Both Houses of Congress will be holding committee meetings and floor votes this week. A House Oversight and Reform subcommittee is holding a hearing on the Postal Service tomorrow, September 14. The Senate Homeland Security and Governmental Affairs Committee will vote on whether to advance John Gibbs nomination to be OPM Director on Wednesday September 16. The FEHBlog will be on the lookout for more news on FY 2021 continuing resolution.
Negotiations between the White House and the pharmaceutical manufacturers have failed because the President signed and made public his most favored nation pricing executive order today. The order requires the Secretary of Health and Human Services to implement most favored nation pricing pilot programs for Medicare Parts B and D drugs. The HHS Secretary will select the drugs to be included in the pilots. Action on the Part B pilot must begin immediately. “The model[s] would test whether, for patients who require pharmaceutical treatment, paying no more than the most-favored-nation price would mitigate poor clinical outcomes and increased expenditures associated with high drug costs.” The Hill reports that “The pharmaceutical industry quickly blasted the surprise move and raised the idea of suing to stop it.”.
A friend of the FEHBlog shared this link to a Governing article on how President James Monroe prevented a yellow fever epidemic when he was governor of Virginia 200 years ago. Governing observes “Over the last few months, there have been countless news stories about the 1918 Spanish flu pandemic and the 1793 yellow fever outbreak in Philadelphia. We know about these stories because the disease spread and thousands of lives were lost. But the outbreak of 1800 is the example we should remember [because of President Monroe’s actions].” Far be it from the FEHBlog who has read and discussed the Great Influenza to overlook President Monroe’s actions.
First let’s agree to never forget that the anniversary of the September 11, 2001, attack on our country and all of the lives that were cut short on that tragic day.
Based on the CDC’s Cases in the U.S. website, here is the FEHBlog’s chart of new weekly COVID-19 cases and deaths over the 20th through 36th weeks of this year (beginning May 14 and ending September 9; using Thursday as the first day of the week in order to facilitate this weekly update):
and here is the CDC’s latest overall weekly hospitalization rate chart for COVID-19:
Because the FEHBlog does look at his charts which are intended to show trends, he realized that new deaths chart is flat because new cases greatly exceed new deaths. Accordingly here is a chart of new COVID-19 deaths over the same period.
The charts are trending down which is hopeful.
Fierce Healthcare reports on ‘Decision Resources Groups’ two-part [telehealth] survey of 4,855 practicing U.S. physicians conducted in March and April, with a follow-up survey in July.” According to the Group’s press release,
As of July 2020, 80% of U.S. physicians had conducted a virtual patient consultation in the previous three months – up from 39% in April and 9% in early March, when use of virtual consults was unchanged over 2019 levels
This trend likely portends more multi-modal care delivery post-pandemic, with physicians making greater use of video visits, emails and phone calls with patients as a means of supplementing traditional in-person visits. Among those physicians surveyed in June and July who said they had conducted virtual consultations in the past three months, 52% said they will likely continue to do so after COVID-19 mitigation measures have ended.
However, barriers to telemedicine use remain – 58% of U.S. physicians have lingering reservations about the quality of care they can provide remotely.
In federal and postal employment news, Federal News Network reports that
The Office of Management and Budget has, at last, offered up more information on the president’s payroll tax deferral, which the Trump administration will implement for most federal employees and military members later this month. But the guidance is brief, vague and leaves many questions unanswered.
The Wall Street Journal informs us that the Postal Service will not be implementing the payroll tax deferral.
Law360 reports that “The U.S Department of Labor issued much-anticipated regulations Friday [September 11] laying out who qualifies for emergency paid sick leave under the Families First Coronavirus Response Act, revising parts of a rule that a New York federal judge recently struck down.” The Labor Department’s press release explains that “the revisions do the following:
Reaffirm and provide additional explanation for the requirement that employees may take FFCRA leave only if work would otherwise be available to them.
Reaffirm and provide additional explanation for the requirement that an employee have employer approval to take FFCRA leave intermittently.
Revise the definition of “healthcare provider” to include only employees who meet the definition of that term under the Family and Medical Leave Act regulations or who are employed to provide diagnostic services, preventative services, treatment services or other services that are integrated with and necessary to the provision of patient care which, if not provided, would adversely impact patient care.
Clarify that employees must provide required documentation supporting their need for FFCRA leave to their employers as soon as practicable.
Correct an inconsistency regarding when employees may be required to provide notice of a need to take expanded family and medical leave to their employers.”
The Wall Street Journal reports that the entire Senate Republican caucus, with the exception of Sen. Rand Paul, voted for the scaled down $500 billion (is that an oxymoron?) COVID-19 relief bill, but the bill failed to receive the 60 votes necessary for cloture because the Democratic caucus lined up in opposition. So we have another political issue for the election.
Thankfully, the Congress and the White House have agreed on a continuing resolution to fund the federal government into the new federal fiscal year. The House will be holding votes next week so the FEHBlog expects that the House will pass the continuing resolution and then peace out for the campaign trail. The Senate will hang around as long as it can to approve more nominations. Following the election Congress will hold a lame duck session at which point another COVID-19 relief bill is likely to be enacted.
In healthcare news —
The National Academies of Sciences has a detailed web page about social determinants of health that is worth a look.
Humana has launched value based hearth surgery and shoulder replacement programs. “””The value-based care models are part of a portfolio of payment bundles created by Humana including a Maternity Episode-of-care Model and an Oncology Model of Care. Humana also offers a Hospital Incentive Program for acute care inpatient admissions. About 2.4 million MA members and 115,000 commercial members are enrolled in value-based models, Humana has said.”
Fierce Biotech reports that quick, inexpensive saliva based COVID-19 tests are being piloted at Heathrow Airport in London, England. Send the tests over here.
The Wall Street Journal informs us that “health experts say it’s increasingly likely that several [COVID-19] vaccines could pass muster in clinical trials and become available in phases over a period of weeks and months.”
The Centers for Disease Control and Prevention sent documents last week to state officials that lay out various scenarios, including availability of a limited number of doses of two vaccines by the end of October with more doses by the end of the year. The CDC document doesn’t name the two vaccines that could become available but describes characteristics that match those of the vaccines from Pfizer and Moderna.
Experts say multiple vaccines will be needed because no single company can make enough for the whole world. Several companies have signed contracts with the federal government to supply at least 100 million doses of each vaccine in the U.S., and are planning to produce larger global supplies.
OPM Director Nominee John Gibbs (Senate video / Federal Times)
The Senate Homeland Security and Governmental Affairs Committee held a confirmation hearing for OPM Director nominee John Gibbs this afternoon. Here’s are links to Mr. Gibbs’ testimony and a Federal News Network article on the hearing. The Committee will vote on whether to advance Mr. Gibbs’ nomination to the full Senate at a business meeting scheduled for next Wednesday October 16.
The Senate Health Education Labor and Pensions Committee heard testimony today from the NIH Director Dr. Francis Collins and the U.S. Surgeon General Vice Admiral Jerome Adams on the topic of vaccines. U.S. News and World Report highlights an important segment of Dr. Collins’s appearance before the Committee.
AstraZeneca announced on Tuesday that its late-stage [COVID-19] vaccine study was being put on hold due to a “potentially unexplained illness” in one of the participants.
“With an abundance of caution at a time like this, you put a clinical hold, you investigate carefully to see if anybody else who received that vaccine, or any other vaccines, might have had a similar finding of a spinal cord problem,” Collins said.
Those who are concerned about the safety of the approval process should be reassured by the development, Collins said. “If it turns out that that is a real consequence of this vaccine and can be shown to be cause and effect then all the doses that are currently being manufactured for that will be thrown away because we do not want to issue something that is not safe,” Collins said. He added that the U.S. is investing in six vaccine candidates “because of the expectation that they won’t all work, although it would be lovely if they did.”
AstraZeneca was one of the nine drugmakers to pledge on Tuesday to uphold standards for science and safety in their pursuit of a coronavirus vaccine.
Healthcare Finance reports on America’s Health Insurance Plan comments on how health insurers can aid the COVID-19 vaccine distribution process. For example,
Insurers can use their member data to help identify which people meet the criteria to be eligible for the vaccine, according to the best available evidence. Outreach efforts must adhere to patient privacy requirements, AHIP said.
Insurers can coordinate across partners such as public health officials for data sharing regarding their members’ vaccine status, encouraging data to be shared with state or regional databases (Immunization Information Systems).
“Health insurance providers play an important role ensuring that people receive the vaccines that are recommended for them, and have experience conducting outreach to their members to inform them of the vaccines that are recommended for them and how they can get them,” AHIP said. This may include reminders to ensure they receive multiple doses of a vaccine when needed.”
The Health Affairs Blog experts offer five recommendations on how to better integrate telehealth with primary care.
Recommendations
Representative Open-Text Survey Responses
Harmonize the reimbursement criteria
“Some insurance companies are paying less than in-person visits for telehealth visits from Day 1. Small practices, like usual, have been left to themselves for the most part.”“Primary care is extremely challenging with the constant change in protocols, the uncertainty and enormously confusing insurance schemes.”
Create billing codes or payment models for the additional work required to offer telehealth
“Insurance companies not reimbursing telephone visits at a rate that supports the level of work done on a telephone visit.”“Elderly patients have no access or are unable to access virtual – more work, have to teach them how to take BP, some hard of hearing, etc.”“I am more stressed out doing telehealth, as we spend time to fix internet, video, and voice. There are calling issues, so it’s more time consuming.”
Provide coverage for at-home monitoring devices
“I need blood pressure cuffs and glucometers covered by insurance for home monitoring.” “I will do tele health… provided patients have equipment.”“Patients lack thermometers, blood pressure cuffs, and pulse oximeters.”
Incentivize the development of and access to, patient- and provider-centered telehealth technology
“Telehealth information technology platform is NOT user friendly.”“Difficult to properly diagnose with telehealth. Have been using photos from patients to supplement but still not really sufficient.”“Our patients are low-income with language barriers. Requiring third party interpreter by speaker phone takes extra time and reduces quality of care.”
Review, revise, and communicate telehealth malpractice policies
“I am not going to practice telehealth; it is not reliable and may increase malpractice cases.”“I’m very concerned about being sued for managing the patients over telehealth especially since many are requesting opioids.”“Malpractice premiums are a major barrier for telehealth.”
The President’s latest OPM Director nominee John Gibbs will receive a confirmation hearing before the Senate Homeland Security and Governmental Affairs Committee on Wednesday September 9, 2020, at 3:30 pm ET.
In other Senate news, the Majority Leader Mitch McConnell is working his caucus to gain support for a scaled down COVID-19 relief bill according to the Hill. “The GOP proposal includes a $300 per week federal unemployment benefit, another round of Paycheck Protection Program (PPP) funding, $105 billion for schools and an additional $16 billion for coronavirus testing.” “’It’s something I hope 53 Republican senators vote yes on,’ said Sen. Ron Johnson (R-Wis.), adding that Treasury Secretary Steven Mnuchin ‘accommodated’ some of his concerns about the initial GOP bill.”
As for healthcare tidbits:
The Centers for Disease Control has posted an extensive set of FAQs on this year flu vaccination program. For example
Q. Are there delays in the availability of flu vaccine?
A. Currently, vaccine manufacturers are not reporting any significant delays in distributing flu vaccine this season. Because a record number of flu vaccine doses are being manufactured this year, the time to produce and distribute them will be longer. CDC will continue to provide weekly updates on total flu vaccine doses distributed throughout the 2020-2021 flu season. Use the VaccineFinder to find out where to get vaccinated near you.
EHR data collected during a patient visit can be leveraged to develop an EHR registry of patients with excessive alcohol use that can be optimized and updated in real-time, Kaiser Permanente researchers reported in the Journal of Medical Internet Research. An EHR registry consisting of patient data could medical professionals address specific high-risk patients. In this case, researchers can utilize the registry to assess alcohol use and recovery methods. Although alcohol abuse is a significant problem in the US, there were no current EHR-integrated registries that assessed these issues.
That was an important gap to fill. It’s good to see the government’s investment in EHR’s paying off.
The FEHBlog drove from New Haven, CT, to Bethesda, MD, today with a stop in Long Island. Traffic was quite cooperative. This trip allowed the FEHBlog to listen to this week’s Econtalk episode in which Econtalk host Russ Roberts interviewed leadership expert Margaret Heffernan about her new book “Uncharted — How to Navigate the Future.” “The central thesis of her book is that while the future may be unpredictable, that doesn’t mean you can’t prepare for it. And smart organizations and people can learn how to do it.” Here’s a valuable nub from the conversation:
I remember–oh, I don’t know, probably 2010 to 2012–having a number of arguments with my husband about when the next banking crash would be. And it suddenly struck me, this was just a stupid argument. Right? Because neither of us knew. No little economic fairy had sprinkled gold dust on us.
And, I said, ‘Okay, let’s ask a different question. Let’s ask the question: If there is another banking crash, or when there is another banking crash, what will we wish we had been doing right now?’ And, we thought through that in some pretty gritty detail about where we would want our investments to be, where we would want to be, what resources we would want to have. And so we slightly changed some of the things we were doing. We accelerated some things. We put other things on hold. And, what it did is it left us feeling, ‘Okay, we don’t know what the future is, but we think we’ve placed ourselves in a reasonably robust context.’ And actually that’s pretty much all we can do.
Accordingly, time would be better spent on thinking about how to restructure healthcare in the post pandemic world or how to better deal with a similar pandemic in the future and not on trying to figure out when this particular pandemic will end. Of course, everyone should work together toward the end of the current pandemic as it eventually will end.
The FEHBlog noticed for example that the benefit consulting firm Willis Towers Watson is holding a virtual conference later this month on resetting health and other employee benefits for the post-pandemic world. The conference website links to already available articles on this important topic.
What’s more with respect to getting current job done, the Wall Street Journal reports this weekend,
FDA [r]egulators authorized [last week] a new test developed by Fluidigm that uses saliva rather than a nasal swab. The clinical study associated with Fluidigm’s submission to the FDA demonstrated 100% agreement between the saliva results and paired nasopharyngeal samples. Fluidigm’s test returns results in several hours. Meanwhile, OraSure Technologies is developing a nasal-swab test that is potentially suitable for at-home use and could be ready this fall. * * * Thanks to health care innovation, a return to normalcy for the United States might just be in the cards in the months ahead.
The FEHBlog hopes that all of his readers are enjoying the Labor Day Weekend. The FEHBlog whose home state Maryland was removed from the COVID-19 travel ban list for New York, New Jersey and Connecticut last month skedaddled up to the Nutmeg State to visit family and friends. He is headed back to his Bethesda hacienda inside the Capital Beltway tomorrow morning.
The House of Representatives and the Senate have full committee schedules in the week ahead. The Senate will also engage in floor business this week while the House will not resume floor votes until next week.
The FEHBlog was pleased to read this Wall Street Journal report that
Several drug makers developing Covid-19 vaccines plan to issue a public pledge not to seek government approval until the shots have proven to be safe and effective, an unusual joint move among rivals that comes as they work to address concerns over a rush to mass vaccination.
A draft of the joint statement, still being finalized by companies including Pfizer Inc., PFE -0.11% Johnson & Johnson JNJ -0.64% and Moderna Inc. MRNA -3.45% and reviewed by The Wall Street Journal, commits to making the safety and well-being of vaccinated people the companies’ priority. The vaccine makers would also pledge to adhere to high scientific and ethical standards in the conduct of clinical studies and in the manufacturing processes.
As President Reagan would say trust but verify.
Health Payer Intelligence provides a 2020 perspective on health plan network centers of excellence. Centers of excellence generally are payer designated facilities that have worthy track records in costly surgeries like transplants. The article explains how payers have branched out this approach to other medical specialties:
Payers can boost their quality of care by working with a COE with particular specialty care providers. For example, Premera Blue Cross recently expanded its own COE strategy in order to improve its quality of care for radiology. Previously, radiology was not part of Premera Blue Cross’s COE strategy, but the payer recognized the need for better quality of care around this service.
“Establishing COEs around the highest quality radiology practices ensures patients are on the most direct treatment path back to health and reduces the high costs associated with misdiagnoses, which are surprisingly common,” explained the press release. At least a third of MRIs and CT scans produce erroneous diagnoses, the release stated.
Healthcare Dive reports that MEDPAC, a nonpartisan legislative branch agency that provides the U.S. Congress with analysis and policy advice on the Medicare program, has concluded that COVID-19 cash from the federal government saved most hospitals from the bleakest financial forecasts made last April. MEDPAC “Commissioners at Thursday’s meeting commended the administration for the speed of getting loans and grants out the door to providers, but said it was time for an in-depth review to make sure the money went to where it was needed most.”
Federal News Network provides an update on the Administration’s plan on the President’s payroll tax deferral program.
All active-duty military members as well as federal civilian employees will be subject to the president’s upcoming payroll tax deferral, a senior administration official told Federal News Network Friday evening.
The president’s payroll tax deferral, which the administration said all payroll providers will launch in unison later this month, has left federal employees, their unions and members of Congress scrambling this week for more details about the policy and its impact on the workforce.
The changes in payroll tax deductions are temporary, and federal employees will have to pay back deferred taxes starting in January. They’ll have until April to do so before penalties and interest may accrue, the IRS has said.
The FEHBlog congratulates OPM’s “Human Resources Solutions because its “USA Staffing® Onboarding platform is the winner of the 2020 Igniting Innovation Awards, hosted by the American Council for Technology and Industry Advisory Council (ACT-IAC). The awards recognize groundbreaking technologies that enhance services for citizens and government operations. USA Staffing Onboarding won with 68% of the vote. * * * Designed to efficiently onboard new hires in ordinary times, this fully online, automated solution proved instrumental in helping Federal agencies adapt to COVID-19.”
Based on the CDC’s Cases in the U.S. website, here is the FEHBlog’s chart of new weekly COVID-19 cases and deaths over the 20th through 35th weeks of this year (beginning May 14 and ending September 2; using Thursday as the first day of the week in order to facilitate this weekly update):
and here is the CDC’s latest overall weekly hospitalization rate chart for COVID-19:
Improvements in [COVID-19] treatments are leading to better outcomes, said Mercedes Carnethon, vice chair of the department of preventive medicine at the Feinberg School of Medicine at Northwestern University. “We’ve gotten better at treating it and the age group populations are younger,” she said, noting that younger people aren’t as likely to have severe or deadly cases of Covid-19.
Healthcare Dive informs us about the American Hospital Association’s reaction to yesterday’s final FY 2020 inpatient prospective payment system rule.
The American Hospital Association quickly criticized the price transparency element of the final rule Wednesday night.
“By continuing to focus on negotiated rates rather than expanding access to a patient’s out-of-pocket costs, the Administration fails to meet the goal it set for itself — assisting consumers in becoming more prudent purchasers of health care,” the group said in a statement. “We once again urge the agency to focus on what is really important to patients — ready access to their out-of-pocket costs.”
Evidently, the hospitals seek to dump the entire transparency burden on the health plans. The FEHBlog thinks that consumers would better informed by requiring hospitals and all providers to publicly announce the health plan network(s) in which they participate, an analog to the summary of benefits and coverage that health plans must distribute to members.
Speaking of comparison tools, the Centers for Medicare and Medicaid Services today launched
Care Compare, a streamlined redesign of eight existing CMS healthcare compare tools available on Medicare.gov. Care Compare provides a single user-friendly interface that patients and caregivers can use to make informed decisions about healthcare based on cost, quality of care, volume of services, and other data. With just one click, patients can find information that is easy to understand about doctors, hospitals, nursing homes, and other health care services instead of searching through multiple tools.
CMS notes that “Although the tool was created for people with Medicare in mind, many of the measures shown here apply to people who may not have Medicare. Information on this site isn’t an endorsement or advertisement for any provider type.”
Treasury Secretary Steven Mnuchin and Speaker Nancy Pelosi (D-Calif.) have informally agreed to pursue a clean, short-term stopgap measure to avert a government shutdown at the end of the month, sources in both parties confirmed Thursday. That means the continuing resolution (CR) needed to keep the government open past Sept. 30 would be free of controversial policy riders that have bogged down previous funding bills, significantly lowering the odds of a shutdown leading up to the crucial Nov. 3 elections.
That my friends is good news for the country.
In other news —
The Wall Street Journal brings us up to date on the cost, accuracy, and turnaround times for popular (?) COVID-19 testing methods.
The Department of Human Services released an action plan for improving rural healthcare in the United States.
Beckers Hospital Review reports that Walmart will be bringing Oak Health primary care centers into their super centers located in Arlington, Benbrook and Carrollton, Texas, later this year.
HR Dive discusses recent back to school guidance from the Labor Department regard the federal relief acts COVID-19 paid leave program. It’s complicated just like COVID-19.
Section 1557 is the individual non-discrimination provision of the Affordable Care Act. In June 2020, the Department of Health and Human Services issued a final rule making numerous changes to the Obama Administration’s rule. Both rule makings sparked lawsuits challenging their legality.
Last time around, the lead case, Franciscan Alliance v. HHS, was filed in the Northern District of Texas. That case is still pending on appeal before the U.S. Court of Appeals for the Fifth Circuit.
This time around, the lead case, Whitman-Walker Clinic v. HHS, was filed in Washington, D.C. Roughly one month following oral argument in the case, U.S. District Judge James Boasberg this afternoon denied the plaintiffs’ motion for a preliminary injunction against enforcement of HHS’s revised Section 1557 rule with two exceptions:
The Court preliminarily enjoined the revised rule’s repeal of the sex discrimination definition found in the replaced Obama Administration rule. That definition afforded express protection to transgendered people.
The Court also preliminarily enjoined the revised rule’s religious organization exception to the law’s sex discrimination restrictions.
Here is a link to the lengthy yet illuminating opinion and the implementing order. The decision called to the FEHBlog’s attention another interesting civil rights provision of the ACA — Section 1554. This provision places limits on the HHS Secretary’s broad reaching regulatory powers under the ACA.
Judge Boasberg’s decision expands on the Brooklyn federal court decision issued August 17, 2020, that stayed enforcement of the sex discrimination definition repeal. While the federal government has not appealed the Brooklyn decision, the plaintiffs in the FEHBlog’s opinion are likely to appeal the denial of their preliminary injunction motion in the Whitman-Walker Clinic case. And so it goes.
The Centers for Medicare and Medicaid today released its final Medicare Part A inpatient prospective payment system rule for the government fiscal year beginning October 1, 2020.
The increase in operating payment rates for general acute care hospitals paid under the IPPS that successfully participate in the Hospital Inpatient Quality Reporting (IQR) Program and are meaningful electronic health record (EHR) users is approximately 2.9 percent. This reflects the projected hospital market basket update of 2.4 percent and a 0.0 percentage point productivity adjustment. This also reflects a +0.5 percentage point adjustment required by legislation.
Hospitals may be subject to other payment adjustments under the IPPS, including:
— Penalties for excess readmissions, which reflect an adjustment to a hospital’s performance relative to other hospitals with a similar proportion of patients who are dually eligible for Medicare and full-benefit Medicaid — Penalty (1 percent) for worst-performing quartile under the Hospital-Acquired Condition Reduction Program — Upward and downward adjustments under the Hospital Value-Based Purchasing Program
Medicare is one complicated program. Medicare is relevant to the FEHBP because the program impact the prices that FEHB plans pay for patient care and there is a large cadre of annuitant enrollees with Medicare Part A coverage.
In other healthcare related news —
Reuters reports that “President Donald Trump said on Tuesday he planned to meet with pharmaceutical companies this week regarding his so-called most- favored-nation executive order aimed at lowering drug prices paid by the U.S. federal government.”
A new analysis of several studies in which [inexpensive] steroid drugs were used to treat severely ill Covid-19 patients found the drugs significantly helped reduce patient deaths, bolstering earlier, preliminary evidence for the benefit of these medications. In multiple studies involving a total of 1,700 patients, a number of corticosteroids—anti-inflammatory drugs that can damp the effects of an overactive immune system—helped reduce deaths from Covid-19 by about a third, compared with patients who didn’t receive steroids, according to the analysis published Wednesday in the Journal of the American Medical Association.
HHS’s Office for Civil Rights, which enforces the HIPAA Privacy and Security Rules, has created a consolidate website regarding HIPAA and Health Apps. The site includes links to generally helpful technical information on cloud computing and HIPAA and HIPAA and health IT. Check it out.
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