Happy National Doctors’ Day

COVID-19

Happy National Doctors’ Day

David Ermer–COVID-19–

Today is National Doctors’ Day, and the FEHBlog can think of no better time to thank the medical and para-medical professions for their dedicated and brave service to America and the world.

The FEHBlog learned from reading the Great Influenza that the horrific influenza pandemic in 1918-19 eventually subsided due to a combination of people who survived the disease (and there was a mild wave of the influenza in early 1918) and the enormous number of deaths. As a result, person to person transfer stopped. (Social distancing helped reduce the spread of that illness, e.g., St. Louis, but the FEHBlog is writing about how the pandemic ended.)

NBC News reports that experts believe that people who gain COVID-19 antibodies (though infection) will have immunity for some (at present) unknown period. However, it strikes the FEHBlog, who certainly is not an expert, that a combination of immunized and vaccinated people eventually should defeat the COVID-19 pandemic. The Wall Street Journal reports today that three prescription drug manufacturers are actively seeking to develop a COVID-19 vaccine.

Johnson & Johnson is one of many companies at work on a vaccine for the disease, which has become a global health crisis. Moderna Inc. has begun human trials for a vaccine using a novel approach that relies on the virus’s messenger RNA, a type of genetic material. Sanofi, a French biotech company, has begun work on a similar approach.

Healthcare Dive and Health Payer Intelligence report on additional steps that commercial payers are taking to reduce cost sharing burdens on patients receiving COVID-19 care.

The FEHBlog is confident that due to vastly improved medical care over the past century, Government and private sector support, and public respect for social distancing (which happened in the breach in 1918-19 due in large part to World War 1), the medical and para-medical professions will be able to handle the still rising number of COVID-19 cases while vaccination development continues.

Weekend update

David Ermer–ACA, CDC, Congress, COVID-19–

Congress is on a State / district work period this week. The Health Affairs blog discusses the health coverage provisions in the CARES ACT. In addition to broadening coverage of COVID-19 testing [Section 3201] and any future FDA-approved vaccine [Section 3203] , the new law permits high deductible health plans with health savings account to pay for telehealth care before the deductible [Section 3701] and repeals the Affordable Care Act provision requiring a doctor’s prescription for over the counter medicines as a prerequisite to reimbursement from a health savings account or a healthcare flexible spending account [Section 3702].

The high deductible health plan telehealth provision took effect last Friday and the over the counter drug coverage change was made retroactively effective January 1, 2020.

Health Affairs blog adds that

Under [Section 3202 of] the CARES Act, all comprehensive private health insurance plans would reimburse a test provider based on the rate negotiated between the plan and the provider (i.e., the in-network rate) that was put in place prior to this emergency. If there is no negotiated rate between the plan and provider (i.e., the provider is out-of-network), the plan would fully reimburse the provider based on the provider’s own “cash price” (or a lower price if the plan can negotiate one). This “cash price” must be publicly available (listed on a public website) while there is a declared public health emergency. Providers that fail to make their price public could face a civil monetary penalty of up to $300/day. This provision essentially allows out-of-network labs to set their own price and expect full reimbursement from the plan, potentially leading to dramatic price increases for testing.

Fierce Healthcare reports that that healthcare actuarial consulting firm TowersWillisWatson has released a projection of healthcare spending associated with the COVID-19 emergency.

On the low end of the spectrum, should the outbreak infect just 10% of the population and prove to have low morbidity, costs will increase by under 1%. However, if the virus infected 50% of the population with high morbidity, costs could increase by 6.8%, the study found. The scenario with the highest cost increases is if the virus 30% of people with high morbidity—a combination that could lead to 7.2% in cost increases, Willis Towers Watson found.

A major federal agency and two other health plan accrediting bodies have centralized their COVID-19 emergency guidance:

Apple in partnership with the Centers for Disease Control has posted a COVID-19 screening tool for consumers.

Friday Stats and More

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

Here are the week by week COVID-19 case statistics for this month from the Centers for Disease Control:

3-6-203-13-203-20-203-27-20
Travel36138290712
Person to Person181293101326
Cause under invest.1101362984283,318
Total Cases164162910,44285,356
Total Deaths1501246
Deaths over cases1.44%1.46%

Quite a spike. In the FEHBlog’s view, it will be interesting to see whether there is any leveling off in the case count increase.

The CDC’s latest Fluline reports “that [according to CDC estimates] so far this season there have been at least 39 million flu illnesses, 400,000 hospitalizations and 24,000 deaths from flu.” That represents a deaths over cases percentage of .06%.

With regard to COVID related guidance from that is relevant to FEHBP carriers and others

  • The Department of Health and Human Services Office for Human Rights has gathered together all of its COVID-19 emergency guidance on the HIPAA Privacy and Security Rules in one website.
  • The Department of Labor and the IRS have issued additional guidance on the Families First Coronavirus Response Act’s paid sick leave mandate and expanded FMLA leave.
  • The National Committee for Quality Assurance has assembled its COVID-19 emergency guidance here.

As previously mentioned the Office of Personnel Management has taken the same consolidated approach with its online COVID-19 emergency guidance which generally is directed at federal agencies.

CARES Act Passes Congress

David Ermer–Congress, COVID-19–

The FEHBlog just watched on C-SPAN the House of Representatives join the Senate in adopting the CARES Act (H.R. 748) so the $2 trillion COVID-19 emergency relief bill heads to the President for his expected signature later today.

CARES Act Update

David Ermer–Congress, COVID-19–

The Hill reports that “[House of Representatives] Speaker Nancy Pelosi (D-Calif.) said Thursday that the House will move quickly on Friday to approve the Senate’s massive, $2 trillion coronavirus relief package [the CARES Act, H.R. 748] through the lower chamber and on to President Trump, who has vowed to sign it immediately.” NPR has provided a link to the text of the bill that the Senate passed unanimously at 11:17 pm last night.

CARES Act Update

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

The President and the entire Senate leadership have agreed on a third COVID-19 relief bill known as the CARES Act (H.R. 748). Senator Charles Grassley, the Senate Finance Committee Chair, has released a summary of the bill’s taxation and unemployment insurance provisions and summary of its health provisions. The key health provisions affecting federal employees benefits are the following:

Sec. 3701. Health Savings Accounts for Telehealth Services
This section would allow a high-deductible health plan (HDHP) with a health savings account (HSA) to cover telehealth services prior to a patient reaching the deductible, increasing access for patients who may have the COVID-19 virus and protecting other patients from potential exposure.

Sec. 3702. Over-the-Counter Medical Products without Prescription
This section would allow patients to use funds in HSAs and Flexible Spending Accounts for the purchase of over-the-counter medical products, including those needed in quarantine and social distancing, without a prescription from a physician.

The FEHBlog mistakenly stated on Sunday that that the House of Representatives would be back on Capitol Hill yesterday. In fact, as the Wall Street Journal explains, House members remain on recess this week. Should the Senate as anticipated pass the CARES Act today, the House leadership is expected to seek approval by a unanimous consent motion. A single member of Congress can block such a motion so a lot rides on entire House leadership support for the bill. According to the Wall Street Journal, House Speaker Nancy Pelosi wants the unanimous consent to clear the House. This motion could be brought to the House floor on tomorrow or Friday. The Journal further reports that the President is ready to sign the bill into law.

The FEHBlog has found a link to a COVID-19 statistics site, The COVID-19 Tracking Project, that displays aggregated lab results from COVID-19 testing, U.S. state by state, where available.

Government Guidance Tuesday

David Ermer–COVID-19, OPM–
  • The Labor Department released FAQs on the newly enacted COVID-19 emergency sick pay law. According to the FAQs the law takes effect on April 1.
  • The Internal Revenue Service issued Notice 2020-18 and related FAQs on the recent Treasury Department decision to move this year’s Tax Day from April to July 15. Remember that “this relief applies only to Federal income tax payments. State filing and payment deadlines vary and are not always the same as the Federal filing and payment deadline. [The IRS] urge[s] you to check with your state tax agencies for those details. More information is available at https://www.taxadmin.org/state-tax-agencies.
  • The Center for Medicare and Medicaid Services Actuaries’ Office released the health care spending cost trend for the next ten years on Health Affairs. “National health expenditures are projected to grow at an average annual rate of 5.4 percent for 2019–28 and to represent 19.7 percent of gross domestic product by the end of the period. Price growth for medical goods and services is projected to accelerate, averaging 2.4 percent per year for 2019–28, which partly reflects faster expected growth in health-sector wages.”
  • Last but not least the Office of Personnel Management released a final rule making self plus one coverage and contract matrix changes to its FEHB Acquisition Regulation, 48 C.F.R. Ch. 16. OPM also released “technical guidance” to FEHB carriers on the preparation of 2021 benefit and rate proposals due May 31, 2021.

Monday Musings

David Ermer–ACA, Congress, COVID-19–

Today is the tenth anniversary of President Obama signing the Patient Protection and Affordable Care Act into law. The FEHBlog is tempted to muse on the law but since he has been writing in this space since 2006, he concluded no need exists for another such musing.

Be sure to check out at least the transcript for this week’s Econtalk interview with Dr. Azra Raza, a veteran oncologist who wrote a book on the human cost of cancer treatment. She explained that the benefit of early detection of cancer lies in the fact that at that point the body has fewer cancer cells that must be killed. She also touted tobacco cessation. She further explained that the new fangled CAR-T drug therapy has a weakness. CAR-T activates the body’s T cells which wind up killing healthy and cancerous tissue in a particular organ. Consequently CAR-T therapy is not used for example on liver cancer because the cure would kill the liver. Cancer is a very complicated disease.

On the COVID-19 front —

  • The Hill reports on continuing Senate negotiations over the third COVID-19 emergency relief bill. The American Hospital Association helpfully lists the healthcare provisions in the draft legislation which includes adjustments to the Families First relief bill’s COVID-19 testing coverage mandate and allow high deductible health plans with health savings accounts to waive their deductible for telehealth services.
  • “Today the U.S. Treasury Department, Internal Revenue Service and the U.S. Department of Labor announced that small and midsize employers [under 500 employees] can begin taking advantage of two new refundable payroll tax credits, designed to immediately and fully reimburse them, dollar-for-dollar, for the cost of providing Coronavirus-related leave to their employees.”
  • The Wall Street Journal offers an illuminating story about its investigation into the COVID-19 deaths at a Washington State nursing home. On February 26 the nursing home order closure of its dining rooms and an institutional scrub down due to a high number of respiratory illnesses among patients. Nevertheless the staff went ahead with a schedule party for patients, their family members and staff and ka-boom. This is why the social distancing guidance is so important right.

Weekend Update

David Ermer–Congress, COVID-19, OPM–

The House and the Senate will be in session this coming week working on a third COVID-19 relief bill. The House returns from a district work week on Tuesday while the Senate cancelled its state work week which had been scheduled for this week.

On the COVID-19 front —

  • OPM posted more COVID-19 emergency related guidance for federal agencies on Friday.
  • The Wall Street Journal explains the current lockdown rules in New York, California, Illinois, and several other states. The California rule cross references to this Department of Homeland Security guidance on essential critical infrastructure workforce. While the guidance is advisory, the FEHBlog finds it significant that the list of “workers who conduct a range of operations and services that are essential to continued critical infrastructure viability” includes “Workers that manage health plans, billing, and health information, who practically work remotely” and “Workers performing cybersecurity functions at healthcare and public health facilities, who cannot practically work remotely.”
  • On Saturday, the Food and Drug Administration issued the first emergency use authorization for a point-of-care COVID-19 diagnostic for the Cepheid Xpert Xpress SARS-CoV-2 test. ” “The test we’re authorizing today will be able to provide Americans with results within hours, rather than days like the existing tests, and the company plans to roll it out by March 30 [a week from today],” explained HHS Secretary Alex Azar. The COVID-19 diagnosis rate will increase more rapidly now that we continue to expand the availability of COVID-19 testing. The Vice President noted on Saturday that 195,000 Americans have been tested so far.
  • The Wall Street Journal informs us about how to avoid COVID-19 misinformation. It’s worth reading.