May the Fourth be with you

COVID-19

Lincoln Memorial

May the Fourth be with you

David Ermer–Congress, COVID-19–

The FEHBlog saw that line several times today. It’s cute.

Healthcare Dive reports that the Department of Health and Human Services decided last Friday to divvy up $22 billion of CARES Act funding by send $12 billion to hospitals in COVID-19 hot spots and another $10 billion to rural hospitals. The American Hospital Association is happy.

RevCycle Intelligence informs us that “Outpatient visits for more than 50,000 providers declined by nearly 60 percent in mid-March when COVID-19 cases started to rise exponentially, researchers from Harvard University recently reported in a Commonwealth Fund study. The volumes have remained low through mid-April.” Here are a couple more tidbits from the study:

  • The decline in visits was generally larger among surgical and procedural specialties and smaller in other specialties such as adult primary care, obstetrics/gynecology, oncology, and behavioral health.
  • As the number of in-person visits dropped, telehealth visits increased. But the increase in telehealth visits only partially offset the drop in in-person visits.
  • Nearly 30 percent of all visits at these ambulatory practices are now provided via telemedicine.
  • The decline in visits was largest among school-age children and older adults.

Health Payer Intelligence informs us that America’s Health Insurance Plans and AHIP member medical directors have proposed a course for health plans to follow while we come out of the great hunkering down. That course includes continuing expansive coverage of COVID-19 testing and care, promoting telehealth, and engaging members, particularly those in need.

In that regard, Medical Economics provides physicians with advice on best practices for billing health plans for telemedicine services during the COVID-19 emergency. The advice strikes the FEHBlog as a bit complicated. It’s therefore not surprising to the FEHBlog that, according to an mHealth Intelligence report, members of Congress “Reps. Kim Schrier (D-WA) and Phil Rose (R-TN), say they want private payers to operate under the same rules as the Centers for Medicare & Medicaid Services, which last month established telehealth payment and coverage parity for the duration of the emergency.” The two representatives have introduced a bill for this purpose H.R. 6644).

Weekend Update

David Ermer–Congress, COVID-19, OPM, SCOTUS–

The Senate, but not the House of Representatives, returns to Capitol Hill tomorrow. On Wednesday, the Senate Homeland Security and Governmental Affairs Committee is holding a roundtable discussion about how new COVID-19 information should drive policy. On Thursday, the Senate Health Education Labor and Pensions Committee is holding a “Shark Tank” about new tests for COVID-19.

Federal News Network reports that George Nesterczuk who was President Trump’s first nominee to be OPM Director, has become a senior advisor to OPM’s current acting Director Michael Rigas. In 2017, Mr. Nesterczuk asked the President to withdraw the nomination in the face of criticism from federal employee unions.

The Wall Street Journal estimates the revenues that major health insurers will receive at some point due to the Supreme Court’s favorable decision in the Affordable Care Act risk corridor case last Monday. The Supreme Court begins its series of May telephonic oral arguments tomorrow.

The Journal further reports

The promise of new payments comes as the health-insurance industry has seen little financial pressure from the pandemic. In earnings calls over the past few weeks, insurers said they’d seen minimal impact on first-quarter results, and they were benefiting from reduced health-care costs due to the widespread cancellation of elective procedures and patients steering clear of routine care.

But the insurers said they could see costs ramp back up later in the year. Overall, several big companies including UnitedHealth Group Inc., Anthem Inc. and Humana left their financial guidance on earnings for 2020 in place despite the coronavirus impact.

A WSJ article posted today adds that

With fewer claims to pay out, some health insurers are using their improved balance sheets to help struggling providers secure loans, pay claims earlier and, in some cases, underwrite patients’ outstanding bills. And they have good reason to ensure providers survive the pandemic: “There is a risk that there is a smaller provider network after this,” said Brad Ellis, a senior director at Fitch Ratings. “So health insurers are trying to maintain the network.”

Well done.

Friday Stats and More

David Ermer–CDC, COVID-19–

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.

Person using a laptop

Thursday Miscellany

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

The Centers for Medicare and Medicaid Services today announced wide ranging Medicare changes to make healthcare more accessible during the COVID-19 emergency. For example,

For the duration of the COVID-19 emergency, CMS is waiving limitations on the types of clinical practitioners that can furnish Medicare telehealth services. Prior to this change, only doctors, nurse practitioners, physician assistants, and certain others could deliver telehealth services. Now, other practitioners are able to provide telehealth services, including physical therapists, occupational therapists, and speech language pathologists.

CMS previously announced that Medicare would pay for certain services conducted by audio-only telephone between beneficiaries and their doctors and other clinicians. Now, CMS is broadening that list to include many behavioral health and patient education services. CMS is also increasing payments for these telephone visits to match payments for similar office and outpatient visits. This would increase payments for these services from a range of about $14-$41 to about $46-$110. The payments are retroactive to March 1, 2020.

It will be interesting to see whether commercial plans adopt these changes (perhaps they already have). Check out the lengthy list. Hopefully many of these changes will be made permanent following the COVID-19 emergency.

As the FEHBlog has listed major COVID-19 testing locations. It occurred that he should also link to the COVID-19 sites for the major actuarial consulting firms, all of which provide useful information for health plans:

These sites are a valuable public service in the FEHBlog’s view.

HHS’s Office for Civil Rights today provided a helpful COVID-19 cyber threat resources. While the FEHBlog could not find a link to the list, he was able to upload the email to Dropbox.

Midweek update

David Ermer–COVID-19, HSA–

Healthcare Dive reports that health plans, health care providers, and the Chamber of Commerce have sent Congress a joint health care wish list for the fourth COVID-19 relief bill.

Becker’s Hospital Review provides an updated list of state by state peak dates for COVID-19 hospital resources from IMHE. According to the chart virtually all of the State have hit their peak by today.

Health Payer Intelligence discusses Oscar Health’s population health oriented approach to connecting with its plan members during the COVID-19 emergency. On a related note, Fierce Healthcare summarizes the steps that the country’s tech giants, Apple, Amazon, and Alphabet/Google, have taken in response to the COVID-19 emergency.

Employee Benefit News provides useful COVID-19 emergency tips for sponsors and holders of health savings accounts.

MedCity News reports good news on the cancer detection front:

A test designed for early detection of cancers from a blood sample was able to more than double the number of cancers picked up through screening, including seven cancers that currently do not have any standard-of-care screening methods, according to a new study.

The study, sponsored by Cambridge, Massachusetts-based Thrive Earlier Detection and carried out by Johns Hopkins University and Geisinger Health, was presented Tuesday at the American Association for Cancer Research’s [virtual] annual meeting.

Bravo.

Tuesday Tidbits

David Ermer–ACA, COVID-19, OPM, SCOTUS–

Following up on yesterday’s post on the Supreme Court’s decision in the Affordable Care Act risk corridor case, read Katie Keith’s article in Health Affairs on all of the decision’s reverberations. Fascinating.

The FEHBlog did virtually attend the NCQA Quality Talks 2020 conference today. Two speakers favorably caught the FEHBlog’s attention:

With regard to OPM’s concern about rooting out low value care in the healthcare system, Cardiologist Rita Redberg, MD, has been editing for years a series in the JAMA Internal Medicine Journal titled “Less is More.” Dr. Redberg blasted the medical device industry for promoting artery stents before first obtaining reliable evidence of the device’s safety and efficacy. As it turns out the device is no more effective than a placebo.

The good doctor explained that normally it’s difficult to perform a blinded research study with a new medical device because the research participant usually knows whether or not she received the device (as a opposed to a sugar pill.) In this recent Orbita study, the researchers convinced all of the study participants that they had received a stent. The good doctor also spoke about a friend who unnecessarily received a stent and wound up needing a heart transplant.

The FEHBlog also was quite impressed by Dana Lewis a young go-getter who along with a colleague developed a small closed loop computerized system to control her continuous glucose monitor as she has type 1 diabetes. She then founded an “open source artificial pancreas system movement (#OpenAPS)” to help others. She is not resting on her laurels.

An article in Medical Economics discusses a proposed Labor Department rule intended to protect TRICARE medical networks. However, the rule if finalized would disrupt FEHBP medical networks. The FEHBlog submitted comments to the Labor Department on the proposed rule for the FEHB plan trade association he represents. The comments asked the Labor Department to protect both TRICARE and FEHBP networks. He hopes the Labor Department will pull back the rule given the COVID-19 emergency.

In a bit of good COVID-19 news, the New York Times reported progress being made in two efforts to create a COVID-19 vaccine. Fingers crossed.

Also the Hill reported this afternoon that the House of Representatives has changed its mind about returning to Capitol Hill on May 4. The Senate continues to plan to return to the Capitol next Monday.

Monday Musings

David Ermer–Congress, COVID-19, Electronic health records, SCOTUS–

Here’s a musing for you. The FEHBlog expects that everyone is familiar with the spiritual titled “Sometimes I feel like a motherless child.” Well after reviewing lots of news, the FEHBlog to paraphrase this spiritual sometimes feels like the only person in America who believes that the U.S. healthcare system can pull us through this pandemic.

The House and Senate announced today that each body of Congress will be returning to Capitol Hill next Monday May 4. Welcome back.

In a decision sure to delight health insurers that took the initial plunge with the ACA marketplaces back in 2014, the U.S. Supreme Court ruled today in a virtually unanimous opinion that the U.S. owes many of those insurers a total of roughly $12.3 billion for unappropriated yet mandated risk corridor payments. The only dissenter was Justice Alito who agreed that the government owed the money but questioned whether there was a private right of action under the ACA to sue the government for the money. It’s not a crazy thought because the government is generally protected against lawsuits by a doctrine known as sovereign immunity.

The FEHBlog thought that this would be a good opportunity to update readers on the major commercial COVID-19 testing sites:

Castlight offers a COVID 19 testing directory which organizations can link to their own websites.

Verily Health, which is an affiliate of Alphabet/Google, has “launched COVID-19 Pathfinder— a new set of tools that provide on-demand access to COVID-19 information directly from a hospital or health system website.” Cool.

In a bit of good news for HHS, Fierce Healthcare reports that the EPIC, the electronic health record (“EHR”) giant, has switched from “fiercely” opposing to supporting the HHS EHR interoperability rules. “Epic controls more than a quarter of the hospital EHR market, according to KLAS Research, and, among hospitals with 500 or more beds, Epic has a 58% market share.”

Weekend Update

David Ermer–Congress, COVID-19, OPM–

Congress remains on a social distancing work period away from Capitol Hill for another week. Fierce Healthcare reports on the Blue Cross Blue Shield Association’s recommendations for the next COVID-19 relief bill which include COBRA/TCC subsidies (as in the 2009 Great Recession), expand tax credits for ACA marketplace plans and eliminate surprise billing through a national benchmark model. Hopefully this will be an appropriate time to adopt such a surprise billing solution that would not increase costs.

In the wake of President Trump signing the COVID-19 relief act no. 3.5 last Friday, the Centers for Medicare and Medicaid Services announced today that it will be re-evaluating how it spends the expanded pool of relief funding for hospitals and other healthcare providers created by that law.

The FEHBlog looks forward to listening to the NCQA’s virtual Quality Talks 2020 program on Tuesday. He will provide some highlights in Tuesday’s post.

The Government Accountability Office released a report on implementation of the Trump Administration’s June 2018 federal agency reorganization plan. GAO reports favorably on the transition of the background search investigations function from OPM to the Defense Department. Late last month, according to Federal News Network, OPM finalized a Congressionally mandated contract with the National Academy of Public Administration. “[NAPA] will provide Congress a report next March [2021] with its findings [on OPM and its mission], as well as its recommendations for addressing OPM’s challenges. OPM has another six months to respond to NAPA’s report to Congress.”

Friday Stats and More

David Ermer–CDC, COVID-19–

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.

Thursday Miscellany

David Ermer–Congress, COVID-19, Federal employment benefits, OPM–

The House of Representatives passed COVID-19 relief bill no. 3.5 (H.R. 266) by a vote of 388-5 this afternoon. The bill restores funding for the Small Business Administration’s relief programs and provides $100 billion in funding for healthcare providers.

OPM issued a new COVID-19 letter to FEHBP carriers today. The FEHBlog was pleased to see that OPM is allowing FEHB high deductible plans with health savings accounts to cover telehealth before the “high deductible” as permitted by the CARES Act (COVID-19 relief bill no. 3).

OPM also announced today that “the Combined Federal Campaign (CFC) will conduct a nationwide special solicitation to support charities serving and affected by COVID-19. This special solicitation will run through June 30.” Good call. Here’s the link to the campaign.

Also over the past two days, OPM has issued FAQs on resuming normal workforce operations at federal facilities and the Families First Coronavirus Response Act’s (COVID-19 relief bill no. 2) paid sick leave program. Meanwhile the U.S. Department of Labor is up to nearly 90 FAQs on that program which also applies to private sector employers with under 500 employees.