Monday Roundup

Monday Roundup

Let’s begin with a story that surprised as well as interested the FEHBlog. The Society for Human Resource Management reports that the U.S. Occupational Health and Safety Administration is requiring health plans, insurers, and other low hazard employers to report to OSHA “work-related coronavirus illnesses that result in a fatality or an employee’s in-patient hospitalization, an amputation or the loss of an eye.” Other employers have broader recording and reporting obligations.

A friend of the FEHBlog called to his attention this Newsweek interview with Dr. Anthony Fauci about whether we may encounter a second wave of COVID-19. While Dr. Fauci expects COVID-19 infections to continue at least through 2020, Dr. “Fauci says whether or not these ongoing new cases will become a wave will depend on whether ‘we prepare ourselves from now through June, July, August and September. We have four months to make sure we have in place the system, the test, the capability, the manpower to do the kind of identification, isolation and contact tracing as cases begin to reappear in the fall, because they will reappear.'”

STATNews also also features an interview with Dr. Fauci which focuses on vaccine development.

Today, prescription drug manufacturer Eli Lilly announced

[hospital] patients have been dosed in the world’s first study of a potential antibody treatment designed to fight COVID-19.

This investigational medicine, referred to as LY-CoV555, is the first to emerge from the collaboration between Lilly and AbCellera to create antibody therapies for the prevention and treatment of COVID-19. Lilly scientists rapidly developed the antibody in just three months after AbCellera and the Vaccine Research Center at the National Institute of Allergy and Infectious Diseases (NIAID) identified it from a blood sample taken from one of the first U.S. patients who recovered from COVID-19. LY-CoV555 is the first potential new medicine specifically designed to attack SARS-CoV-2, the virus that causes COVID-19.

The FEHBlog heard a discussion of the investigational new drug on television this morning. The Eli Lilly representative explained that this drug focuses on one antibody while convalescent plasma relies on an array of antibodies. The investigation. The Wall Street Journal explains that

Researchers at AbCellera Biologics Inc., a Canadian company that partnered with Lilly in March, and the U.S. National Institute of Allergy and Infectious Diseases identified an antibody with virus-fighting potential in a blood sample taken from one of the first U.S. patients who recovered from Covid-19.

Lilly’s scientists then essentially cloned the antibody to make the new therapy [which is administered intravenously]. Its goal is to block the virus from attaching to and entering human cells, thus neutralizing it.

This first random study uses hospitalized patients and if successful the next random study will use non-hospitalized patients. “Lilly said it is starting large-scale manufacturing of the therapy, so that if studies prove successful, it will have several hundred thousand doses available by the end of the year.” Let’s go.

Weekend update

The House of Representatives and the Senate both will be in session on Capitol Hill this coming week, Of note from an FEHBP perspective is that Senate Homeland Security and Governmental Affairs Committee has scheduled a confirmation hearing for the President’s nominee for OPM Inspection General, Craig E. Leen, for Tuesday June 2 at 2:30 pm. Mr. Leen currently is Director of the Office of Federal Contract Compliance Programs (OFCCP) at the U.S. Department of Labor. The FEHBlog plans to tune in.

The Supreme Court heads into the home stretch of its October 2019 term tomorrow. The Court has 25 decisions left to issue before adjourning for the summer according to the Scotusblog.

OPM released more COVID-19 guidance last Friday. This guidance concerns preparedness for returning to OPM facilities.

Fierce Healthcare brings us up to date on COVID-19 testing at home options. The latest product receiving FDA approval is offered by Quest Diagnostics a/k/a Quest Labs.

The FEHBlog ran across on Twitter today this May 24 column from Reason senior editor Jacob Sillum.

According to the Centers for Disease Control and Prevention (CDC), the current “best estimate” for the fatality rate among Americans with COVID-19 symptoms is 0.4 percent. The CDC also estimates that 35 percent of people infected by the COVID-19 virus never develop symptoms. Those numbers imply that the virus kills less than 0.3 percent of people infected by it.

The FEHBlog also found this reassuring (at least to the FEHBlog) Science News article on COVID-19 mutations.

[C]oronavirus mutations are guaranteed to pop up over the coming months — and experts will continue to track them. “The data will tell us whether we need to worry, and in what way we need to worry,” [Louise] Moncla[, an evolutionary epidemiologist at the Fred Hutchinson Cancer Research Center in Seattle] says. “Everyone should take a deep breath and realize that this is exactly what we’ve always expected to happen, and we don’t necessarily need to be concerned.”

Thursday Miscellany

Earlier this month, the National Center for Health Statistics released a report on 2019 births in our country. Here are some notable snippets from that report:

  • The provisional number of births for the United States in 2019 was 3,745,540, down 1% from the number in 2018 (3,791,712). This is the fifth year that the number of births has declined after the increase in 2014, down an average of 1% per year, and the lowest number of births since 1985.
  • The birth rate for teenagers in 2019 was 16.6 births per 1,000 females aged 15–19, down 5% from 2018 (17.4), reaching another record low for this age group. The rate has declined by 60% since 2007 (41.5), the most recent period of continued decline, and 73% since 1991, the most recent peak.
  • The low-risk cesarean delivery rate, or cesarean delivery among nulliparous (first birth), term (37 or more completed weeks based on the obstetric estimate), singleton (one fetus), vertex (head-first) births, also decreased to 25.6% of births in 2019 from 25.9% in 2018.
  • The percentage of infants born preterm (births at less than 37 completed weeks of gestation) fell 8% from 2007 (the most recent year for which national data are available based on the obstetric estimate of gestation) to 2014, but has risen 7% from 2014 (9.57%) to 2019.

Healthcare Dive reports that

The number of Medicare beneficiaries using telehealth skyrocketed in the early weeks of the pandemic as the Trump administration relaxed regulations to virtual care.

The looser regulations are only in place for the extent of the national public health emergency, but myriad groups have called on HHS to permanently relax the barriers. Top administration health officials have said they’re exploring the possibility.

Here’s hoping.

Health IT Security informs us about Verizon’s latest data breach investigations report.

For healthcare, there were 798 security incidents and 521 confirmed data breaches in 2019, compared to 304 incidents in the previous year. While miscellaneous insider errors, privilege misuse, and web applications were the leading causes 2018 healthcare data breaches, external threats outpaced insiders in this year’s report.

In fact, 51 percent of healthcare data breaches were caused by external actors, and insider-related breaches fell to 48 percent. Despite the slight increase in external-related breaches, healthcare does remain the leading industry for internal bad actors.

It’s not always a good thing to be in first place.

Let’s wrap it up with a story about responsible corporate citizenship. Becker’s Hospital CFO Report informs us that

CMS automatically sent out the first slice of federal funding under the Coronavirus Aid, Relief and Economic Security Act based on historical Medicare fee-for-service reimbursement. Now, several companies are returning the relief aid.

[Healthcare companies] Cigna, CVS Health, DaVita, Encompass and Walmart are among the companies sending back federal grants they received under the CARES Act, which are meant to reimburse healthcare providers for expenses or lost revenues tied to the COVID-19 pandemic, according to Business Insider. The companies are returning a total of nearly $574 million.

The common reason for returning these large amounts of money was aptly stated by CVS Health:

“We have made the decision to return the funds and forgo participation in subsequent disbursements,” CVS Health President and CEO Larry Merlo wrote in a May 19 letter to HHS Secretary Alex Azar. “In doing so, we hope to help HHS provide additional support to other providers who are facing significant financial challenges as a result of the pandemic.”

Bravo.

Tuesday Tidbits

The Senate Health Education Labor and Pensions Committee held a COVID-19 hearing today featuring a number of federal government healthcare luminaries including Dr. Fauci. Here is a link to the hearing and the submitted testimony. The Wall Street Journal reports

Dr. Fauci said that with some states reopening before seeing a steady decline in cases and deaths, “there is a real risk you could trigger an outbreak…that could set you back rather than going forward.”

Adm. Brett Giroir, who is heading up the administration’s testing efforts, said an increased focus on testing in schools could be used as a means of surveillance to help ensuree students stay healthy.

Other health officials also emphasized the need for widespread testing to get a more accurate picture of how many people have fallen sick and to spot potentially undetected clusters of cases.

Here’s a link to the COVID Tracking Project site which provides a ton of state by state COVID-19 data, including testing data. As previously noted, GoodRx offers a complete, growing list of drive up COVID-19 test sites. Last week, one of the big U.S. lab test companies, LabCorp, began to offer “expanded access to COVID-19 antibody test through LabCorp’s wide network of doctors, healthcare providers, and online. Individuals have the ability to receive the COVID-19 IgG antibody test from their doctor, in person or through a telemedicine program, and now directly using www.LabCorp.com/antibody-testing.

A friend of the FEHBlog pointed out this National Institutes of Health website which is chock-a-block full of COVID-19 research tidbits. For example, the FEHBlog noticed a NIH study finding “nearly everyone who recovers from COVID-19 makes coronavirus antibodies.” Check it out.

The Hill brings us to date on the four leading U.S. and European COVID-19 vaccine development efforts. “There are more than 100 potential vaccine candidates, according to the World Health Organization, but only eight have entered the crucial clinical trials stage. Four are in the United States and Europe, with the rest in China.”

Healthcare Dive reports that the American Hospital Association flipped out over new price transparency rules in the fiscal year 2021 Medicare Part A hospital PPS changes proposed rule released yesterday.

Friday Stats and More

Per the CDC’s COVID-19 Cases in the U.S. that the FEHBlog tracks, the number of COVID-19 cases crossed the 1.2 million mark and the number of COVID-19 deaths exceeded 70,000 this week. The case mortality rate hit 6% on Thursday after being in the 5 to 6% range for 2 1/2 weeks. Before then the case mortality rate was increasing much faster. So we evidently are plateauing. The Wall Street Journal reports that the leading cause of death in our country remains heart disease. For an even better perspective, check out the CDC’s COVIDView which is released on Fridays.

The Wall Street Journal offers a perspective on State reopening here. The FEHBlog got a kick out of listening too this 20 minute long WSJ podcast on office reopenings titled “Welcome Back to the Office. Your Every Move Will Be Watched.”

The Wall Street Journal also has a regularly updated site on COVID-19 testing and treatments.

Health Payer Intelligence brings us up to date on the Texas v. U.S. case over the Affordable Care Act’s constitutionality. The Supreme Court will hear the case next fall.

Friday Stats and More

At this point, according to the Centers for Disease Control’s COVID-19 cases in the United State website, which the FEHBlog tracks, the number of confirmed cases topped one million on Wednesday and the number of confirmed deaths topped 60,000 on Thursday. Interestingly, the case fatality rate (deaths over cases) has remained between 5 and 6% for the last fourteen days after jumping from 2% on April 1 to 5% on April 17. The case fatality rate (“CFR”) should drop as the number of confirmed cases increases due to antibiotic testing. The American Spectator observes

To put this in perspective: Last winter 250,000 people tested positive for the flu. 25,000 died. If these numbers are right, the CFR for the flu is 10 percent … but that can’t be right.

And, in fact, it isn’t. The Centers for Disease Control and Prevention (CDC) estimates that, although only 250,000 people tested positive for the flu last year, 39 million people actually got it. Generally only those who are older or otherwise unhealthy, or those who have a severe case, go to the doctor and get tested for the flu; everyone else just takes Motrin and Tylenol and stays home. This drives up the CFR dramatically.

Also check out the CDC’s weekly COVIDView.

The Boston Globe’s STAT offers a pessimistic view of the COVID-19 emergency over time. If the STAT’s view is correct, then we have experienced no progress in medical care since 1918-1919 when the flu decimated the world. The FEHBlog has confidence in our healthcare system to pull us through this crisis.

America’s Health Insurance Plans discusses the steps that health insurers take to expand coverage in the face of the COVID-19 emergency. Health benefits did not exist in 1918-19.

For those interested, the American Medical Association reviews advocacy efforts for its membership during the crisis.

The Harvard Business Review called the FEHBlog’s attention to

Kanter’s Law: that everything can look like a failure in the middle. Unexpected obstacles and difficult predicaments can arise in the middle of any human and organizational endeavor. Give up, and by definition it’s a failure. Persist, pivot, and persevere, and there’s hope for finding another successful path.

In closing Happy Law Day. ” Law Day is held on May 1st every year to celebrate the role of law in our society and to cultivate a deeper understanding of the legal profession.”

The Law Day 2020 theme is “Your Vote, Your Voice, Our Democracy: The 19th Amendment at 100.” In 2019-2020, the United States is commemorating the centennial of the transformative constitutional amendment that guaranteed the right of citizens to vote would not be denied or abridged by the United States or any state on account of sex. American women fought for, and won, the vote through their voice and action.

Friday Stats and More

Here are the Centers for Disease Control’s top line COVID-19 statistics for the past four weeks:

4/34/104/174/24
Confirmed Cases239,279459,165661,712862,648
Confirmed Deaths5,44216,57028,82343,451
Deaths over Cases2.27%3.61%4.36%5.04%

Don’t forget to check out the CDC’s weekly COVIDView which comes out on Fridays. The COVIDView is more encouraging reading than the bare statistics.

A new study in Health Affairs estimates “that a single symptomatic COVID-19 infection would cost a median of $3,045 in direct medical costs.”

Fierce Healthcare reports that CIGNA studied “care utilization among their commercial group and individual plan members between January and March across seven [serious] conditions and found decreases in hospitalizations across the board.”

[The lead researcher] said the team was surprised by the size of these decreases and that they were found across all seven conditions, because going without treatment for these conditions can have serious consequences.

[A research team physician] added that providers can help encourage patients to seek care in these situations by developing a care plan with those at high risk for certain conditions and having open conversations that affirm they should seek care in an emergency situation even if they should stay home otherwise.

It’s a crazy time.

Friday Stats and More

Here are the latest four weeks from the CDC’s COVID-19 Cases in the U.S. website:

Covid-193-274-34-104-17
Cases85,356239,279459,165661,712
Deaths12465,44216,57028,823
Cases / Deaths1.46%2.27%3.61%4.36%

This week the CDC began to include deaths probably caused by COVID-19 in its death count. The FEHBlog will stick with confirmed COVID-19 deaths. The probable COVID-19 death count today was 4,226. The CDC’s number close out at 4 pm on the day before the report.

Today the CDC added demographic data to its Cases in U.S. website. The FEHBlog was surprised to find that in almost 75% of the COVID-19 cases, race/ethnicity was not specified. The majority of cases are found in the 18 to 64 age range. The CDC’s statistics do not provide a gender breakdown.

The CDC also released its weekly COVIDView report. 680,000 COVID-19 lab tests were conducted in the week ended April 11. (The CDC’s weekly summaries customarily are a week behind the release date.)

Here’s a link to the President’s three phase guidelines on reopening our country that were issued yesterday. According to the Fierce Healthcare report, Dr. Deborah Birx from the CDC explains that before entering phase one, states and cities “must see data that shows a sustained decline in influenza-like illness, as well as positive COVID-19 cases with persistent testing, for a minimum of 14-days.”

Friday Stats and More

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

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

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

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

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

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

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

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

Person using a laptop

Thursday Miscellany

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

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

Healthleaders Media discusses a Guidehouse study finding

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

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

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

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

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

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

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

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

Our firm is closely monitoring the impacts of COVID-19. Effective 3/16/20, Ermer & Suter has implemented telework for all of our staff to encourage social distancing and help contain the virus. We remain fully operational and are readily available from our telework locations with no change in telephone numbers or email addresses.