcement.

Among the nuances: workers who’ve been suspended for failing to comply need to have their suspensions lifted, and new proposals to fire or suspend employees need to be “held in abeyance” for as long as the injunction is in place, the task force said. But agencies don’t need to reverse other disciplinary procedures that have already taken full effect.

From the free OTC tests front, Govexec.com asks

What group is especially vulnerable to the ravages of COVID-19 even if fully vaccinated and boosted? Seniors. And who will have an especially tough time getting free at-home COVID tests under the Biden administration’s plan? Yes, seniors.

As of Jan. 15, private insurers will cover the cost of eight at-home rapid COVID tests each month for their members — for as long as the public health emergency lasts.

Finding the tests will be hard enough, but Medicare beneficiaries face an even bigger hurdle: The administration’s new rule doesn’t apply to them.

It turns out that the laws governing traditional Medicare don’t provide for coverage of self-administered diagnostic tests, which is precisely what the rapid antigen tests are and why they are an important tool for containing the pandemic. * * *

The Medicare program does cover rapid antigen or PCR testing done by a lab without charging beneficiaries, but there’s a hitch: It’s limited to one test per year unless someone has a doctor’s order.

Because the article describes orignal Medicare as exempt, one must assume that Medicare Advantage plans also are offering reimbursement for OTC COVID tests. The original Medicare exemption is a weak cup of tea because no commercial health plans covered OTC testing before the mandate.

From the No Suprises Act front, The American Hospital Association informs us that

The Centers for Medicare & Medicaid Services will host a conference call for health care providers Jan. 26 at 1 p.m. ET on the balance billing provisions of the No Surprises Act. To participate in the Special Open Door Forum, dial 888-455-1397 and reference passcode 5109694. Slides for the call are available here. P

Participants may email questions in advance to Provider_Enforcement@cms.hhs.gov, noting “Questions for 1/26 Open Door Forum” in the subject line. A replay will be available after the call through Jan. 28 by dialing 800-308-7855 and entering the passcode.

The CMS slides are helpful.

From the telehealth front, Fierce Healthcare tells us that

Integrating virtual care can save the healthcare system significant amounts of money, as well as avoid unnecessary visits to the emergency department or urgent care center, according to a new study from Cigna.

The study, conducted alongside its telehealth arm MDLive, found that patients who saw virtual providers also saw 19% fewer visits to the ER or urgent care. In addition, virtual urgent care visits reduced duplication of care by 16% compared to other virtual primary care providers or specialists.

Cigna notes that these reductions in unneeded visits are especially crucial as hospitals face down the current COVID-19 surge, caused by the highly infectious omicron variant. 

Weekend Update

David Ermer–Congress, COVID-19, COVID-19 vaccine, Electronic health records, Rx coverage, U.S. Healthcare–

Both Houses of Congress will be engaged in Committee business and floor voting this week as we are now less than one month away from the expiration of the current continuing resolution funding the federal government. That resolution runs through February 18.

From the Omnicron front, the New York Times reports that ‘

New coronavirus cases have started to fall nationally, signaling that the Omicron-fueled spike that has infected tens of millions of Americans, packed hospitals and shattered records has finally begun to relent.

More and more states have passed a peak in new cases in recent days, as glimmers of progress have spread from a handful of eastern cities to much of the country. Through Friday, the country was averaging about 720,000 new cases a day, down from about 807,000 last week. New coronavirus hospital admissions have leveled off.

Even as hopeful data points emerge, the threat has by no means passed. The United States continues to identify far more infections a day than in any prior surge, and some states in the West, South and Great Plains are still seeing sharp increases. Many hospitals are full. And deaths continue to mount, with more than 2,100 announced most days.

But following a month of extraordinary rates of case growth, blocklong lines at testing centers and military deployments to bolster understaffed I.C.U.s, the declining new-case tallies offered a sense of relief to virus-weary Americans, especially in the Northeast and parts of the Upper Midwest, where the trends were most encouraging. After another round of masking up or hunkering down, some were considering what life might look like if conditions continued to improve. 

Bloomberg adds

The omicron variant spreads so rapidly that sometimes it feels as if resistance is futile. It’s disheartening to hear of omicron infecting people who are up-to-date on their shots and wear an N95 mask every time they leave home. Even some well-known public-health experts are getting infected. But that doesn’t mean everyone is going to get it. 

What it does mean is that life is profoundly unfair. In some of us, the Covid-19 vaccines work quite robustly, even against omicron. In others, the vaccines’ effect is weaker. Chalk this up to the spectacular diversity of the human immune system, which is partly regulated by some of the most varied genes in the human body. 

A recent study led by Harvard and MIT showed that about 20% of people get much poorer protection from their vaccines against omicron. They’re still better off than completely unvaccinated people, but this variability could account for some of the fully vaccinated people who’ve been hospitalized in the omicron wave.

According to the American Medical Association (AMA), here’s what physicians want their patients to know about Omicron. “The AMA has developed frequently-asked-questions documents on COVID-19 vaccination covering safety, allocation and distribution, administration and more. There are two FAQs, one designed to answer patients’ questions (PDF), and another to address physicians’ COVID-19 vaccine questions (PDF).”

From the Rx coverage front, the New York Times offers an interview with CVS Health’s CEO Karen Lynch. For example,

What do you see as the most effective ways that we could reduce health care costs for everyday Americans? And what’s your company’s role in doing that?

There’s a couple of things. One is there’s the site of care. Our role is offering an alternative site of care, either in our retail locations, or in the home with virtual connections. We’re entering into the primary care space because we believe that primary care has real significant influence over the cost of health care.

And I’m pretty passionate about the fact that the head is attached to the body, and most people experience behavioral health issues when they are experiencing physical health issues. We only deal with the physical health. We don’t deal with the behavioral health part, and I think there’s more we can do.

Healthcare Dive provides us with industry perspective on last week’s launch of TEFCA which is intended to vastly improve interoperability by linking together regional health information exchanges.

The goal of TEFCA is to get rid of individual legal agreements between health information networks, health plans, providers and other entities by instituting one common agreement that qualified networks and their participants sign onto, paring back on administrative burden. The framework standardizes the operational side of data exchange, while raising the privacy and security bar for entities that want to be certified as qualified health information networks (QHINs), groups of organizations that agree to the same data-sharing infrastructure. * * *

Getting a nationwide network of groups of organizations that agree to the same data-sharing infrastructure could significantly streamline patient care across different geographies.

For example, if a patient from Virginia takes a vacation to California and ends up in an emergency room, doctors currently do the best they can to treat them without their medical record, which can contain valuable information about preexisting conditions, allergies and other health factors. But with a nationwide QHIN infrastructure, clinicians can query all participating networks for that patient’s data and use it to inform their clinical choices, Barrett said.

That budding future all centers on buy-in. * * *

Many, including ONC, are optimistic on TEFCA adoption, citing the competitive disadvantages to nonparticipation.

The hope is that the more networks use it, the more its value proposition will be proved. Patients will inquire why their provider doesn’t have their data from other facilities, and the provider will then wonder why the exchanges it’s a participant in aren’t qualified to work with other networks, Lee Barrett, CEO of EHR standards development organization EHNAC said.

Cybersecurity Saturday

David Ermer–Cybersecurity–

To set the stage, last Tuesday, “ECRI, an independent, nonprofit organization that provides technology solutions and evidence-based guidance to healthcare decision-makers worldwide, lists cybersecurity attacks as the top health technology hazard for 2022 in its just-released annual report.”

What’s more, HC3 issued its Fourth Quarter 2021 Healthcare Cybersecurity Bulletin.

Getting down to business, HC3 also released a useful PowerPoint presentation with background and remediation / prevention tips for the Log4j vulnerability.

From the irony department, ZDNet reported yesterday that

Microsoft researchers have discovered a previously undisclosed vulnerability in the SolarWinds Serv-U software while monitoring threats related to Log4J vulnerabilities. 

Jonathan Bar Or explained on Twitter that while he was hunting for a Log4J exploit attempt, he noticed attacks coming from serv-u.exe. 

“Taking a closer looked revealed you could feed Ssrv-U with data and it’ll build a LDAP query with your unsanitized input! This could be used for log4j attack attempts, but also for LDAP injection,” he wrote. 

“Solarwinds immediately responded, investigated and fixed the #vulnerability. Their response is the quickest I’ve seen, really amazing work on their part!”

On a broader scale, ZDnet also reports that

The US government has urged organizations to shore up defenses “now” in response to website defacements and destructive malware targeting Ukraine government websites and IT systems. 

The US Cybersecurity and Infrastructure Security Agency (CISA) has published a new ‘CISA Insights‘ document aimed at all US organizations, not just critical infrastructure operators. The checklist of actions is CISA’s response to this week’s cyberattacks on Ukraine’s systems and websites, which the country’s officials have blamed on hackers linked to Russian intelligence services.

From the latest vulnerabilities front, Cyberscoop informs us that

QR codes are among the few “winners” of the coronavirus pandemic, the joke goes, because restaurants and other businesses have deployed them in far greater numbers over the past few years, in an effort to make more interactions contactless.

The FBI is warning, however, that scammers love them, too.

The bureau’s Internet Crime Complaint Center (IC3), issued a general alert Tuesday about “malicious” QR codes that reroute unsuspecting consumers to the world of cybercrime.

“[C]ybercriminals are taking advantage of this technology by directing QR code scans to malicious sites to steal victim data, embedding malware to gain access to the victim’s device, and redirecting payment for cybercriminal use,” the announcement says.

Last but never least, here is a link to Bleeping Computer’s The Week in Ransomware.

Friday Stats and More

David Ermer–CDC, COVID treatment, COVID vaccine mandate, COVID-19, COVID-19 testing, COVID-19 vaccine, Medicare, Mental health care, OPM, Telehealth, U.S. Healthcare–

Based on the CDC’s Covid Data Tracker and using Thursday as the first day of the week, here is the FEHBlog’s weekly chart of new Covid cases from the 27th week of 2021 through the third week of 2022:

My word, could that be a cresting of the Omicron surge as discussed in this week’s posts?

The FEHBlog’s weekly chart of new Covid deaths has bounced up and down after climbing to just over 10,000 weekly deaths during the Delta surge. .

Last but not least here is the FEHBlog’s weekly chart of new Covid vaccinations distributed and administered from the 51st week of 2020 through the third week of 2022.

Here are links to the CDC’s Covid data tracker weekly review and its weekly Fluview.

In other COVID vaccination news —

  • The Wall Street Journal reports that

Vaccines and booster shots offer superior protection from the Delta and Omicron variants, according to three new studies released by the Centers for Disease Control and Prevention.

The data back up earlier findings supporting booster shots and offer the first comprehensive insight into how vaccines fare against the Omicron variant. In one of the studies published Friday, a CDC analysis found that a third dose of either the vaccine from Pfizer Inc.and BioNTech SE or Moderna Inc. was at least 90% effective against preventing hospitalization from Covid-19 during both the Delta and Omicron periods.

The American Hospital Association adds

According to data from 25 state and local health departments, adults who were unvaccinated against COVID-19 as the omicron variant emerged in December had nearly three times higher risk of infection than adults fully vaccinated against COVID-19 and five times higher risk than adults who had received a booster, the Centers for Disease Control and Prevention reported today. The highest impact of COVID-19 booster doses compared with full vaccination was recorded among persons aged 50 and older. Because of reporting lags, the influence of the omicron variant on COVID-19-associated deaths could not be evaluated by vaccination status in December, the authors note.

The FDA could authorize Pfizer’s COVID-19 vaccine for children under age 5 in the next month, Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, said Wednesday.

“My hope is that it’s going to be within the next month or so and not much later than that, but I can’t guarantee that because I can’t out-guess the FDA,” he said during an interview with Blue Star Families, a nonprofit group that supports military families.

The younger age group will likely need three vaccine doses, he said, since two shots didn’t provide enough of an immune response during Pfizer’s clinical trials for kids ages 2-4.

In Covid vaccine mandate news, Govexec tells us

A federal court in Texas has issued an injunction against President Biden’s COVID-19 vaccine mandate for the federal workforce, pausing implementation of a requirement for more than 2 million civilian servants. 

The Biden administration has already had sweeping success with the mandate, as most agencies have seen virtually their entire workforces come into compliance. Still, federal offices across the country were just beginning to move forward with suspensions—which could eventually result in firings—for those who did not meet the requirements. Biden issued the mandate by executive order in September.    

Judge Jeffrey Brown, appointed by President Trump to the U.S. Court for the Southern District of Texas, said the case was not about whether individuals should be vaccinated or even about federal power generally. 

“It is instead about whether the president can, with the stroke of a pen and without the input of Congress, require millions of federal employees to undergo a medical procedure as a condition of their employment,” Brown wrote. “That, under the current state of the law as just recently expressed by the Supreme Court, is a bridge too far.” 

The Justice Department has appealed the decision to the U.S. Court of Appeals for the Fifth Circuit. The FEHBlog expects that the Fifth Circuit will lift the stay as soon as this weekend. The Society for Human Resource Management offers a helpful article for employers trying to keep track of the vaccine mandate decisions from the courts.

In other COVID vaccine mandate news, the Labor Department’s Wage and Hour Division announced today that

Employees [who are not exempt from the Fair Labor Standards Act] must be paid for time spent going to, waiting for, and receiving medical attention required by the employer or on the employer’s premises during normal working hours. Therefore, if an employer requires an employee to obtain a COVID-19 vaccine dose, undergo a COVID-19 test, or engage in a COVID-19 related health screening or temperature check during the employee’s normal working hours, the time that the employee spends engaged in the activity is compensable. Employees must be paid for such time during normal working hours, regardless of where the activity occurs. This is true regardless of whether the employer is subject to the OSHA Vaccination and Testing ETS.

In Covid treatment news, the Food and Drug Administration announced today that the agency “took two actions to expand the use of the antiviral drug Veklury (remdesivir) to certain non-hospitalized adults and pediatric patients for the treatment of mild-to-moderate COVID-19 disease. This provides another treatment option to reduce the risk of hospitalization in high-risk patients. Previously, the use of Veklury was limited to patients requiring hospitalization.”

From the Covid OTC testing coverage mandate department, the Kaiser Family Foundation has surveyed the coverage approaches of 13 large health insurers. Don’t blame the insurers on this one because health insurers don’t typically cover OTC products and the government only allow four days to implement the mandate.

From the and more department

  • In telehealth news, mHealth Intelligence tells us that

Telehealth utilization peaked in the first half of 2020 and decreased as the year came to a close, with providers predicting that virtual care use would continue to decline in upcoming years, according to the 2021 Medical Group Telehealth Survey.

AMGA Consulting conducted the survey and gathered responses from 56 medical groups representing more than 38,000 healthcare providers.

The majority of the participants (86 percent) were part of multispecialty groups with primary care, while the remaining were either multispecialty without primary care, primary care, or single-specialty groups. * * *

The survey results suggest that although telehealth use skyrocketed during the COVID-19 pandemic, virtual care may see the most success with patients who prefer the modality over in-person care or whose health concerns can be easily addressed virtually.

The FEHBlog remains a strong proponent of hub and spoke telehealth for mental health care because every televisit is in network.

  • The American Hospital Association informs us that “The Department of Health and Human Services’ Office of the National Coordinator for Health Information Technology seeks comments through March 25 to inform potential future rulemaking on how the ONC Health IT Certification Program could incorporate standards, implementation specifications and certification criteria to reduce the burden of prior authorization.”
  • The Congressional Budget Office released a report titled “The Prices That Commercial Health Insurers and Medicare Pay for Hospitals’ and Physicians’ Services.”

CBO examined potential explanations for why the prices paid by commercial insurers are higher and more variable than those paid by Medicare FFS. CBO’s analysis and literature review suggest the following conclusions:

— Greater market power among providers consistently leads to prices for commercial insurers that are higher than Medicare FFS’s prices and that vary more widely, both among and within areas. Hospitals and physicians’ groups may have market power because they have a dominant share of the market in an area or because an insurer sees them as essential to its network of providers.

— Some of the variation in the prices that commercial insurers pay for hospitals’ and physicians’ services is explained by differences in the prices of inputs needed to deliver those services.

— Higher hospital quality is associated with higher prices paid by commercial insurers, although whether there is a causal link between quality and prices, and the direction of any such link, is not clear.

— The share of providers’ patients who are covered by Medicare and Medicaid is not related to higher prices paid by commercial insurers. That finding suggests that providers do not raise the prices they negotiate with commercial insurers to offset lower prices paid by government programs (a concept known as cost-shifting).

IBM is selling the data and analytics assets of its Watson Health business to a private equity firm as it looks to refocus on its core cloud business.

The sale, which is expected to close in the second quarter this year has been anticipated for quite some time, and comes following the limited success of Watson Health, despite a spate of high-profile acquisitions of health information companies to bolster the enterprise.

Financial terms of the deal were not disclosed.

[F]ederal civilian employees in the U.S. will now be paid at least $15 per hour.

OPM issued a memorandum for heads of Executive departments and agencies that provides implementing guidance for how agencies should adjust pay rates for General Schedule (GS) and Federal Wage System (FWS) employees stationed in the U.S., and how to use administrative authority for other pay systems to lift the pay of federal employees who currently make less than $15 per hour. In total, these changes will impact 67,000 out of 2.2 million federal employees. The largest share of these workers, over 56,000 of them, currently work at the Department of Defense. OPM’s guidance directs agencies to implement these changes by January 30, 2022

  • To tide you over the weekend, here is a link to Healthcare Dive’s Deep Dive on four 2022 key trends for providers and payers.

Thursday Miscellany

David Ermer–COVID treatment, COVID vaccine mandate, COVID-19, COVID-19 testing, No Surprises Act, Rx coverage–

The American Hospital Association released its latest COVID Snapshot today.

Bloomberg adds that

The U.S. hospital-staffing shortage exacerbated by the latest Covid-19 wave is showing signs of easing, but many West Coast and rural states are still seeing the worst of it.

Over the past seven days, about 16.7% of U.S. hospitals have reported critical staffing shortages, down from a recent peak of 18.7% on Jan. 9, according to data from the Department of Health and Human Services. Fewer facilities are reporting shortages in populous New York, Florida and Illinois. 

The numbers are still concerning to state leaders, but are at least returning to the levels seen in October and November, before the omicron spike.

From the Covid treatment front —

The niftiest COVID news that the FEHBlog ran across today is this GoodRx website that provides “Live Updates on How to Find Paxlovid and Molnupiravir,” respectively the Pfizer and Merck Covid pills. Bookmark it.

From the COVID testing front —

SHRM brings us up to date on the unnecessarily rushed rollout of the federal government mandate that health plans cover over the counter Covid tests. Most plans did not have time to create in-network coverage because health plans do not cover OTC drugstor items except when mandated to do so.

From the COVID vaccine mandate front, FedWeek reports that

The impact of the Coronavirus vaccine mandate in terms of turnover in the federal workforce—either voluntary or not—remains largely anecdotal, although the largest agency, DoD has said there have been “no terminations yet.”

“We are still finalizing the guidance to the civilian force in that regard,” a Pentagon spokesman said late last week in a comment that seems to characterize the state of affairs in general.

From the Rx coverage front —

  • Drug Store News reports that

CVS Health is embarking on a collaboration with Uber Health, Uber’s healthcare arm, to provide critical transportation support at no cost to people who need it most when seeking access to medical care, work or educational programs.

The relationship is part of Health Zones, CVS Health’s new initiative that provides concentrated local investments designed to reduce health disparities and advance health equity in high-risk communities across the country. Health Zones is an integrated approach to addressing six key social determinants of health: housing, education, access to food, labor, transportation, and health care access. 

The Health Zones initiative is now active in five markets nationwide: Atlanta, Ga.; Columbus, Ohio; Fresno, Calif.; Hartford, Conn.; and Phoenix, Ariz. with plans to expand into more cities later this year. Working with trusted national and local partners, CVS Health is addressing community health care needs, ensuring at-risk communities have access to resources and opportunities that can help them thrive.

  • Fierce Healthcare tells us that

Mark Cuban Cost Plus Drug Company (MCCPDC) has launched its online pharmacy as part of an ongoing effort to provide consumers with low drug prices. 

The pharmacy claims to offer significant savings, with several prescription drugs reportedly at more than half the cost of the next most affordable option. For instance, leukemia treatment imatinib has a retail price of $9,657 a month, according to MCCPDC, compared to $120 with a common voucher. Its price through the new company, however, is just $47 per month.

The pharmacy’s initial inventory launch consists of 100 generic drugs. 

From the No Suprises Act front, Health Payer Intelligence discusses how the new law is likely to spur collaboration between providers and payers to improve the accuracy of provider directories. The FEHBlog has always thought the providers should post the a notice about the networks in which they participate at their offices and on their websites.

Midweek update

David Ermer–COVID treatment, COVID vaccine mandate, COVID-19, Mental health care, Rx coverage, U.S. Healthcare–
Photo by JOSHUA COLEMAN on Unsplash

In this morning’s New York Times, columnist David Leonhardt writes

Omicron appears to be in retreat, even if the official national data doesn’t yet reflect that reality. Omicron also appears to be mild in a vast majority of cases, especially for the vaccinated. This combination means that the U.S. may be only a few weeks away from the most encouraging Covid situation since early last summer, before the Delta variant emerged.

If that happens — and there is no guarantee it will, as Katherine Wu of The Atlantic explains — it will be time to ask how society can move back toward normalcy and reduce the harsh toll that pandemic isolation has inflicted, particularly on children and disproportionately on low-income children.

When should schools resume all activities? When should offices reopen? When should masks come off? When should asymptomatic people stop interrupting their lives because of a Covid exposure? Above all, when does Covid prevention do more harm — to physical and mental health — than good?

These are tricky questions, and they could often sound inappropriate during the Omicron surge. Now, though, the surge is receding.

Yes, indeed. Helen Branswell, writing in STAT News, offers an array of expert opinions on what could be next on the COVID front.

John Moore, a virologist at Weill Cornell Medical College, said a post-Omicron decrease in transmission “is certainly a plausible scenario,” suggesting it might take until late February or early March for most of the country to get there. But equally possible, he suggested, is that another variant will emerge, with the transmissibility of Omicron but without its reticence to replicate in the deep lungs [like Alpha and Delta did].

“This is where it’s all so freaking difficult. There are scenarios. You don’t know what the future’s going to hold. All these people who say ‘This is what’s going to happen.’ Well, this is what they think might happen, if they’re being honest,” he said.

While the situation remains unsettling, the FEHBlog thinks that Mr. Leonhardt’s thinking is on the right track.

From the masking front, the Wall Street Journal reports that

The Biden administration on Wednesday announced plans to make 400 million N95 masks available for free at pharmacies and community health centers across the country.

The move comes as President Biden has stepped up the federal government’s response to a nationwide surge in Covid-19 cases triggered by the highly transmissible Omicron variant. Some scientists and doctors have said popular single-layer cloth masks may not be sufficient to protect against Omicron and called on the administration to expand access to high-filtration masks such as N95s.

The nonsurgical N95 masks will start to be available at pharmacies and community health centers late next week and the program will be fully up and running by early February, the White House official said. The masks will be sourced from the Strategic National Stockpile, the nation’s safety net of medical-equipment supplies. * * *

Three masks will be available per person, the official said, to ensure broad access. Most of the pharmacies that are part of the federal pharmacy vaccine program will distribute the masks, the official said.

Following up on yesterday’s post on distribution of the Pfizer and Merck Covid pills, the New York Times offers a reporter’s saga of tracking down the Pfizer treatment for her ailing mother.

The fact that the process was so hard for a journalist whose job it is to understand how Paxlovid gets delivered is not encouraging. I worry that many patients or their family would give up when told “no” as many times as I was.

I was also reminded that even a “free” treatment can come with significant costs.

The federal government has bought enough Paxlovid for 20 million Americans, at a cost of about $530 per person, to be distributed free of charge. But I spent $256.54 getting the pills for my mother. I paid $39 for the telemedicine visit with the provider who told my mother that she would need to visit in person. The rest was the Uber fare and tip. Many patients and their families can’t afford that.

President Biden recently called the Pfizer pills a “game changer.” My experience suggests it won’t be quite so simple.

FEHB and other health plans hopefully are looking into helping their members navigate this complicate process.

From the COVID vaccine mandate front, Fierce Healthcare reports

All 50 states are now subject to the Centers for Medicare & Medicaid Services’ (CMS’) healthcare workforce mandate after a federal court tossed Texas’ lawsuit and preliminary injunction contesting the requirement.

Today’s dismissal comes less than a week after the Supreme Court removed a stay of the federal government’s industry-wide vaccine requirement in 24 states that opposed the policy. The Biden administration filed an appeal of Texas’ injunction the following day.

Although CMS’ requirement may now be enforced across the country, the agency has set varying compliance deadlines reflecting whether its initial interim final rule was enjoined in a particular state.

Healthcare Dive adds

Healthcare workers in the 24 states that legally challenged the requirement will now be on a different vaccine deadline than the rest of the nation. For these states, healthcare workers must be fully inoculated by March 15, CMS confirmed with Healthcare Dive.        

But for the healthcare workers in the other 25 states and D.C., which were not a part of the litigation, workers will need to be fully vaccinated by Feb. 28, per CMS.         

From the healthcare business front —

Healthcare Dive tells us that

UnitedHealth reiterated its 2022 enrollment targets for Medicare Advantage on Wednesday, easing recent concerns that rising competition could hamstring future growth in the fruitful market.

The forecast was released along with its fourth-quarter and full-year 2021 results. The Minnetonka, Minnesota-based healthcare behemoth also reported no serious change in utilization trends despite skyrocketing COVID-19 case counts due to the highly infectious omicron variant.

UnitedHealth beat Wall Street expectations on both earnings and revenue in the fourth quarter, with revenue of $73.7 billion, up 13% year over year, thanks in part to the outsized growth of its health services business Optum. Net earnings of $4.2 billion were almost double the $2.4 billion in profit brought in at the same time last year.

Healthcare Dive adds that

Antitrust regulators said Tuesday they are looking to modernize merger guidelines in an effort to crack down on tie-ups amid a flood of merger filings that has more than doubled in the past year.

Leaders of the Federal Trade Commission and Department of Justice are launching a review of the current guidelines that are used to detect and analyze potentially unlawful mergers. Those policing guidelines have not been updated in 12 years, potentially excluding realities of a modern economy, leaders said.

To bring the guidelines up to date, the FTC and DOJ are calling on the public to submit information and new evidence, about the potential effects of mergers so the agencies can ultimately beef up tools to block anticompetitive deals.

From the Rx coverage front —

  • Drug Channels offers five takeaways from the Big Three PBM’s exclusion lists.
  • The Congressional Budget Office released a report titled “Prescription Drugs: Spending, Use, and Prices.”

In general healthcare news —

  • The American Medical Association discusses what drives Black maternal health inquities in the U.S.

Researchers at the University of Wisconsin-Madison have spent years making sure that their meditation app, called the Healthy Minds Program, passes clinical muster and delivers positive outcomes. Designing studies to test the app’s efficacy led Simon Goldberg, an assistant professor at UW, to confront the mountain of thousands of studies of different mobile mental health tools, including apps, text-message based support, and other interventions.

Researchers had taken the time to synthesize some of the studies, but it was hard, even for someone steeped in the science like Goldberg, to draw definitive conclusions about what works and what doesn’t. So Goldberg teamed up with a few other researchers and took a step back to see if they could put order to the work collected in these meta-analyses — a kind of deep meditation on the existing research inspired by UW’s meditation app.

The meta-review, published on Tuesday in PLOS Digital Health, examined 14 meta-analyses that focused specifically on randomized control trials for mental health interventions, including treatments for depression, anxiety, and smoking cessation. In total, the review included 145 trials that enrolled nearly 50,000 patients. The review found universal shortcomings in study design, leading the researchers to write that they “failed to find convincing evidence in support of any mobile phone-based intervention on any outcome.”

Ruh roh.

Tuesday Tidbits

David Ermer–COVID treatment, COVID-19, COVID-19 testing, Electronic health records–
Photo by Patrick Fore on Unsplash

Back in President George W. Bush’s first term, health information professionals were talking about the linking budding health information exchanges with a “national backbone.” That backbone was finally unveiled today and it has been named TEFCA. Hopefully TEFCA will be the answer to nationwide FEHB plan prayers for interoperability.

An Office of National Coordination press release explains,

The Trusted Exchange Framework and Common Agreement is now available. Within the health information technology (health IT) world, few things have been as elusive as a governance framework for nationwide health information exchange. When ONC was formed in 2004, the concept of a nationwide health information network—where your information could be located across the country in a click—was a big picture vision that drove the federal government’s early health IT infrastructure, standards, policy actions, and investments.

What’s followed as a result of two laws (HITECH Act and 21st Century Cures Act) and remarkable continuity across four administrations has been steady growth, maturity, and investment from both the public and private sectors. Most health care providers use electronic health records.1,2,3 Many are connected to and engage in at least one form of electronic health information exchange.4,5,6 And health information networks are now dotted across the US map supporting communities with a wide range of services.7

Today’s milestone marks the beginning of a new era of electronic health information exchange in the US. That world we wanted to see back in 2004—it’s here—and now it’s time to put what we’ve built to use.

Our goals for the Trusted Exchange Framework and Common Agreement (TEFCA) are:

Goal 1: Establish a universal policy and technical floor for nationwide interoperability.

Goal 2: Simplify connectivity for organizations to securely exchange information to improve patient care, enhance the welfare of populations, and generate health care value.

Goal 3: Enable individuals to gather their health care information.

The Trusted Exchange Framework is a set of non-binding principles to facilitate data-sharing among health information networks. The Common Agreement will operationalize simplified electronic health information exchange for many across the US and will provide easier ways for individuals and organizations to securely connect. Most notably, the Common Agreement sets a new baseline for the exchange purposes that need to be supported—a common source of friction across networks today. The Common Agreement includes support for treatment, payment, health care operations, individual access services, public health, and government benefits determination.

The Common Agreement is a new legal contract that ONC’s Recognized Coordinating Entity (RCE), The Sequoia Project, will sign with each Qualified Health Information Network (QHIN). QHINs will then execute certain corresponding policies within their own networks. Published in tandem is the QHIN Technical Framework, which sets the functional and technical requirements that QHINs need to support to make this new connectivity come online. While road-tested production standards are being used at the start, we are also actively working with the RCE to develop a TEFCA Health Level Seven (HL7®) Fast Healthcare Interoperability Resource (FHIR®) Roadmap (TEFCA FHIR Roadmap) to outline how FHIR will also become an established part of TEFCA-based exchange over time.

The FEHBlog is happy that the Biden Administration hit the regulatory accelerator to launch TEFCA in the Administration’s first year in office. Here’s a link to the Sequoia Projects’ TEFCA website which offers a wealth of resources.

From the Omicron front, the Wall Street Journal reports that

Pfizer Inc.’s new Covid-19 pill, Paxlovid, was effective against the Omicron variant in laboratory tests, an encouraging early sign the drug will be an important tool while the strain spreads. 

Pfizer said Tuesday the drug’s main component, nirmatrelvir, worked in three separate laboratory studies. Patients take two tablets of nirmatrelvir with one tablet of another antiviral called ritonavir twice a day for five days.

The company issued the results by news release. The research hasn’t been published in a peer-reviewed medical journal.

PBS recently posted this helpful article on U.S. distribution plans for the Merck and Pfizer COVID pills. The pills are helping some folks already, but access to the medication seems serendipitous just like access to the COVID vaccines seemed a year ago.

From the OTC testing front, the Federal Government launched its COVIDTest.gov website today. The site appears to be user friendly. Let’s hope it’s holds up better than healthcare.gov did in 2014 when stress tested by the public.

The COVIDtests.gov reminds users that health plans will reimburse the costs of OTC Covid tests, and by golly Blue Cross FEP has an OTC tests coverage page on its website and so does GEHA.

Holiday weekend update

David Ermer–CDC, Congress, Federal employment benefits, Medicare, Mental health care, U.S. Healthcare–

Happy King Day! Here is a link to the NPR website that includes a video and a transcript of his “I Have a Dream” speech given August 28, 1963. Dr. King proves that you don’t have to be President to lead the country. He accomplished so much in his tragically shortened life for which we all should be grateful.

From the Congress front, the House of Representatives remains in session this week for Committee business and floor voting while the Senate is on State work period. Govexec lets us know that last Thursday

Lawmakers sounded a rare note of optimism about reaching a spending agreement for the remainder of fiscal 2022 as they look to avoid yet another stopgap measure.  Leaders in both parties called a bicameral, bipartisan meeting “constructive,” saying they shared the goal of setting full-year appropriations by their Feb. 18 deadline. 

From the Omicron front, STAT News informs us that

As the coronavirus continues to wreak havoc, an expert panel at the World Economic Forum delivered a mix of good news and bad news on Monday: More variants will emerge, but vaccine production is accelerating and research is progressing toward a combined shot that may be able to attack these different variants.

On one hand, the world needs to prepare for newer strains that could be more vexing, or the “worst case scenario,” said Annelies Wilder-Smith, a professor of emerging infectious diseases at the London School of Hygiene and Tropical Medicine. “Omicron will not be the last variant. There’s a high probability we will have another variant coming up. The question is when and will it be less dangerous?”

Wall Street Journal columnist Alyssia Finley offers a column on the benefits of natural immunity created by Omicron breakthrough infections.

A study last month by the Oregon Health and Science University found that vaccinated people who experienced breakthrough infections produced higher levels of antibodies that were up to 1,000% more effective than those generated two weeks after a second dose of the Pfizer vaccine. The researchers described this as superimmunity. 

“I think this speaks to an eventual end game,” said co-author Marcel Curlin. “It doesn’t mean we’re at the end of the pandemic, but it points to where we’re likely to land: Once you’re vaccinated and then exposed to the virus, you’re probably going to be reasonably well-protected from future variants.” Dr. Curlin added: “Our study implies that the long-term outcome is going to be a tapering off of the severity of the worldwide epidemic.” * * *

All of this suggests that infection with Omicron is likely to stimulate potent and durable protection against Covid-19—and potentially other coronaviruses—even if it mutates to become more virulent. As Omicron rapidly spreads, people who have been vaccinated or previously infected will develop superimmunity. Covid-19 will become a virus that causes cold- and sometimes flulike symptoms—annoying but rarely deadly or disruptive.

One caveat is that older people generate weaker T-cell responses and memories to infections and vaccines. They’re likely to need annual booster shots. Omicron will end the pandemic by making Covid-19 endemic.

The Journal also offers masking advice which help the FEHBlog finally understand the difference between N-95 and KN-95 masks. “If you can’t get an N95 [which is certified in the US], doctors suggest KN95, KF94 and FFP2 masks, which are certified in China, South Korea and Europe, respectively.”

The Journal also reports that

One year into her tenure as director of the Centers for Disease Control and Prevention, Rochelle Walensky acknowledges that she should have communicated certain things better to the American public.

She says the pandemic threw curveballs that she should have anticipated. She thinks she should have made it clearer to the public that new rules and guidelines were subject to change if the nature of the fight against Covid-19 shifted again.

“I think what I have not conveyed is the uncertainty in a lot of these situations,” Dr. Walensky said in an interview with The Wall Street Journal.

Dr. Walensky deserves credit for making these remarks.

From the FEHB and TRICARE fronts, benefits consultant Tammy Flanagan discusses the merits of enrolling in Medicare Part B when you retire from federal employment at or over age 65.

From the healthcare business front, Revcycle Intelligence calls to our attention the fact that “2021 did not set any records for the number of hospital mergers and acquisitions, but data shows a shift to larger deals between well-established organizations”

The report identified eight “mega-mergers” in which the seller or smaller partner by revenue had over $1 billion in annual revenue. Out of all the announced transactions, that is the largest percentage of announced mega-mergers in the last six years at 16.3 percent. It was also nearly double the percentage of mega-mergers announced in 2020.

The average size of the smaller party in hospital merger and acquisition deals was also up significantly compared to previous years, according to the report. The average size by annual receive increased to $619 million from $388 million in 2020.

The data may point to a new trend in healthcare consolidation.

From the benefit design front, Health Payer Intelligence reports that

Although acupuncture utilization has grown in recent years, only half of acupuncture visits had any form of coverage in 2019, according to a research letter published in JAMA Network Open.

The researchers analyzed acupuncturist visits in Medical Expenditure Panel Survey (MEPS) data from 2010 to 2019. Their aim was to uncover the total cost of the visit, the annual out-of-pocket healthcare spending for these visits, the portion of these visits that were covered under the patients’ insurance plans, and the percent of out-of-pocket costs.

The majority of the participants were female and nearly six in ten were White individuals.

Finally MedPage Today gives us a community-oriented story written by “a physician [Avik Chatterjee, MD, MPH] in a shelter-based clinic in Boston, near the intersection of Massachusetts Avenue and Melnea Cass Boulevard, where a large encampment of people experiencing homelessness has emerged. Injection drug use in this area has picked up recently, and overdoses are not uncommon. When people need help, outreach workers and shelter staff run in and call for us.” And clinic doctors and nurses respond to the calls.” His story concludes as follows:

The skills, knowledge, and compassion necessary to address the overdose crisis exist in the community of people who use drugs. Historically, this group of people has been particularly marginalized by healthcare institutions. But people who use drugs are finally starting to demand a seat at the table where decisions are made around research and treatment of substance use disorders. Researchers, clinicians, and policymakers need to come up with creative ways to partner with this community to meaningfully incorporate lived and living experience in designing research and clinical programs.

In the face of one of the biggest health crises of our generation, it’s time to realize that “we’re all family here.”

And the post comes full circle.

Cybersecurity Saturday

David Ermer–Cybersecurity–

The headline news of the week is brought to us by the Wall Street Journal

The Russian government on Friday [January 14] said it had arrested members of the prolific criminal ransomware group known as REvil that has been blamed for major attacks against U.S. business and critical infrastructure, disrupting its operations at the request of U.S. authorities.

Russia’s security service, the FSB, said in an online press release that it had halted REvil’s “illegal activities” and seized funds belonging to the group from more than two dozen residences in Moscow, St. Petersburg and elsewhere. REvil members were arrested in relation to money-laundering charges, the FSB said. It didn’t provide names of any of the suspects.

The arrests included “the individual responsible for the attack on Colonial Pipeline last spring,” a particularly devastating ransomware offensive that led to the main conduit of fuel on the U.S. East Coast being shut down for days, a senior Biden administration official said. A different Russian ransomware gang had previously been linked to the Colonial hack, but security experts and officials have said they are not neatly defined and that individual hackers often overlap.

“We welcome reports the Kremlin is taking law enforcement steps to address ransomware within its borders,” the official said.

Needless to say this development also is the focus of Bleeping Computer’s The Week in Ransomware.

From the log4j front, Healthcare Dive tells us that

— Jen Easterly, director of the Cybersecurity and Infrastructure Security Agency, said the agency has not yet seen the Log4j vulnerability used for significant intrusions but cautioned that sophisticated threat actors may be lying in wait for cybersecurity defenders to be caught off guard during a lower level of awareness.

— Threat actors have used the vulnerability to install and sell cryptomining software on victims’ computers and to potentially launch future botnet attacks. CISA cannot independently confirm research showing nation-state threat actors developing attacks based on Log4Shell, Easterly said during a presser Monday. 

— Microsoft security researchers identified a China-based threat actor, tracked as DEV-0401, exploiting the Log4j vulnerability in systems using VMware Horizon to deploy NightSky ransomware, researchers said in an updated blog.

Federal News Network interviewed about this infamous yulnerability. Gordon Bitko, former FBI chief information officer, now the senior vice president of policy at the Information Technology Industry Council.

Gordon Bitko: Tom, where there’s a difference from SolarWinds. Log4j wasn’t a coordinated — as far as we know — attack by an adversary. It was a vulnerability that was identified, and so the people who are exploiting it now seem more like cybercriminals who were using it as a way to implant ransomware, things of that nature.

Tom Temin: Alright, so you can never rest on your laurels.

Gordon Bitko: That is 100% the case. It is important for everybody doing cybersecurity and their management to understand it’s a race on a treadmill. You can never stop.

Last Wednesday Cyberscoop reported that

Tech giants and federal agencies will meet at the White House on Thursday to discuss open-source software security, a response to the widespread Log4j vulnerability that’s worrying industry and cyber leaders.

Among the attendees are companies like Apple, Facebook and Google, as well as the Apache Software Foundation, which builds Log4j, a ubiquitous open-source logging framework for websites.

“Building on the Log4j incident, the objective of this meeting is to facilitate an important discussion to improve the security of open source software — and to brainstorm how new collaboration could rapidly drive improvements,” a senior administration official said in advance of the meeting.

Here’s the White House readout from that meeting. According to that document, the discussion focused on three topics:

Preventing security defects and vulnerabilities in code and open source packages, improving the process for finding defects and fixing them, and shortening the response time for distributing and implementing fixes. In the first category, participants discussed ideas to make it easier for developers to write secure code by integrating security features into development tools and securing the infrastructure used to build, warehouse and distribute code, like using techniques such as code signing and stronger digital identities.

In the second category, participants discussed how to prioritize the most important open source projects and put in place sustainable mechanisms to maintain them.

In the final category, participants discussed ways to accelerate and improve the use of Software Bills of Material, as required in the President’s Executive Order, to make it easier to know what is in the software we purchase and use. 

For a government meeting open to you, dear readers:

The Cybersecurity and Infrastructure Security Agency (CISA) is holding virtual mini-Industry Day events throughout this year. These events will allow CISA and industry to have meaningful discussions about cybersecurity capabilities, challenges, top priorities, requirements, and technologies as well as future business opportunities.

The first Virtual Mini-Industry Day will be Wednesday, January 26, at 10 a.m. (EST). This event will provide insight into current and future challenges as well as provide presentations regarding IT  FY22 information technology focus areas, FY23-25 foundational work, engineering, information assurance, information technology operations, and records management/governance. To attend, please register by Tuesday, January 18, at 5 pm ET

Finally ZDnet offers its recommendations on

Friday Stats and More

David Ermer–CDC, CMS, Congress, COVID vaccine mandate, COVID-19, COVID-19 testing, COVID-19 vaccine, U.S. Healthcare–

Based on the Centers for Disease Control’s COVID Data Tracker and using Thursday as the first day of the week here is FEHBlog’s weekly chart of new COVID cases from the 27th week of 2021 through the second week of this year:

Four million new cases of COVID in a week. Wow. The Delta surge is the long hill that starts at the left of the chart. Omicron is Mount Everest by comparison.

Here’s the FEHBlog’s weekly chart of new COVID deaths for the same time span.

Weekly COVID deaths haven’t crossed 10,000 since the Delta surge peaked. Of course deaths are a lagging indicator.

The FEHBlog does think based on his reading that we are close to turning another corner but it’s not showing in these charts yet. We remain in the soup.

Here’s the FEHBlog’s chart of weekly Covid vaccinations distributed and administered since COVID shots were made available to the public in December 2020.

For the first time since before the holidays the number of administered vaccines, including boosters, exceeded 10 million last week. We are closing on 75% of the U.S. population aged 18 and older being fully vaccinated and over 65% of the U.S. population aged 65 and older being boostered.

Here are links the the CDC’s interpretation of its recent Covid and Flu statistics. The American Hospital Association informs us that

As urged by the AHA, the Department of Health and Human Services today renewed the COVID-19 public health emergency declaration for another 90 days effective Jan. 16. The extension will help hospitals and health systems combat COVID-19 in their communities.

In the wake of the Supreme Court lifting the stay on the CMS healthcare worker stay mandate, the American Hospital Association explains

The Centers for Medicare & Medicaid Services today released updated interpretive guidance on its Omnibus COVID-19 Health Care Staff Vaccination Interim Final Rule for states affected by yesterday’s Supreme Court’s decision  on the rule. The guidance does not apply to Texas, where the Interim Final Rule is still subject to a preliminary injunction in a separate legal action that was not before the Supreme Court. Under the guidance, the first dose compliance date for those states is Feb. 14, 2022, with full compliance expected from providers by March 15, 2022. For states not impacted by the Supreme Court decision, the previously announced compliance dates of Jan. 28 and Feb. 27 remain in effect. For both groups, the underlying interpretive guidance released on Dec. 28 applies and all members can still refer to the previously released Frequently Asked Questions for additional information. 

Tomorrow is the implementation date for the President’s mandate that health plans cover over-the-counter COVID tests. It’s worth noting that health plans generally don’t cover any products sold over-the-counter so needless to say plans needed many more than the four days that federal govenment gave them to implement. The New York Times delves into the details.

The Wall Street Journal reports that

The U.S. public can begin ordering free at-home rapid Covid-19 tests through a new government website on Jan. 19, senior Biden administration officials said.

Initially, orders will be limited to four tests per residential address. Tests will ship via mail within 7-12 days of ordering, the officials said. The administration expects that timeline to shorten as the program ramps up, one of the officials said.

The public will be able to order tests at covidtests.gov. Those without access to the internet can place orders via phone, and the administration will work with community groups to help people request tests, the officials said. The government will give priority to orders from areas that have been hard-hit by the pandemic and low-income parts of the country.

Here’s a link to the White House’s fact sheet on these programs. Govexec discusses the Postal Service’s important role in distributing the tests ordered over the government website.

From the masking front, STAT News reports that

U.S. health officials on Friday encouraged more Americans to wear the kind of N95 or KN95 masks used by health-care workers to slow the spread of the coronavirus.

Those kinds of masks are considered better at filtering the air. But they were in short supply previously, and Centers for Disease Control and Prevention officials had said they should be prioritized for health care workers.Related: Comparing the Covid-19 vaccines developed by Pfizer, Moderna, and Johnson & Johnson

In updated guidance posted late Friday afternoon, CDC officials removed concerns related to supply shortages and more clearly said that properly fitted N95 and KN95 masks offer the most protection.

However, agency officials noted some masks are harder to tolerate than others, and urged people to choose good-fitting masks that they will wear consistently.

“Our main message continues to be that any mask is better than no mask,” Kristen Nordlund, a CDC spokeswoman, said in a statement.

In other news —

  • Regulatory News informs us that “The Senate Health, Education, Labor and Pensions (HELP) Committee on Thursday voted 13-8 to advance the nomination of Robert Califf for a second stint as commissioner of the US Food and Drug Administration (FDA).”

Researchers at Weill Cornell Medicine and the University of Oxford announced on January 10, 2022, their new study shows that common vaccines could help reduce the health burden of the COVID-19 pandemic. 

A peer-reviewed study published in the Proceedings of the National Academy of Sciences crystallizes decades of evidence suggesting that the generalized immune-boosting properties of many vaccines can cross-protect people against multiple pathogens.

While these researchers did not specify particular vaccines, they chose values for cross-protection consistent with data from earlier studies on measles, influenza, tuberculosis, and other immunizations.

  • Fierce Healthcare tells us that “A top Medicare advisory board [MEDPAC] did not recommend any new payment hikes for acute care hospitals or doctors for 2023, stating that targeted relief funding has helped blunt the impact of the COVID-19 pandemic.” We shall see.