Memorial Day Update

COVID-19

Memorial Day Update

David Ermer–CMS, COVID-19, COVID-19 vaccine, Rx coverage, U.S. Healthcare–
Thanks to Justin Casey for sharing their work on Unsplash.

On this second (and hopefully last) Memorial Day of the COVID-19 pandemic, let’s take a look at recent reports on the nation’s COVID-19 vaccination campaign —

  • The Wall Street Journal reports that while vaccination rates in the Southeastern states have been relatively low, COVID-19 transmission has been slowed in those states by a combination of vaccinations supplemented by people engaging in open air activities.

Health officials in warm-weather states have launched public-information campaigns to encourage residents to spend as much time outside as possible and are pushing for more vaccinations at outdoor sites such as state parks and minor league baseball parks, as a way of heading off another potential summer surge this year.

“Vaccination and people spending time outdoors are the two biggest factors” in why cases have been relatively low this spring, said Brannon Traxler, an epidemiologist who heads South Carolina’s public-health division.

Encouraging people to spend time outside is a high priority, but the even bigger priority is the focus on vaccination, Dr. Traxler said: “If we can get folks vaccinated, then the weather and where and how people congregate becomes less of a problem.”

  • The Centers for Disease Control reports on Patterns in COVID-19 Vaccination Coverage, by Social Vulnerability and Urbanicity from December 2020 through April 2021:

What is already known about this topic?

Counties with higher levels of social vulnerability have been disproportionately affected by COVID-19.

What is added by this report?

Disparities in county-level vaccination coverage by social vulnerability have increased as vaccine eligibility has expanded, especially in large fringe metropolitan (areas surrounding large cities, e.g., suburban) and nonmetropolitan counties. By May 1, 2021, vaccination coverage among adults was lower among those living in counties with lower socioeconomic status and with higher percentages of households with children, single parents, and persons with disabilities.

What are the implications for public health practice?

Outreach efforts, including expanding public health messaging tailored to local populations and increasing vaccination access, could help increase vaccination coverage in counties with high social vulnerability.

  • The San Francisco Chronicle reports that “Hope builds that COVID vaccine boosters won’t be needed for a year – or much long.” “’I expect we will have to be revaccinated eventually, but I don’t think it’s going to be in a year-or-two time frame,’ said Dr. Joel Ernst, an infectious disease expert at UCSF. ‘Obviously we don’t have a long period of observation, because we haven’t had the vaccines that long. But so far I’m reassured that the vaccine-induced immunity seems to be pretty durable.’”

In other news

  • Healthcare Dive informs us that “The Mayo Clinic reported turning a profit in the first quarter of the year, although its expenses rose significantly compared to the first quarter of 2020, which was mostly completed before the COVID-19 pandemic became a significant issue. * * * [M]ost patient volumes returned to pre-pandemic levels. Outpatient visits for the quarter matched 2019 numbers, while surgical volumes exceeded those of 2019, although inpatient days were down.”
  • Kaiser Health News tells us that “The Biden administration said Friday it has no timeline on whether it will allow states to import drugs from Canada, an effort that was approved under President Donald Trump as a key strategy to control costs.  Six states have passed laws to start such programs, and Florida, Colorado and New Mexico are the furthest along in plans to get federal approval.  The Biden administration said states still have several hurdles to get through, including a review by the Food and Drug Administration, and such efforts may face pressures from the Canadian government, which has warned its drug industry not to do anything that could cause drug shortages in that country.” Smart move by the Administration. Our country’s population dwarfs Canada’s.
  • The Wall Street Journal reports that “Genetically altered mosquitoes target deadly Dengue fever and ZikaIn pioneering test, insects with a gene primed to interrupt breeding are flying in the Florida Keys. Go get em. One pandemic is enough.

Memorial Day Weekend update

David Ermer–CDC, Congress, Congress, COVID-19, OPM, Rx coverage, SCOTUS, U.S. Healthcare–
Thanks to Justin Casey for sharing their work on Unsplash.

Congress is on a State / district work break this coming week. The Supreme Court has over thirty cases to decide, including the latest Affordable Care Act constitutionality case, before adjourning for the summer in late June / early July.

The federal employee news organizations have highlighted portions of the President’s fiscal year 2022 budget proposal which was released last Friday.

  • The Federal Times reports that “President Joe Biden’s fiscal year 2022 budget anticipates a more than 50,000 full-time-equivalent employee increase to the federal payrolls next year, as part of concerted efforts to attract young and expert workers to federal service. * * * ‘The Federal workforce continues to become older on average. Almost 30 percent (635,397) of employees are older than 55, while 8.1 percent (176,805) of employees are younger than 30. By comparison, in the private sector, 23 percent of the workforce is younger than 30. Every single agency has fewer employees younger than 30 today than they had in 2010,’ the budget proposal’s analytical perspectives state.
  • Govexec informs us that “President Biden on Friday formally proposed an average 2.7% pay increase for federal civilian employees in 2022 as part of his fiscal 2022 budget proposal. * * * It was unclear Friday how Biden’s proposal would be divvied up between an across-the-board boost to basic pay and increases in locality pay. In recent years, pay raise provisions have included a 0.5% average increase in locality pay, although it was frozen at 2020 levels this year. * * * The proposal also marks a return to the principle of pay parity between the civilian and military workforce, as service members would also receive a 2.7% pay raise in 2022. 

Federal News Network offers three brief stories on the U.S. Postal Service

The Postal Service sent its first reduction in force notices to non-union management employees Friday [no indication of how many notices were sent out], and is planning to set higher prices on its mail products well above the rate of inflation [first class stamp would increase by 5% from 55 cents to 58 cents].

The Senate, meanwhile, voted [by unanimous consent] to confirm [Anton Hajjar] President Joe Biden’s third nominee to serve on the USPS Board of Governors. The board is now fully staffed for the first time since 2010, and will help the agency get its 10-year reform plan off the ground.

Thus the Senate has confirmed all three of the President’s Postal Governor nominees who shared a confirmation hearing with OPM Director Kiran Ahuja while Ms. Ahuja waits for a confirmation vote.

In healthcare news —

  • Bloomberg tells us that “The U.S. reported the lowest level of infection since the early days of the pandemic and welcomed back sports fans to stadiums. The Indianapolis 500 was run before 135,000 fans, the largest crowd for a sporting event since the pandemic began [but 1/3 of capacity].  * * * The world needs the cooperation of the Chinese government to trace the origins of Covid-19 and prevent future pandemic threats, two leading U.S. disease experts said Sunday.
  • NPR reports that “For children in particular, the risk of serious consequences from COVID-19 is the same magnitude as the risk they face from the flu, she says. But many parents seem more worried about the new and less familiar disease. * * * [E]xperts urge parents to try not to worry too much.
  • Because many FEHB plans provide hypertensive members with at home blood pressure monitor, the FEHBlog wants to share the American Medical Association’s views on what doctors wish their patients knew about home blood pressure measurement.

Finally, the FEHBlog’s eyes were drawn to the weekend Wall Street Journal’s Heard on the Street column which discusses the efforts of Walmart and Amazon to enter the healthcare business.

Friday Stats and More

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

Based on the Centers for Disease Control’s COVID-19 Data Tracker website, here is the FEHBlog’s chart of new weekly COVID-19 cases and deaths over the 14th week of 2020 through 21st week of this year (beginning April 2, 2020, and ending May 26, 2021; 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:

The FEHBlog has noticed that the new cases and deaths chart shows a flat line for new weekly deaths  because new cases significantly exceeds new deaths. Accordingly here is a chart of new COVID-19 deaths over the period (April 2, 2020, through May 26, 2021):

Finally here is a COVID-19 vaccinations chart over the period December 17, 2020, through May 26, 2021 (five months) which also uses Thursday as the first day of the week:

The Centers for Disease Control observes that “COVID-19 cases and deaths in the United States have dropped to their lowest levels in nearly a year, and the number of people vaccinated continues to grow. As of May 27, 2021, nearly 133 million people in the U.S. are fully vaccinated, and the national percentage of COVID-19 tests that came back positive over the last 7 days was less than 3%”

Also on the COVID-19 vaccine front, Healthcare Dive reports that

Federal equal employment opportunity laws do not prohibit policies requiring that all employees who physically enter a workplace receive a COVID-19 vaccination, so long as such policies comply with the reasonable accommodation provisions of the Americans with Disabilities Act and Title VII of the Civil Rights Act as well as other applicable laws, according to technical assistance from the U.S. Equal Employment Opportunity Commission updated May 28.

Title VII and the ADA require employers to provide reasonable accommodations for employees who, because of a disability or a sincerely held religious belief, practice, or observance, do not get vaccinated for COVID-19, unless providing an accommodation would pose an undue hardship on the operation of the employer’s business, EEOC said. Employers with such a requirement also may need to respond to allegations that the requirement has a disparate impact on, or disproportionately excludes, an employee based on protected characteristics including age, race, color, religion, sex and national origin.

Employers also may offer incentives to employees to voluntarily show documentation or confirmation that they have received a COVID-19 vaccine, but the agency outlined some limits in the event that employers are incentivizing employees to voluntarily receive a vaccine administered by an employer or its agent. An employer may offer an incentive to employees to provide documentation or other confirmation from a third party not acting on the employer’s behalf, such as a pharmacy or health department, that employees or their family members have been vaccinated.

In other news —

  • Today, the President released his Fiscal Year 2022 U.S. budget. Here is a link to the Office and Management and Budget’s fact sheet. OPM’s budget information may be found beginning on page 1211 of the Appendix.
  • Yesterday, the Milliman consulting firm released its 2021 Medical Index. Peering into its crystal ball, Milliman states that “We project healthcare costs will grow by approximately 8.4% for the MMI family from 2020 to 2021. This rate, driven by a forecasted rebound in healthcare utilization, is higher than historical healthcare cost increases and gross domestic product (GDP) growth over the past five years.”
  • Healthcare Dive informs us that “Despite the financial turmoil COVID-19 wrought on U.S. medical practices over the past year, physician income has remained relatively steady, according to a new survey by the Medical Group Management Association. The survey — which included 185,000 providers among more than 6,700 physician-owned and hospital-owned practices — concluded they experienced flat or modest income growth in 2020. While compensation for primary care physicians — traditionally one of the lowest-paid specialties — grew, most specialist physicians either experienced small bumps or decreases in their income. Many medical specialties also experienced a decrease in patient encounters last year — a nearly inevitable outcome after many elective procedures were postponed in order to keep hospital capacity low enough to treat COVID-19 patients. However, the MGMA survey concluded that most practices saw patient volumes return to normal by mid-summer of 2020. Analysts predict the trend will continue to grow in 2021.” Agreed.
  • Recycle Intelligence informs us that “Hospital revenue, volumes, and margins increased in April 2021 both year-to-date and year-over-year, but have a long way to go in terms of COVID-19 recovery, according to a report by health care consulting firm Kaufman Hall. Despite the increases, hospital financial performance is down compared to last month.”
  • Last but not least, the Wall Street Journal reports that “A pathbreaking pill for lung cancer from Amgen Inc. was approved by the U.S. Food and Drug Administration, adding a new potential blockbuster to the biotech giant’s aging stable of drugs. The drug, called Lumakras, was approved Friday to treat a portion of lung cancer patients with a particular genetic mutation who have already tried other therapies. The mutation, known as KRAS, is among the most common found in cancers, but researchers struggled for so many years to find a medicine that can treat it that the mutation came to be considered ‘undruggable.’” Bravo. The Journal adds that “The company will charge $17,900 a month for the drug in the U.S., an Amgen spokeswoman said. Analysts project the drug could eventually ring up more than $1 billion in annual sales.”

Thursday Miscellany

David Ermer–COVID-19, COVID-19 vaccine, OPM, Rx coverage–
OPM Headquarters a/k/a the Theodore Roosevelt Building

Federal News Network reports

The Office of Personnel Management is reshuffling current senior leadership and reorganizing a few of its offices as it waits for the arrival of its new director.

“OPM is making staff and organizational updates in order to better serve the agency’s mission,” the agency told Federal News Network. “These staff and organizations updates will help us to increase efficiency, better leverage our incredible internal talent and build back the agency for the future.”

Dennis Coleman, the agency’s current chief financial officer, will be the new chief management officer, OPM announced Thursday.

Margaret Pearson, OPM’s deputy chief financial officer, will be the acting CFO until the agency fills the job permanently. It will conduct a national search to find a new permanent CFO, OPM said.

From the COVID-19 vaccine front

  • The Wall Street Journal informs us that “The Food and Drug Administration and vaccine maker Johnson & Johnson expect to announce as early as Friday that contamination problems at a Covid-19 vaccine plant in Baltimore are resolved, clearing the way for millions more doses to become available.”
  • The New York Times tells us that “Immunity to the coronavirus lasts at least a year, possibly a lifetime, improving over time especially after vaccination, according to two new studies. The findings may help put to rest lingering fears that protection against the virus will be short-lived. Together, the studies suggest that most people who have recovered from Covid-19 and who were later immunized will not need boosters. Vaccinated people who were never infected most likely will need the shots, however, as will a minority who were infected but did not produce a robust immune response.”
  • A Bloomberg op-ed write opines (accurately in the FEHBlog’s opinion) that “The news that some employers have started handing out cash rewards to workers who are vaccinated against Covid-19 warms my libertarian heart. Yes, the idea is controversial; yes, there are legal implications. But providing incentives to get people to do what others think they should is almost always superior to punishing them for defying those wishes.” To that end, CVS Health announced that “beginning June 1, eligible customers who received or plan to receive a COVID-19 vaccination through CVS Health may choose to enter the #OneStepCloser sweepstakes for an opportunity to win one of over a thousand fun and exciting prizes through weekly drawings and grand prizes over a six-week period.” (Regrettably the FEHBlog got his vaccinations at a Maryland mass vaccination flight.)
  • Fierce Biotech reports that “Sanofi, GlaxoSmithKline kick-start phase 3 COVID-19 vax test as the pair targets variants, Q4 approval.”

From the prescription drug front —

  • Fierce Pharma informs us that “Within hours of granting emergency use approval to a COVID-19 antibody drug by GlaxoSmithKline and Vir, the United States has restricted the use of another COVID antibody treatment, this one from Eli Lilly. The FDA has halted the distribution of Lilly’s combination of bamlanivimab and etesevimab in Arizona, California, Florida, Indiana, Oregon and Washington––all states where coronavirus variants from Brazil and South Africa account for more than 10% of those with the disease. The antibody combo had previously been paused in Illinois and Massachusetts.  Providers in those states should use Regeneron’s antibody treatment of casirivimab and imdevimab, the FDA says. Lab studies have shown that option is more effective against the Brazilian (P.1) and South African (B.1.351) strains, according to the agency.’
  • Fierce Healthcare reports that CMS delays for six months [until July 1, 2022] a [complex] requirement for drugmakers to offer multiple best prices for Medicaid value-based deals. Also “The Pharmaceutical Research and Manufacturers of America, a top drug lobbying group, sued CMS in federal court on May 21 over another section of the Dec. 31, 2020, final rule. The drug industry wants a federal judge to ditch a requirement for manufacturers to factor in copay assistance into the Medicaid best price.”
  • Business Insider tells us that “Amazon is considering options for creating a physical retail-pharmacy presence in the US, three people familiar with the matter told Insider. It’s part of a plan to win over a larger slice of the prescription-drug industry. There is not a concrete plan to do so, and the talks are mostly exploratory, the people said. They were not authorized to speak to the press. Any meaningful rollout of stores could take more than a year, one of them said.” The FEHBlog watched a Bloomberg TV interview of Amazon’s CEO Jeff Bezos. The interview asked Mr. Bezos how he fills his workdays. He responded that he and his direct reports think about the future so this makes sense.
  • Virta Health, which offers diabetic treatments, announced a free webinar on Thursday June 17 at 2 pm to discuss a new potentially blockbuster Novo Nordisk anti-obesity drug. Here’s the skinny so to speak —

Obesity rates continue to soar, but earlier this year we were met with intriguing news. Early 2021, Novo Nordisk released phase 3 data for their diabetes drug, Semaglutide, in which the outcomes which were described as “breakthrough” and “game-changing” Patients on average lost 33.7 pounds after 68 weeks, more than 1.5 higher than the next best obesity drug. Experts predict the record-breaking efficacy rates could unleash the obesity drug market, which has historically lingered at a low <1% penetration rate. 

Despite what looks like a promising turn of events at the surface, there is growing concern that we’re at a tipping point for a healthcare cost crisis. With an estimated list price per patient of $13,000, semaglutide could take a huge hit on employers and payers who are already struggling to control growing medication and healthcare costs. 

Midweek Update

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

The Wall Street Journal reports that

A monoclonal antibody drug to treat early Covid-19 infections has been authorized by the U.S. Food and Drug Administration, said Vir Biotechnology Inc.and GlaxoSmithKline PLC, makers of the drug.

The drug, called sotrovimab, is the third antibody medicine authorized to treat patients early in the course of disease who are at high risk of developing severe cases.

Vir and Glaxo said in March that a study of the drug had been stopped early because it was shown to be highly effective, reducing hospitalizations or death by 85%, compared with a placebo. * * *

It is unclear what near-term role the drug will play in the U.S., where new infections are falling and there remains a glut of unused antibody drugs made by Eli Lilly & Co. and Regeneron Pharmaceuticals Inc.

Having a Plan B usually is a prudent step.

Speaking of prescription drugs, Healthcare Dive informs us that

  • “The Institute for Clinical and Economic Review, a nonprofit and frequent critic of drugmakers for excessively high drug prices, now plans to assess how health insurance policies harm patient access to care, the group announced Tuesday. This follows research by the group that argued cost-sharing should not be structured to shift healthcare costs to patients when they have no medically appropriate lower cost option.
  • “ICER’s review will not, however, look at whether cost-sharing should be reduced for drugs on which payers receive large rebates or whether payers should be asked to demonstrate how their policies on drug access save overall healthcare costs.
  • “Drugmakers have repeatedly tried to shift the blame for high out-of-pocket costs and limited access to drugs by pointing to the design of insurance plans. ICER’s review suggests a new emphasis by the group on examining the role insurers play alongside pharmaceutical companies in determining patient access and costs.”

Fedweek features Reg Jones’ latest missive on the relationship between federal employment benefits and life events. This report concerns the coverage of children under FEHB and FEGLI.

The FEHBlog has been tracking developments in the implementation of the No Surprises Act. In the course of doing so today, he found several letters from healthcare trade associations to federal regulators on this topic. Because it can be helpful to look over the fence, here are implementation comments from American Association of Orthopedic Surgeons, the American College of Radiology, the National Association of Free Standing Emergency Centers, the American Association of Medical Colleges, and the American College of Emergency Physicians. What’s more the Workgroup for Electronic Data has helpfully collected links to a bevy of expert analyses of the law. It’s a heavy lift.

In healthcare business news

  • Healthcare Dive tells us that “Hospital operator HCA Healthcare is linking up with Google Cloud on a new data analytics platform to support provider decision-making, the companies announced Wednesday. The deal between the 186-hospital system and the technology behemoth will build on HCA’s existing use of technology to streamline both clinical and non-clinical operations, and represents “significant investments” in the system’s mobile functions, the companies said. The goal is to give doctors and nurses workflow tools, analysis and alerts on their mobile devices for real-time updates on patients’ conditions, while also improving workflows such as supply chain, human resources and physical plant operations.”
  • Fierce Health reports that “The combined company of Grand Rounds Health and Doctor On Demand has expanded yet again to include a care concierge platform for the LGBTQ+ community. The virtual care companies announced Wednesday they signed a definitive agreement to acquire Included Health to improve health outcomes and address the health challenges facing communities including lesbian, gay and transgender patients as well as black, indigenous and people of color (BIPOC), the companies said in a press release.” Terms of the agreement were not disclosed

Tuesday’s Tidbits

David Ermer–ACA, CDC, CMS, Congress, COVID-19, COVID-19 vaccine, Federal employment benefits, OPM, U.S. Healthcare–
Photo by Patrick Fore on Unsplash

Federal News Network provides the latest on the controversy over the Postal Service Health Benefits Program provisions in the Postal Reform Act (H.R. 3076 which has a Senate companion bill).

The new legislation requires current postal workers to enroll in Medicare Part A and B when they reach age 65. It gives current retirees the option of enrolling in Medicare, waiving the usual late enrollment penalties. Medicare will pick up initial hospital and prescription costs, and the Postal Service will become the secondary payer.

But current retirees who choose not to opt into Medicare will stay in the FEHBP.

While this arrangement is designed to save the Postal Service billions over the next decade, NARFE [ a prominent federal employee organization] worries it could raise premiums for federal employees and retirees still enrolled in the FEHBP. Those who are Medicare-eligible but choose not to enroll are some of the most expensive participants to insure.

The FEHBlog has a different outlook. First off, all federal annuitants, with exception of a naturally diminishing cadre of members who retired before 1984, have no cost Medicare Part A coverage. Most federal annuitants do join Part B. Income adjusted Part B premiums likely are the cause of newer annuitants tending to decline Part B coverage. In any event, Part A hospital expenses are weightier than Part B expenses. If a federal annuitant over 65 has declined Part B coverage and is enrolled in an FEHB fee for service plan, that Plan covers the annuitant’s expenses at Medicare rates which the FEHB Act, 5 U.S.C. Sec. 8904(b), obligates the provider to accept. That law has been in effect for nearly 30 years.

As the FEHBlog has mentioned on occasion, the enormous new savings opportunity that Postal reform will unleash lies in Part D prescription drug integration, not in Part B integration. In the 2003 Medicare Modernization Act that created Part D, Congress expressly permitted FEHB plans to integrate their benefits with Medicare Part D for annuitants over 65 (see 42 USC 1395w–132(b),(c)(3)). Integrated Part D programs known as EGWPs pay the Part D premium while reaping tremendous savings over going it alone. If OPM simply allowed all FEHB plans to exercise this option, FEHB premiums would be lower, and the Postal Service would not be militating for a separate program, in the FEHBlog’s considered opinion.

Healthcare Dive reports the Senate today confirmed the President’s nomination of Chiquita Brooks-LaSure to be Administrator of the Centers for Medicare and Medicaid Services by a 55-45 vote.

Brooks-LaSure has a long career in public policy, working in the Office of Management and Budget as a Medicaid analyst before moving on to serve as deputy director for policy at the Center for Consumer Information and Insurance Oversight during the Obama administration. She was also a director of coverage policy at HHS before transitioning to the private sector, working as a Medicare and Medicaid policy consultant for Manatt Health. With Tuesdays vote, Brooks-LaSure becomes the first Black woman to lead CMS.

The Senate has turned to considering an Assistant Attorney General nomination, and the FEHBlog hopes that Kiran Ahuja’s nomination to be OPM Director reaches the Senate floor soon thereafter for a confirmation vote.

From the COVID-19 front, Fierce Pharma informs us that

Teens across the U.S. started getting COVID-19 vaccines this month after Pfizer’s shot. With new data released Tuesday, Moderna’s shot could soon be available to kids, too.

In a phase 3 trial in kids ages 12 to 18, Moderna’s vaccine posted 100% efficacy after two doses. Investigators enrolled 3,700 participants and randomly assigned two-thirds to receive two doses of the Moderna vaccine. The remaining third received two doses of placebo.

Investigators recorded zero COVID-19 cases in the vaccinated group 14 days after the second dose, and four in the placebo group. They didn’t identify any new safety concerns.

The results set Moderna up for an FDA filing in the age group next month. Under that timeline, the vaccine could score an authorization in teens sometime this summer and play a role in a back-to-school vaccination push. * * *

Even younger children could be on their way to eligibility, too; Pfizer and Moderna are both running studies testing their vaccines in children as young as six months.

As of today, 50% of the U.S. population over age 18 is fully vaccinated against COVID-19, and public health experts opine in Medscape on why the jury is out on COVID-19 vaccination boosters.

And here are Tuesday’s Tidbits —

  • Medscape reports on how the COVID-19 pandemic has lead doctors to rethink low value care.
  • The Annals of Internal Medicine discusses on a study finding that “In clinician-owned practices, implementing a workflow to routinely screen, counsel, and connect patients to smoking cessation resources, or implementing a documentation change or a referral to a resource alone led to an improvement of at least 10 points in the smoking outcome with a moderate level of facilitation support. These patterns did not manifest in health- or hospital system–owned practices or in Federally Qualified Health Centers, however. The [blood pressure] BP outcome improved by at least 10 points among solo practices after medical assistants were trained to take an accurate BP. Among larger, clinician-owned practices, BP outcomes improved when practices implemented a second BP measurement when the first was elevated, and when staff learned where to document this information in the electronic health record. With 50 hours or more of facilitation, BP outcomes improved among larger and health- and hospital system–owned practices that implemented these operational changes.” Little things.
  • OPM released today a corrected version of Benefits Administration Letter No. 21-802, dated May 20, 2021, “which provides guidance on the OPM implementation of FSAFEDS Program flexibilities offered under the Consolidated Appropriations Act 2021 and accompanying law and guidance.”
  • MedPage Today posts a transcript of an interesting podcast in which “Vinay Prasad, MD, MPH, breaks down a new study that examined differences in breast cancer screenings before and during the COVID-19 pandemic overall, and among sociodemographic population groups.“
  • The Internal Revenue Service released draft 2021 Forms 1095-B and 1095-C which health plans and employers respectively use to report individual health coverage information to the Service.
  • Healthcare Dive reports that “The finances of U.S. hospitals continue to improve as the coronavirus pandemic wanes, following months of steep losses last year, according to a new report from Kaufman Hall. In April, hospital margins, volumes and revenues were up across most performance metrics year to date and year over year, though they were down compared to March, the consultancy found. Researchers called the results ‘encouraging,’ but noted they were more indicative of a recovering industry following the record-low performance seen in the first two months of COVID-19 in 2020, rather than strong performance overall this year.”

Monday Roundup

David Ermer–COVID-19, COVID-19 testing, COVID-19 vaccine, Patient safety, U.S. Healthcare–
Photo by Sven Read on Unsplash

From the COVID-19 front:

  • Beckers Hospital Review reports that

Of the more than 123 million people fully vaccinated as of May 17, just 1,949 breakthrough cases involving hospitalizations or death had been reported to the CDC. 

Three more [CDC] findings:

  • Ninety-three percent of cases involved hospitalizations. Of these, 25 percent involved people who were asymptomatic and hospitalized for reasons not related to COVID-19.
  • Eighteen percent of all reported cases were fatal. Of these deaths, 18 percent involved people who were asymptomatic and died for reasons unrelated to the virus. 
  • In total, 79 percent of all reported cases involved people aged 65 or older.

The new data comes after the CDC changed how it tracks breakthrough COVID-19 cases among fully vaccinated Americans. As of early May, the agency only monitors the most severe cases.

  • The New York Times’ Upshot column discusses opinions on how vaccinated parents can do in terms of socializing activities with children under 12 years of age, the minimum age threshold for COVID-19 vaccination,

As vaccinated Americans return to many parts of their prepandemic lives this summer, one group will be left out: children under 12, who cannot yet be vaccinated. So what should families with young children do when everyone else starts socializing again?

We asked experts as part of an informal New York Times survey. The group of 828 who responded included epidemiologists, who study public health, and pediatric infectious disease physicians, who research and treat children sick with diseases like Covid-19.

They noted that this phase was temporary. Pfizer has said vaccines for children ages 2 and up could come as soon as September. Of the survey respondents with young children, 92 percent said they would vaccinate their own children as soon as a shot was approved. (Only five said no; some were undecided.) In the meantime, families with young children may need to retain more precautions, like masking and distancing, than their childless friends do. But they said some minimally risky activities could help counteract the mental health effects of pandemic living.

  • David Leonhardt also in the New York Times believes that vaccination hesitancy is affecting the working class.

Public health experts believe that there are specific strategies that can narrow the vaccination divide [between classes].

One is information. About 25 percent of unvaccinated people remain unsure whether somebody who previously had Covid should still get the vaccine, according to Kaiser. The answer is yes: Almost everybody 12 and older should.

Another promising strategy is making shots even more convenient. Employers can help by hosting on-site vaccinations and giving workers paid time off — including the day after the shot for people who experience side effects. Drugstores and supermarkets can accept walk-ins, as some already do. Government officials can send mobile, walk-in clinics into more communities. (Text your ZIP code to 438829 — or text “VACUNA” for Spanish — and you’ll find your local options.)

“We’ve just got to remove all the barriers,” Brodie said.

Finally, friends and relatives can turn a vaccination into something more than just a shot. “Say, ‘Let’s do this together. Let’s do something, so if you get vaccinated, let’s grab dinner after. Let’s celebrate together,’” Dr. Edith Bracho-Sanchez, a New York pediatrician, told CNN.

  • A friend of the FEHBlog called attention to this American Psychology Association “Stress in America survey conducted in late February 2021 found 42% of U.S. adults reported undesired weight gain since the start of the pandemic, with an average gain of 29 pounds.” Whoa Nelly!
  • The FEHBlog’s dogs pointed out this American Hospital Association report that “a new study from researchers at the London School of Hygiene & Tropical Medicine and others suggests that people infected with COVID-19 have a distinct body odor that specially trained dogs can rapidly detect with up to 94.3% sensitivity and up to 92% specificity. The study found dogs could detect the odor on clothing samples from individuals, including those who were asymptomatic, had low viral loads and two different strains. The study has yet to be peer reviewed and replicated in real-world settings, but shows promise as a way to screen individuals for COVID-19 testing at airports and other public places, the authors said.” Man’s best friend indeed.

In a Monday mishmosh of other healthcare news

  • A Wall Street Journal reporter discusses her own postpartum illness that nearly resulted in another maternal death.

The U.S. has a maternal mortality rate double that of most other high-income countries, including Britain, Canada and Australia, according to the New York City-based Commonwealth Fund, a healthcare research foundation. The CDC says that about two-thirds of pregnancy-related deaths are preventable; factors include lack of access to care, delayed diagnoses and missed warning signs. Black women and those on Medicaid are disproportionately affected.

To help address this, the American College of Obstetricians and Gynecologists recommended in 2018 that women have contact with their providers much sooner than six weeks—within three weeks after birth for low-risk women and sooner for women at higher risk of complications. (The roughly 30% of women who have cesarean sections sometimes already have a follow-up appointment after two weeks.)

The doctors who authored the 2018 recommendations said such a major change is challenging. “It is old habits. This is a huge culture shift,” said Tamika Auguste, chairwoman of Women’s and Infants’ services at MedStar Washington Hospital Center, who co-wrote the recommendations. My midwife said that in her two decades of practice, she has seen most women after about six weeks and found it effective.

Wouldn’t telehealth provide a Goldilocks solution here?

The American College of Obstetricians and Gynecologists also supports in-home visits by a nurse in the days after birth, which is a standard practice in other high-income countries but isn’t always covered by insurance in the U.S. * * * Even doctors who support adding more care say it’s hard to find the right balance. “We don’t know how much contact or care that we need that would be beneficial,” said Mark Clapp, a maternal-fetal medicine specialist at Massachusetts General Hospital.

See above telehealth suggestion.

  • UPMC’s Health Plan has a created a virtual concierge for its members using Amazon’s Alexa and the Google Home Assistant.
  • The Pew Charitable Trust has released an interesting report on the impact of state No Surprise billing laws on healthcare costs.

Eighteen states have passed surprise billing laws since 2014, most of them in the past three years. Last year, former President Donald Trump signed a federal version that covers self-funded health plans, including those offered by many employers, as opposed to the individual and commercial health plans regulated by states.

The concerns stem from guidelines states have established to help impartial arbitrators resolve disputes between providers and insurance carriers over how much should be paid for surprise, out-of-network bills.

“An upward trend in payments for out-of-network care could push rates higher in in-network contracts,” health policy researchers at Georgetown University wrote in a blog post last month. “These costs, in turn, could push premium costs higher for employers and consumers.”

A healthy lifestyle can lower dementia risk, even among those with a family history of cognitive decline, according to a study presented Thursday during an American Heart Association conference held virtually because of the COVID-19 pandemic.

This includes eating a healthy diet, exercising regularly, not smoking or drinking alcohol to excess and maintaining good sleep habits and a healthy body weight, the researchers said during the Epidemiology, Prevention, Lifestyle and Cardiometabolic Health Conference.

Adults ages 50 to 73 who embrace at least three of the behaviors can reduce their dementia risk by 30%, the data showed.

Those with a family history of dementia who followed at least three of the behaviors had a 25% to 35% reduced risk for the condition compared to those who followed two or fewer.

  • The National Committee for Quality Assurance issued an illuminating blog post describing the digital changes taking place with its HEDIS healthcare quality measures which play an important role in OPM’s FEHB Plan Performance Assessment system.

Friday Stats and More

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

Based on the Centers for Disease Control’s COVID-19 Data Tracker website, here is the FEHBlog’s chart of new weekly COVID-19 cases and deaths over the 14th week of 2020 through 20th week of this year (beginning April 2, 2020, and ending May 19, 2021; 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:

The FEHBlog has noticed that the new cases and deaths chart shows a flat line for new weekly deaths  because new cases greatly exceed new deaths. Accordingly here is a chart of new weekly COVID-19 deaths over the period April 2, 2020, through May 19, 2021:

Finally here is a COVID-19 vaccinations chart over the period December 17, 2020, through May 19, 2021, which also uses Thursday as the first day of the week:

With respect to COVID-19 vaccinations, Medscape reports that

The COVID-19 vaccines authorized for use in the United States and Europe offer protection against the four main coronavirus variants known to exist, a World Health Organization official says. “All COVID-19 virus variants that have emerged so far do respond to the available approved vaccines,” WHO European Regional Director Hans Kluge said Thursday at a news conference.

In sum, from the COVID-19 stats front, the Centers for Disease Control states

COVID-19 cases, hospitalizations, and deaths are going down, and the number of people vaccinated continues to go up, providing a sense of optimism as summer approaches. As of May 20, 48.4% of the U.S. population ages 18 years and older is fully vaccinated, and 60.5% have received at least one dose of a COVID-19 vaccine. Additionally, as of last week, millions more are now eligible to receive a COVID-19 vaccine. These trends and new CDC evidence-based guidance on masking provide encouragement that we are making progress toward returning to a sense of normalcy.

As you look ahead to summer, consider how COVID-19 is spreading in your community when choosing activities. Outdoor activities and visits are safer than those indoors, but fully vaccinated people can participate in most indoor activities without much risk. If you are not yet vaccinated, you should continue to practice prevention strategies such as wearing a well-fitted mask, practicing physical distancing, avoiding crowds, and washing your hands. 

In the “and more” category

Health Affairs discusses five keys to realizing health equity in U.S. health plans. To wit

“The five major priorities (and the achievements that will result from these priorities) for health equity leadership in health plans are:

  • Prioritizing Prevention and Wellness: Benefits and care delivery redesign
  • Prioritizing Communities: Engagement and investments
  • Prioritizing Innovation: Population and digital health
  • Prioritizing Education, Research, and Workforce Development: Academic-community collaborations
  • Prioritizing Action and Accountability: Data-driven improvement.”

mHealth Intelligence reports that “GAO tells Congress to wait on expanding telehealth coverage past the pandemic.
A new report and testimony from the Government Accountability Office says the full effect of CMS waivers on telehealth coverage during the pandemic isn’t yet known, and more study is needed. That conclusion won’t make the American Medical Association happy.

Reuters informs us that “CVS Health Corp., best known for its national chain of drugstores, said on Thursday it had started offering clinical trial services to support drug developers with tasks like patient enrollment. CVS said it had already collaborated with drug developers to help facilitate clinical trials for investigational COVID-19 vaccines and treatments, which the new business will now expand.”

Speaking of clinical investigations, Medscape reports that

The novel Galleri blood test (GRAIL, Inc.), which claims to detect up to 50 different cancers from single blood draw, is about to make its clinical debut in the United States. However, an expert cautions that this test should be considered as being under clinical investigation. Providence Health System, based in Renton, Washington, will be the first health system in the US to offer access to the Galleri test, where it will be available as a complement to recommended single-cancer screening tests.

On its website, GRAIL notes that the Galleri blood test is recommended for use in adults with an elevated risk for cancer, such as those aged 50 or older. It is intended to detect cancer signals and to predict where in the body the cancer signal is located. However, it does not detect all cancers and should be used in addition to routine cancer screening tests recommended by a healthcare provider. It is “intended to be used in addition to, and not replace, other cancer screening tests,” [GRAIL’s Leslie] Strope emphasized.

The FEHBlog strongly recommends this week’s episode of the Econtalk podcast (three strong weekly episodes in a row) in which

Podcaster and author Julia Galef talks about her book The Scout Mindset with EconTalk host Russ Roberts. Galef urges us to be more rational–to be open-minded about what we might discover about the world–rather than simply defend what we already believe, which she calls the soldier mindset. The conversation is a wide-ranging discussion of our biases and the challenges of viewing the world objectively.

Thursday Miscellany

David Ermer–Congress, COVID-19, Federal employment benefits, OPM, U.S. Healthcare–

Following up on yesterday’s post about the proposed Postal Service Health Benefits Program that Congress is considering, here is a link to the Senate Homeland Security and Governmental Affairs Committee’s press release on its companion bill to the House measure (HR 3706). The press release provides a link to the Senate bill for those interested.

The Office of Personnel Management issued a benefit administration letter to federal agencies “which provides guidance on the OPM implementation of FSAFEDS Program flexibilities offered under the Consolidated Appropriations Act 2021 and accompanying law and guidance.”

From the COVID-19 front, the American Hospital Association reports

FDA authorizes storing thawed Pfizer COVID-19 vaccine in refrigerator for up to 30 days before diluting. The Food and Drug Administration yesterday authorized storing thawed, undiluted vials of the Pfizer COVID-19 vaccine at refrigerator temperatures (35°F to 46°F) for up to 30 days after the company submitted data showing the vials can remain stable that long, up from the previously authorized five days. For details, see the updated fact sheet for health care providers administering the vaccine.
Peter Marks, M.D., director of FDA’s Center for Biologics Evaluation and Research, said the change should make it easier for vaccine providers such as doctors’ offices to administer the vaccine.
Once the thawed vials are diluted, providers must use them within six hours, a potential challenge for clinicians who lack sufficient demand for the vaccine during regular office visits.

That’s quite a conundrum. On the brighter side, Politico informs us

Emergent BioSolutions could resume manufacturing Johnson & Johnson’s Covid-19 vaccine within days, CEO Robert Kramer told a House [of Representatives] panel Wednesday. Restarting Emergent’s production of the J&J shot would revitalize efforts to get the single-dose vaccine to many Americans. The United States is currently relying entirely on vaccines from Pfizer and Moderna for its vaccination efforts; for the second straight week, the White House on Tuesday told state officials that the J&J vaccine was not available to order.

The American Medical Association adds that “The biggest impediment to getting more people fully vaccinated for COVID-19 is access, not vaccine hesitancy, according to Thomas R. Frieden, MD, MPH, former director of the Centers for Disease Control and Prevention during the Obama administration.” “We can make a lot of progress by making vaccination more convenient,” said Dr. Frieden, CEO of Resolve to Save Lives, an initiative to prevent epidemics and cardiovascular disease. “That’s really important. That means walk-in hours. That means easy locations, easy hours, supporting transportation and setting up pop-up sites outside of everywhere, from ballgames to bars to bowling alleys to shopping centers. We need to make it the default choice, basically, to get a vaccine.”

In healthcare business news,

  • Healthcare Dive lets us know that “Anthem and Epic on Wednesday announced a collaboration expanding bidirectional data exchange, in a bid to streamline administrative process like prior authorizations, a frequently cited pain point for providers, and give providers more real-time data on patient behaviors like medication adherence. The partnership will integrate Epic’s payer platform into Anthem’s operating system. The Indianapolis-based payer will also combine Epic’s information with other sources such as claims logs, health information exchanges and lab companies. Providers will also be notified of significant health events, such as when a patient is discharged, in an effort to improve follow-up care.” Awesome!
  • Fierce Healthcare reports that “While its joint venture with Amazon and Berkshire Hathaway, Haven, is no more, JPMorgan Chase is launching a new effort to address the cost and efficiency of employer-sponsored healthcare. Morgan Health will serve as a new business arm within the company that’s focused on these issues, the financial giant announced Thursday. Dan Mendelson will serve as CEO of Morgan Helth and report to Peter Scher, vice president of JPMorgan Chase. Mendelson is the founder and former CEO of Avalere Health.”

In healthcare news

  • The Associated Press informs us that “Screening and the HPV vaccine have led to drops in cervical cancers over the last two decades in the U.S., a new study finds, but the gains are offset by a rise in other tumors caused by the [HPV] virus. In the U.S., the HPV vaccine has been recommended since 2006 for girls at age 11 or 12, and since 2011 for boys the same age, and catch-up shots are recommended for anyone through age 26 who hasn’t been vaccinated. Experts agree it will take years to see the true impact because it can take decades for a chronic HPV infection to turn into cancer. What’s driving the HPV cancer trends is the youthful sexual behavior of baby boomers before the vaccine was out. The vaccine works best when given at younger ages before people are exposed to HPV through sexual activity, so it arrived too late for the boomers.
  • The Blue Cross Blue Shield Association reports that “Black women under the age of 24 are more likely to experience severe childbirth complications than white women over the age of 35 – an age group usually considered high risk, according to new data from the Blue Cross Blue Shield Association (BCBSA). Data shows the rates of childbirth complications have been increasing for women of color. In the last two years, the rate of Hispanic women with severe childbirth complications increased 19%. “There is an urgent maternal health crisis in our country,” said Kim Keck, president and CEO of BCBSA. “It is unconscionable that women of color face a greater risk of childbirth complications compared to white women. We must confront health disparities across the board to change the trajectory.” Amen to that.

Tuesday’s Tidbits

David Ermer–Congress, COVID-19, COVID-19 vaccine, Mental health care, Telehealth, U.S. Healthcare–
Photo by Patrick Fore on Unsplash

Over 275 million doses of the COVID-19 vaccines have been administered in the United States and 47.5% of the U.S population has received at least one dose of COVID-19 vaccine ,and 37.5% of the total U.S. population has been fully vaccinated. The Wall Street Journal reports today that

Covid-19 vaccines are showing up in unlikely places—on public transportation, at churches and in factories. Shots are also being offered in restaurants, casinos and ballparks. These pop-up locations represent a bid by health advocates and community leaders to reach a group of unvaccinated individuals less likely to make headlines: the ambivalent.

From the American Medical Association front

  • The AMA continues to rail against health insurer requests for prior authorizations.
  • In contrast the AMA is now a fan of telehealth as long as health insurers pay adequately for it.

“Here are the top five services physicians surveyed say they want to offer after the COVID-19 pandemic has ended, along with the percentage who said they wanted to continue each service:

  • Chronic disease management—73%.
  • Medical management—64%.
  • Care coordination—60%.
  • Preventative care—53%.
  • Hospital or emergency department follow-up—48%.

“Physicians also identified what they anticipate to be the barriers to maintaining telehealth after the public health emergency. No. 1 on that list? About 73% of physicians worry there will be low—or no—payment.”

STAT News reports that the House Oversight and Reform Committee bludgeoned prescription drug manufacturer Abbvie’s CEO over its pricing practices particularly for its blockbuster drug Humira during a hearing held today.

Three powerful Democrats wrote to the Federal Trade Commission Tuesday urging them to investigate whether drug maker AbbVie violated the law in trying to keep cheaper versions of its blockbuster drug Humira off the market.

The surprise announcement came in the first minutes of a Tuesday hearing held by the House Oversight Committee investigating the company’s pricing practices. AbbVie’s CEO Richard Gonzalez is testifying.

“I sent a letter to the FTC today … asking for a formal inquiry into whether AbbVie’s anticompetitive practices violated the law,” said the committee’s chair, Rep. Carolyn Maloney (D-N.Y.). The letter was also signed by the chair of the House Judiciary Committee, Rep. Jerrold Nadler (D-N.Y), and the chair of that committee’s antitrust subcommittee, Rep. David Cicilline (D-R.I.).

From the tidbit front

  • The Internal Revenue Service released guidance for employers on the American Rescue Plan’s subsidization of COBRA continuation coverage for employees who lose their health coverage due to an involuntary termination or reduction in hours.
  • The Department of Health and Human Services announced that its “Substance Abuse and Mental Health Services Administration (SAMHSA) is distributing $3 billion in American Rescue Plan funding — the largest aggregate amount of funding to date for its mental health and substance use block grant programs. The Community Mental Health Services Block Grant (MHBG) Program and Substance Abuse Prevention and Treatment Block Grant Program (SABG) will disperse $1.5 billion each to states and territories (with the latter also awarding money to a tribe). This follows the March announcement of supplemental funding of nearly $2.5 billion for these programs.”
  • The U.S. Preventive Services Task Force released a new final recommendation that persons aged 45 through 49 should receive screening for colorectal cancer. This supplements USPSTF’s current recommendation that persons aged 50 to 75 received this testing. The new recommendation will become a mandate on FEHB carriers and other group health plans to provide in-network coverage with no member cost sharing for this service for the lower aged cadre beginning January 1, 2023.
  • In 2019 the FEHBlog heard a hospital system executive vociferously object to Medicare’s new site neutrality policy under which Medicare pays the same rate whether the service is rendered inpatient or outpatient. It occurred to the FEHBlog that this site neutrality rule may lower healthcare costs. Needless to say, a trade association lawsuit challenged the rule, and the government won before the U.S. Court of Appeals for the D.C. Circuit. Healthcare Dive reports that Justice Department is opposing the American Hospital Association’s petition for U.S. Supreme Court review of the D.C. Circuit ruling.