Tuesday Tidbits

COVID-19

Tuesday Tidbits

David Ermer–CDC, Congress, COVID-19 testing, HIPAA Privacy and Security Rules, OPM–

The Senate Health Education Labor and Pensions Committee held a hearing this morning on progress made in reopening schools and businesses from the great hunkering down. Fierce Healthcare reports on the hearing here.

The Department of Health and Human Services announced today the extension of “its partnership with national pharmacy and grocery retail chains CVS, Rite-Aid, Walgreens, Quest (through services at Walmart) and eTrueNorth (through services at Kroger, Health Mart, and Walmart) so they may continue to seamlessly provide Americans convenient access to COVID-19 testing. The partnership, which is part of the Community-Based Testing Program, has scaled up to more than 600 COVID-19 testing sites in 48 states and the District of Columbia. Approximately 70% of these testing sites are located in communities with moderate-to-high social vulnerability, as evidenced by their racial, and ethnic composition, and their housing, economic, language barrier, and similar considerations.” “The [partnership] contract utilizes a federal bundled payment program paid directly to retailers that receive a flat fee for each test administered, with participating retailers responsible for coordinating the full end-to-end testing.” So far the collaborative program has tested 750,000 Americans. That makes sense.

The Office of Management and Budget’s Office of Information and Regulatory Affairs issued its anxiously awaited Spring 2020 regulatory agenda. The regulatory agenda tells you what’s baking in each agency’s regulatory oven but you can rely on the oven timers’ shown in the reports. Here’s a link to OPM’s “rule list.” Nothing earth shaking to report.

The FEHBlog’s favorite healthcare quality consulting firm, Discern Health, notes the release of the National Health Quality Roadmap by the Department of Health and Human Services. “The National Health Quality Roadmap highlights not only many of the challenges that have been faced by health care stakeholders across the quality environment, but also a plan for addressing them,” Discern Health Vice President Donna Dugan said. “It will be important for stakeholders across the continuum to participate where possible in order to facilitate this transformation and aid in the realization of quality goals.”

Becker’s Hospital Review reports on a class action settlement of a phishing attack related lawsuit against UnityPoint Health which is based in Iowa. ‘The class action lawsuit alleges the health system didn’t notify [over 16,000] patients of the breach in a timely manner and told patients Social Security numbers weren’t compromised, but they were.’ The settlement is valued at $2.8 million.

For what it’s worth, Forbes reports an IRS announcement that that “the 2019 tax filing deadline remains July 15, 2020.” Forbes considers and the FEHBlog agrees that this will be the IRS’s final work on the topic. Also the Labor Department yesterday added q&a 93 to its list of frequently asked questions on the Families First Coronavirus Response Act’s paid leave program

Monday Roundup

David Ermer–CDC, COVID-19, Rx coverage, U.S. Healthcare–

Modern Healthcare reports tonight that

HHS spokesperson Michael Caputo on Monday tweeted that HHS intends to extend the COVID-19 public health emergency that is set to expire on July 25. The extension would prolong the emergency designation by 90 days. Several payment policies and regulatory adjustments are attached to the public health emergency, so the extension is welcome news for healthcare providers.

The Centers for Disease Control released updated guidance on the use of cloth face coverings during the COVID-19 emergency.

Cloth face coverings are recommended as a simple barrier to help prevent respiratory droplets from traveling into the air and onto other people when the person wearing the cloth face covering coughs, sneezes, talks, or raises their voice. This is called source control. This recommendation is based on what we know about the role respiratory droplets play in the spread of the virus that causes COVID-19, paired with emerging evidence from clinical and laboratory studies that shows cloth face coverings reduce the spray of droplets when worn over the nose and mouth. COVID-19 spreads mainly among people who are in close contact with one another (within about 6 feet), so the use of cloth face coverings is particularly important in settings where people are close to each other or where social distancing is difficult to maintain.

Healthcare Dive alerts us that

Gilead will charge between $2,340 and $3,120 for a typical course of treatment with its COVID-19 drug remdesivir, which has been shown to speed the recovery of patients hospitalized with the infectious disease.

The drug’s price will depend on whether patients are covered by government insurance or commercial health plans. Gilead will offer remdesivir to governments in developed countries at a price of $390 per vial. In the U.S., private insurers will pay $520 per vial. 

Most patients will be treated for five days, using six vials, Gilead said in announcing its much anticipated pricing decision Monday. If treatment stretches to 10 days — initially the standard treatment course — remdesivir’s cost would rise to $5,720 for patients who are commercially insured. 

The announced prices are in line with expert predictions.

MedCity News discusses Walmart’s new health clinics.

The company rolled out two Walmart Health clinics this month, in Loganville, Georgia and Springdale, Arkansas.

These aren’t your usual walk-in clinics that might serve as a quick place to get vaccinated or get a cold checked out. Rather, they’re more like a one-stop shop for healthcare, with primary care, urgent care, diagnostics, x-rays, behavioral health and dental care.

Walmart Health’s other big differentiator: A primary care appointment costs just $40. For children? $20.

Weekend Update

David Ermer–Congress, COVID-19, Rx coverage, SCOTUS, U.S. Healthcare–

The House and Senate will be conducting legislative and committee business this week preceding the Fourth of July holiday. Of note, on Tuesday at 10 am the Senate Health Education Labor and Pensions Committee will hold a hearing on ways to return to work and school safely following the great hunkering down.

The Supreme Court has thirteen more opinions to release before its summer break. The Court is expected to release opinions on Monday, Tuesday, and Wednesday this week, all at 10 am.

On the COVID-19 front —

  • Fierce Healthcare discusses how the Walgreen’s Pharmacy chain has leveraged its partnership with Microsoft and other technology companies to better respond to the COVID-19 emergency.
  • A few weeks ago, the Journal podcast offered a fascinating show on the Hertz bankruptcy. It’s worth a 17 minute long listen. The story highlights how a strong balance sheet helps companies weather storms like the COVID-19 emergency. Becker’s Hospital Review identifies 14 well known health systems in this favorable situation, including Kaiser Permanente. It’s not an exclusive list.
  • Healthcare Dive reports on the significant adverse financial impact that the COVID-19 emergency has had on primary care practices in the U.S. Surprisingly that article does not note that these practices have been eligible for Payroll Protection loans and federal grants. The government deserves credit for trying to soften the blow to this critical sector of our health care system. Tuesday June 30 is the deadline for applying for a PPP loan.

On the human nature front, the Wall Street Journal reports that COVID-19 first responders have been relaxing by playing a boardgame called Pandemic.

Friday Stats and More

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

According to the CDC’s COVID-19 cases in the U.S. website, which the FEHBlog tracks, over the past seven weeks the numbers of new COVID-19 cases had taken a downward path for the first four weeks and then has turned up for the past three weeks. New deaths saw steady weekly reductions over the same time span until this week when there was a slight upturn. The COVID-19 hospitalization rates continue to trend down.

Week endingNew CasesNew Deaths
May 15297,5818,856
May 22159,4968,160
May 29142,2107,561
June 5142,2896,353
June 12153,3715,850
June 19161,2894,865
June 26199,2525,270

In other healthcare news —

  • Health Payer Intelligence reports that the CDC “estimates that 90 percent of national healthcare spending goes toward chronic disease management and mental healthcare, which means that strong mental health and chronic disease prevention strategies can help reduce payer spending. The CDC has named the eight most expensive chronic diseases in the US. The good news for payers is that most of these can be prevented to some degree. By being aware of preventive care strategies for these eight chronic conditions, payers can actively reduce their healthcare spending and support positive patient outcomes.”
  • The Commonwealth Fund and the Healthcare Transformation Task Force have created a Maternal Health Hub.

In federal agency news

  • Govexec.com informs us about the President’s executive order, issued today, requiring federal “agencies to increase the use of skill assessments and interviews with subject matter experts to determine an applicant’s qualifications, rather than simply looking at educational achievements. Degree requirements will not go away entirely, and certain positions—such as those in medical, legal and certain technical fields—will still require advanced degrees. The goal of the order, Trump administration officials said on Friday, is to create a broader pool of potential federal employees and a more equitable hiring process.”
  • Federal News Network reports that “The Postal Service expects to withstand the financial impact of the coronavirus impact better than it anticipated a few months ago, but warns that it could still run out of cash before the end of 2021 without long-term reform from Congress.”

Thursday Miscellany

David Ermer–CDC, COVID-19, U.S. Healthcare–

Robert Redfield, MD, the Director of the Centers for Disease Control gave a press conference on the COVID-19 emergency today as discussed in this STAT News article.

“I’m asking people to recognize that we’re in a different situation today than we were in March, in April, where the virus was being disproportionately recognized in older individuals with significant comorbidities and was causing significant hospitalizations and deaths,” he said.

“Today we’re seeing more virus. It’s in younger individuals. Fewer of those individuals are requiring the hospitalizations and having a fatal outcome. But that is not to minimize it.”

But Redfield went on to note that descriptions of the state of the pandemic in the country can be misleading, with maps that show where transmission is high suggesting much of the nation is experiencing high levels of spread. In reality, he said, about 110 or 120 counties in the country currently have significant transmission. There are more than 3,100 counties in the United States.

The CDC also released updated guidance identifying categories of people who are most at risk for severe illness by contracting COVID-19.

The Washington Post reports that drug manufacturers are increasing production of the flu vaccine for the next flu season. “Getting a flu shot does not protect against the coronavirus, but disease experts said reducing episodes of flu could prove pivotal in freeing up space in hospitals and medical offices to deal with covid-19, the disease caused by the coronavirus.”

Healthcare Dive informs us that pediatric visits are lagging in the recent doctors office visit rebound following the great hunkering down. “[O]ver the past week, visits to some specialists have returned to normal, including dermatology and rheumatology. However, pediatric practices are among the hardest hit and have seen the greatest decline in visits when comparing specialties . . .”

Health Payer Intelligence discusses CVS Health’s new service called “Return Ready.” It’s “a COVID-19 testing strategy for employers whose workforces are returning to the workplace and academic populations returning to campus.” Timely. Here’s a link to current Equal Employment Opportunity Commission guidance on employer compliance with the Americans with Disabilities Act and the Rehabilitation Act in COVID-19 related matters. .

The Society for Human Resource Management provides observations about how the the Supreme Court’s recent ruling holding that Title VII’s sex discrimination protections extend to sexual orientation and gender identity situations affects employer sponsored health coverage.

Midweek update

David Ermer–COVID-19, Rx coverage, U.S. Healthcare–

Fierce Healthcare reports on PriceWaterhouseCooper’s three tier approach to estimating 2021 health care costs. Of course, the variable is impact of the COVID-19 emergency. The Goldilocks increase is estimated at 6%.

Fierce Pharma informs us that Gilead’s as yet unpriced remdesivir treatment for severe COVID-19 has gained stiff competition for a “low-cost [drug called] dexamethasone.”

According to results just published on preprint site medRxiv, dexamethasone treatment led to a 35% reduction in death rate among patients on invasive mechanical ventilation and 20% for those receiving oxygen without invasive ventilation.

Because of that showing, clinical experts told ICER that dexamethasone could soon become the new standard of care throughout the U.S., “and that the relative benefits of remdesivir will now be judged to be most pertinent as an adjunct to dexamethasone treatment,” the organization noted in its new analysis. In the ACTT-1 trial, the death rate for remdesivir among severe patients were reduced to 7.7% from 13% for placebo, a difference that was not statistically significant.

Both drugs remain under study.

Smartbrief offers four innovative approaches for payers in the post hunkering down world. The FEHBlog’s favorites approach is as follows:

Humana Vice President Caraline Coats defined whole person care through the lens her company’s Bold Goal initiative uses: Primary care, social determinants of health, pharmacy, home health and behavioral health. Their work strives to help members in targeted communities enjoy more Healthy Days per month – when they feel physically and mentally well. A lot of their progress comes down to taking the time to ask members the right questions, and then having the ability to act on what is learned.

In an industry built around episodic care, “whole-person care is really different,” Coats said, and it is still being defined. So, her team’s work looks a lot like vetting of clinical interventions: rigorous testing, followed by publication of results so others may learn, too. Among their recent promising experiments is a partnership with Mom’s Meals to meet the needs of certain members with diabetes and a program with Papa (which provides companionship and help with everyday tasks) that measurably brought down loneliness scores among participants.

Meanwhile Blue Cross and Blue Shield of North Carolina is offering monetary support to primary care practices in that State. That’s quite a helping hand. Bravo.

On the technology front —

  • Anthem, the large Blue Cross licensee, is now an Alexa skill. Currently

Using the Anthem Skill, you can:

Order your digital member ID card.
Access your health savings account (HSA) or health reimbursement account (HRA) balance.
Check your progress toward meeting your medical plan’s deductible and out-of-pocket maximum.
Schedule a call with someone from our Member Services team.
Refill, renew and check the order status of any home delivery prescription medicines.
Find out how close you are to reaching your dental plan’s deductible and annual maximum.
Use the glossary to learn what a health care term means.

  • STAT News has an interesting article about about how North Dakota is testing a contacts app with COVID-19 patients. The app was developed by a Microsoft engineer for use with North Dakota football games. Unfortunately, however, according to the article:

While apps can’t replace health care workers, they may be used to bolster their efforts — so long as enough people use them. So far, though, that hasn’t gone as planned: Early excitement over cutting-edge technology has given way to a largely lackluster role for contact tracing apps. Many states have opted against adopting the tools as part of their arsenal. And the handful of states that are launching such apps — including North Dakota — haven’t seen them gain much traction.

Tuesday Tidbits

David Ermer–ACA, CDC, Congress, COVID-19, Medicare, Rx coverage, Uncategorized–

At today’s House Energy and Commerce Committee hearing on the COVID-19 emergency, Dr. Fauci, according to the Wall Street Journal, remarked that “he is ‘cautiously optimistic’ that a successful vaccine could be produced around the end of 2020. ‘I believe it will be when and not if,’ he said.” Amen to that. Here’s a link to today’s Senate Health Education Labor and Pension Committee’s hearing on the same topic.

The Labor Department’s Employee Benefit Security Administration issued a wide-ranging set of frequently asked questions on the health plan related provisions of the Families First Coronavirus Response Act and the CARES Act. Check it out.

Reuters reports on a sobering CMS study of the COVID-19 emergency on Medicare beneficiaries. ““The disparities in the data reflect longstanding challenges facing minority communities and low income older adults,” said Seema Verma, administrator of the Centers for Medicare & Medicaid Services (CMS).”

MedCity News informs us that “Clinical development will soon begin for an inhaled version of a [Gilead] antiviral drug {remdesivir} used to treat Covid-19 that is currently available only to hospitalized patients in intravenous form.” That’s a pro move.

Drug Channels offers its annual study of 2019 PBM drug spending reports.

The PBMs’ data highlight key trends about drug spending:
— For 2019, CVS and Express Scripts reported overall changes in drug spending that were in the low single digits. Prime reported mid-single-digit growth in overall drug spending.
— Spending growth on traditional drugs declined by mid-single digits for the third consecutive year. This decline came from deeper commercial rebates on brand-name drugs, ongoing deflation in generic drugs, and a small increase in the generic dispensing rates.
— The results for CVS and Express Scripts were comparable. For CVS Caremark’s commercial clients, net drug prices for traditional drugs declined by -6.3%, while utilization grew by 1.5%. For Express Scripts’ commercial clients, net drug prices for traditional drugs declined by -6.4%, while utilization grew by 1.4%.

In legal news

  • It was no surprise to learn from Politico that LGBTQ advocates already have brought a lawsuit against the Department of Health and Human Services (“HHS”) “over its rollback of LGBTQ patient protections, arguing that last week’s Supreme Court decision extending workplace legal protections to gay and transgender employees invalidates the new rules.” That should be a rollover win for the plaintiffs.
  • It was a pleasant surprise to learn that the U.S. District Court for the District of Columbia today ruled in favor of an HHS rule requiring hospital to disclose real prices, e.g, negotiated prices with health plans, for their services just like retail stores. The FEHBlog expects that this rule will lead to more and better (e.g., quality based) competition among hospitals. But first the decision will need to be affirmed by the Court of Appeals.

Monday Roundup

David Ermer–COVID-19, HIPAA Privacy and Security Rules–

On the COVID-19 front

  • Researchers continue to make progress in developing a convalescent plasma treatment for COVID-19. Specifically, “Mayo Clinic researchers and collaborators have found investigational convalescent plasma to be safe following transfusion in a diverse group of 20,000 hospitalized patients transfused with investigational convalescent plasma as part of the U.S. Food and Drug Administration’s national Expanded Access Program (EAP) for COVID-19.” Testing continues on the efficacy of the treatment.
  • In view of the FEHBlog’s concern about super spreader events, he also calls attention to this Society for Human Resource Management article on thermal scanners. The scanners are an early warning device for use at “airports, sporting events, concerts or food-processing plants.” The particular article discusses the use of these devices by large and medium sized business.

For a change of pace, the FEHBlog takes note of these Wall Street Journal reports from the cybersecurity front

The health-care sector reported far less [cybersecurity] vulnerability than other areas. Health care is sometimes seen as one of the most targeted sectors. Yet, while 63% of construction and infrastructure companies admitted cybersecurity breaches on one or more occasions in the past 12 months, only 17% of health-care organizations said they had been compromised.

“We think the reduction is due to a combination of factors, including improvements in the cybersecurity posture of health-care organizations,” says Dave Wong, vice president with cyber-incident response provider Mandiant, a division of FireEye Inc., “but the behavior of attackers had also changed.”

In 2017, health care was the third-most-targeted sector, according to Mandiant’s annual threat report. By 2019, security improvements and evolution of the attackers’ tactics led to the sector dropping to eighth place. Cybercriminals follow the money, Mr. Wong says, and when fewer ransoms were being paid, they shifted their focus elsewhere. “Ransomware operators previously targeted hospitals knowing that the operational disruption could potentially cost patients’ lives,” he says. “Now, the same ransomware operators target larger companies with deeper pockets.”

  • and a list of five books “recommended by cybersecurity experts” that are accessible to all readers, just in time for the summer reading season. The FEHBlog plans to put at least one on his Kindle.

Weekend Update

David Ermer–CDC, Congress, COVID-19, Employee Wellness Programs, OPM, SCOTUS–

Happy Fathers’ Day.

The House and Senate are holding committee hearings and floor votes this week. On Tuesday the Senate Health Education Labor and Pensions Committee will hold a hearing on applying lessons learned from the current COVID-19 emergency to prepare for the next pandemic emergency.

Speaking of the current pandemic:

  • The FEHBlog was wondering about whether there has been an uptick in COVID-19 related hospitalizations to accompany the uptick in COVID-19 cases over this month. The FEHBlog was delighted to find this handy CDC website on COVID-19 related hospitalizations which shows that new hospitalizations have continued to trend down this month.
  • On Friday, OPM released guidance on the relationship paid leave / other time off and COVID-19 work by Federal employees. According to the guidance, OPM plans to issue “regulations [that ] will deem the COVID-19 national emergency to be an exigency of the public business for the purpose of restoring forfeited annual leave. The regulations [among other things] will provide that employees who would forfeit annual leave in excess of the maximum annual leave allowable carryover because of their essential work during the national emergency will have their excess annual leave deemed to have been scheduled in advance and subject to leave restoration.”

The U.S. Supreme Court has 15 decisions left to issue before its summer break. The Court is expected to issue some of those decisions tomorrow at 10 am. The Court is continuing to hold its Thursday conferences so all of 15 of the decisions may not be ready for issuance.

Georgetown Law Professor Katie Keith provided a welcome Health Affairs blog analysis of a complicated topic — federal regulation of employee wellness programs. The key complicating factor is that there are so many different applicable federal laws in play.

Friday Stats and More

David Ermer–COVID-19, Mental health care–

Happy Juneteenth!

According to the CDC’s COVID-19 cases in the U.S. website, which the FEHBlog tracks, over the past five weeks the numbers of new cases had taken a downward path for the first three weeks and then turned up for the past two weeks. New deaths have seen consistent weekly reductions over the same time span.

Week endingNew CasesNew Deaths
May 22159,4968,160
May 29148,2107,561
June 5142,8296,553
June 12155,3715,850
June 19161,2894,865

The FEHBlog had been wondering when the current COVID-19 emergency period expires. The American Hospital Association informs us that the expiration date is July 25. The AHA is seeking an extension.

In other news —

  • The Labor Department’s Employee Benefits Security Administration released “a proposed Self-Compliance Tool intended to help improve compliance with the Mental Health Parity and Addiction Equity Act (MHPAEA) and additional related requirements under the Employee Retirement Income Security Act of 1974 (ERISA). The tool [which was last updated in 2018[ will enable group health plans, plan sponsors, plan administrators, health insurance issuers and other parties determine whether a group health plan or a health insurance issuer complies with the provisions in both laws. EBSA is requesting public comments on the MHPAEA’s Self-Compliance Tool proposed revisions by July 24, 2020
  • The Labor Department’s Occupational Safety and Health Administration released non-essential business re-opening guidance.