Weekend update

COVID-19

Weekend update

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

In view of the impending national election on Tuesday, Congress is out of session for the next two weeks except for one Committee hearing on November 10.

On the COVID-19 front –

  • The Wall Street Journal reports about research and medical efforts to address the health problems of so-called COVID-19 long haulers.

Nearly a year into the global coronavirus pandemic, scientists, doctors and patients are beginning to unlock a puzzling phenomenon: For many patients, including young ones who never required hospitalization, Covid-19 has a devastating second act.

Many are dealing with symptoms weeks or months after they were expected to recover, often with puzzling new complications that can affect the entire body—severe fatigue, cognitive issues and memory lapses, digestive problems, erratic heart rates, headaches, dizziness, fluctuating blood pressure, even hair loss.

What is surprising to doctors is that many such cases involve people whose original cases weren’t the most serious, undermining the assumption that patients with mild Covid-19 recover within two weeks. Doctors call the condition “post-acute Covid” or “chronic Covid,” and sufferers often refer to themselves as “long haulers” or “long-Covid” patients.

According to the article, the estimated numbers of long haulers varies “widely.” Nevertheless, [w]ith more than 46 million cases world-wide, even the lower estimates would translate into millions living with long-term, sometimes disabling conditions, increasing the urgency to study this patient population, researchers said. What they find could have implications for how clinicians define recovery and what therapies they prescribe, doctors said.” What’s more, “[o]ther viral outbreaks, including the original SARS, MERS, Ebola, H1N1 and the Spanish flu, have been associated with long-term symptoms.”

  • Last Friday, ” the U.S. Department of Health and Human Services (HHS) and the U.S. Department of Defense (DOD) jointly announced a $12.7 million contract with InBios International Inc., of Seattle, to expand domestic production capacity for two rapid point-of-care tests for SARS-CoV-2, the virus that causes COVID-19. The first, called the SCoV-2 Ag Detect Kit, detects current infections by identifying antigens – genetic material – of the virus in a nose swab sample. The second test, called the SCoV-2 Detect IgM/IgG Kit, detects antibodies for the virus in a finger prick of blood, indicating whether the person had a previous COVID-19 infection. The contract enables InBios to ramp up production of either or both tests to 400,000 units per week – 20 times the facility’s current output – by May 2021, significantly expanding the nation’s testing capacity.

Fierce Healthcare informs us

According to UnitedHealth Group’s fifth annual UnitedHealthcare Consumer Sentiment Survey, which examines Americans’ opinions about multiple areas of healthcare, a survey-record 56% said it is likely they would use virtual care for medical services.  More than a quarter of respondents (26%) said they would prefer a virtual relationship with a primary care physician, the survey found. And when comparison shopping for care, 55% of respondents said they had used the internet or mobile apps to comparison shop for healthcare during the past year, with 1 in 4 patients saying that online or mobile resources were their first option for evaluating health issues.

Follow up on a couple of stories that the FEHBlog has been following:

  • Health Payer Intelligence discusses various angles on the payer transparency rule that the ACA regulators issued last week. That rule is applicable to the FEHBP.
  • A friend of the FEHBlog related that the federal government has noticed an appeal to the D.C. Circuit of District Judge James Boasberg’s September 2, 2020, decision preliminarily enjoining certain provisions of the Trump Administration’s revised ACA Section 1557 rule that adversely affected transgendered people. The government’s 60 day period to notice such an interlocutory appeal would have expired tomorrow.

Friday Stats and More

David Ermer–COVID-19, OPM, Telehealth–

Based on the CDC’s Cases in the U.S. website, here is the FEHBlog’s chart of new weekly COVID-19 cases and deaths over the 20th through 43rd weeks of this year (beginning May 14 and ending October 28; using Thursday as the first day of the week in order to facilitate this weekly update):

By golly that’s a wavelike graph of new cases but bear in mind that new weekly cases have been over 200,000 since late June.

Here is the CDC’s latest overall weekly hospitalization rate chart for COVID-19:

Although hot spots for hospitalizations continue to occur around the country, the overall hospitalization rate is trending down even while new cases jump.

The FEHBlog has noted 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 COVID-19 deaths over the same period (May 14 through October 28).

In this regard, Medscape reports that

A new study conducted by researchers at Imperial College London found the COVID-19 infection fatality ratio is about 1.15% of infected people in high-income nations [e.g. the U.S.] and 0.23% in low-income nations.

The infection fatality ratio (IFR) represents the proportion of deaths among all infected individuals. It is “a key statistic for estimating the burden of COVID-19 and has been continuously debated throughout the current pandemic,” the Imperial College London said in a news release.

For context here are stats that the FEHBlog captured for the 2019-2020 flu season in the U.S.

CDC Fluview 28-Mar
Flu Deaths24000
Flu Cases39,000,000
Deaths over total cases0.06%

The CDC’s latest Fluview surveillance report indicates that seasonal flu activity in the United States remains low.

In other telehealth news, Healthcare Dive reports

  • “Teladoc has completed its $18.5 billion acquisition of Livongo following overwhelming shareholder approval, the virtual care giant announced Friday. Under the terms of the merger, Livongo shareholders will receive 0.5920 times shares of Teladoc, plus cash of $11.33 for each Livongo share. Teladoc shareholders will own about 58% of the combined company, and Livongo shareholders about 42%.” The merged company will continue to use the Teladoc name and its Purchase NY headquarters. Now that the merger has closed, “several of Livongo’s top executives, including CEO Zane Burke and President Jennifer Schneider, will depart the company, along with Livongo’s CFO and SVP of Business Development. The combined company’s board will consist of eight directors from Teladoc, including CEO Jason Gorevic, and five from Livongo, including founder Glen Tullman.”
  • More generally, “telehealth claim lines increased 3,552% in August this year compared to last, according to new data from Fair Health’s monthly tracker. Virtual care volume was relatively flat compared to July, following two months of declines, hinting at the staying power of telehealth even as COVID-19 cases fluctuate nationwide. Telehealth rose from just 0.17% of all medical claim lines in August last year to 6.07% this year. That’s compared to 6% in July this year.”

Federal News Network informs us that

The Office of Personnel Management has told its workforce it’s no longer actively pursuing the administration’s proposed merger with the General Services Administration.

In an email to staff, which covered everything from flu shots for employees to the status of reopening agency facilities, acting OPM Director Michael Rigas said Thursday he wanted to provide an update about the administration’s proposed GSA merger.

“As Congress has not acted on the administration’s legislative proposal, we are no longer devoting time and energy to the merger and are focused on ensuring OPM can function as a standalone personnel agency for the federal government,” Rigas said in the email, which Federal News Network obtained. “We are also conducting an independent analysis of the agency to help inform how OPM can best carry out its mission and meet the needs of the American people.”

A senior OPM official told Federal News Network the agency was looking at other options, especially now that the governmentwide security clearance business had moved to the Defense Department.

Thursday Miscellany

David Ermer–ACA, CDC, COVID-19, HIPAA Privacy and Security Rules, Medicare, U.S. Healthcare–
Photo by Juliane Liebermann on Unsplash

Today’s big news is that the ACA regulators (the Departments of Health and Human Services (“HHS”), Labor, and Treasury) finalized a lengthy pricing transparency rule for payers, including ERISA and FEHBP group health plans (see footnote 233). The related fact sheet explains

This final rule includes two approaches to make health care price information accessible to consumers and other stakeholders, allowing for easy comparison-shopping.

First, most non-grandfathered group health plans and health insurance issuers offering non-grandfathered health insurance coverage in the individual and group markets will be required to make available to participants, beneficiaries and enrollees (or their authorized representative) personalized out-of-pocket cost information, and the underlying negotiated rates, for all covered health care items and services, including prescription drugs, through an internet-based self-service tool and in paper form upon request. For the first time, most consumers will be able to get real-time and accurate estimates of their cost-sharing liability for health care items and services from different providers in real time, allowing them to both understand how costs for covered health care items and services are determined by their plan, and also shop and compare health care costs before receiving care. An initial list of 500 shoppable services as determined by the Departments will be required to be available via the internet based self-service tool for plan years that begin on or after January 1, 2023. The remainder of all items and services will be required for these self-service tools for plan years that begin on or after January 1, 2024.

Second, most non-grandfathered group health plans or health insurance issuers offering non-grandfathered health insurance coverage in the individual and group markets will be required to make available to the public, including stakeholders such as consumers, researchers, employers, and third-party developers, three separate machine-readable files that include detailed pricing information.
The first file will show negotiated rates for all covered items and services between the plan or issuer and in-network providers.
The second file will show both the historical payments to, and billed charges from, out-of-network providers. Historical payments must have a minimum of twenty entries in order to protect consumer privacy.
And finally, the third file will detail the in-network negotiated rates and historical net prices for all covered prescription drugs by plan or issuer at the pharmacy location level.
Plans and issuers will display these data files in a standardized format and will provide monthly updates. This data will provide opportunities for detailed research studies, data analysis, and offer third party developers and innovators the ability to create private sector solutions to help drive additional price comparison and consumerism in the health care market. These files are required to be made public for plan years that begin on or after January 1, 2022.

The final rule also provides some medical loss ratio relief to compliant health insurance issuers as explained in the fact sheet. Here is AHIP’s reaction to the final rule.

Also today HHS issued an interim final rule with a comment period that “extends the compliance dates and timeframes necessary to meet certain requirements related to information blocking and Conditions and Maintenance of Certification (CoC/MoC) requirements. Released to the public on March 9, 2020, ONC’s Cures Act Final Rule established exceptions to the 21st Century Cures Act’s information blocking provision and adopted new health information technology (health IT) certification requirements to enhance patients’ smartphone access to their health information at no cost through the use of application programming interfaces (APIs).” The rule had been scheduled to take effect beginning next week.

Fierce Healthcare reports that “Regeneron’s anti-SARS-CoV-2 antibody cocktail has significantly reduced medical visits in ambulatory COVID-19 patients. The phase 2/3 clinical trial linked REGN-COV2 to a 57% decline in medical visits associated with COVID-19 in the 29 days after treatment.”

HealthPartners, a Minneapolis health insurer that participates in the FEHBP, offers a helpful, complete explanation of the benefits of wearing masks to prevent COVID-19. “At its core, wearing a mask is an act of kindness and neighborliness. It’s one of the simplest good deeds you can do these days, and a great way to be a force of positivity for the people in your life.”

Fierce Healthcare reports

The financial crisis for hospitals and physician practices caused by the COVID pandemic is a “clarion call” for the healthcare industry to move from a fee-for-service payment model to value, said Kevin Mahoney, chief executive officer of the University of Pennsylvania Health System (Penn Medicine).

“The hospital sector has taken a giant hit. We keep hearing about ‘the new normal.’ The lesson that we learned is that there is nothing new or normal about a pandemic, there’s just been an acceleration of trends,” Mahoney said during a recent virtual event hosted by the University of Pennsylvania. “It has laid bare how dependent hospitals are on commercially-insured, elective procedures, and without them, we don’t make money.”

The FEHBlog’s youngest son is a research coordinator for Penn Medicine. The FEHBlog seconds his boss’s sentiments.

The Surgeon General issued a timely

Call to Action to Control Hypertension (Call to Action) seeks to avert the negative health effects of hypertension by identifying evidence-based interventions that can be implemented, adapted, and expanded in diverse settings across the United States.

The Call to Action outlines three goals to improve hypertension control across the United States, and each goal is supported by strategies to achieve success:

Goal 1. Make hypertension control a national priority.
Goal 2. Ensure that the places where people live, learn, work, and play support hypertension control.
Goal 3. Optimize patient care for hypertension.

Following up on yesterday’s post about mandatory of coverage of COVID-19 vaccines with no member cost sharing once available, the FEHBlog wants to add that the same rule applies to Medicare. CMS “estimates the overall cost of providing the vaccine to every senior on Medicare would be around $2.6 billion, which would be covered by the federal government. CMS will also cover the vaccine for any uninsured individuals by using money from a $175 billion provider relief fund passed as part of the CARES Act.” It appears however that the vaccine would be administered through the Part D program. That would not be much help to FEHB plans as most FEHB members with primary Medicare coverage does not carry Medicare Part D.

Nextgov reports that

The Health and Human Services Department, the Cybersecurity and Infrastructure Security Agency and the FBI warn hospitals face an imminent threat from cybercriminals that encrypt and hold their data hostage—and some health care facilities are already dealing with the fallout.

The agencies collectively issued an advisory Wednesday detailing the tactics, techniques and procedures reportedly used against at least five hospitals already this week. The advisory includes recommendations for mitigating what observers are referring to as the most serious cyber threat the U.S. has seen to date, being perpetrated by an especially ruthless group of criminals.  

“CISA, FBI, and HHS have credible information of an increased and imminent cybercrime threat to U.S. hospitals and healthcare providers,” reads the advisory.

Midweek Update

David Ermer–ACA, COVID-19, Telehealth, U.S. Healthcare–
Photo by Manasvita S on Unsplash

The Affordable Care Act regulators (the Departments of Health and Human Services, Labor and Treasury) issued an interim final rule with an opportunity to comment (“IFC”) on coverage of COVID-19 preventive services. This rule focuses on coverage of COVID-19 vaccinations. The fact sheet explains with respect to private plans, including FEHB plans, that

the Departments [have] amend[ed] existing regulations to implement the unique requirements related to rapid coverage of qualifying coronavirus preventive services. This coverage is required to be provided within 15 business days after the date on which the United States Preventive Services Task Force or the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) makes an applicable recommendation relating to a qualifying coronavirus preventive service.

Specifically, plans and issuers must cover COVID-19 immunizations that have in effect a recommendation of ACIP with respect to the individual involved, even if not listed for routine use on the Immunization Schedules of the CDC. This IFC also provides that during the public health emergency for COVID-19, plans and issuers must cover without cost sharing qualifying coronavirus preventive services, regardless of whether an in-network or out-of-network provider delivers such services. The IFC also affirms that plans and issuers subject to section 2713 of the Public Health Service Act must cover without cost sharing items and services that are integral to the furnishing of recommended preventive services, including the administration of COVID-19 immunizations.

In related news, Route Fifty reports that

When the coronavirus vaccine arrives on the market, demand will far exceed supply. During those first few months, state and county public health officials will face tough questions about who should be first in line to get one of the limited vaccine doses. The Vaccine Allocation Planner for Covid-19, a new tool released Wednesday, aims to help make those decisions with data.

Jointly developed by Ariadne Labs, a project run out of Brigham and Women’s Hospital and the Harvard T.H. Chan School of Public Health, and the Surgo Foundation, a nonprofit at the intersection of behavioral and data science, the tool allows policymakers to look at region-specific data. They can estimate the size of high-risk populations, consider factors like particular community’s vulnerabilities, and run scenarios based on an estimated number of vaccine doses available.

The New York Times maintains a COVID-19 vaccine tracker here

In other healthcare news —

Anthem beat Wall Street’s third-quarter expectations on earnings and reported revenue of $31.2 billion, up 16.8% from the year prior, in results released Wednesday morning. Expenses, however, were up more than 22% year over year, leaving profit to plummet roughly 80%.
Total medical membership jumped 4%, attributed to increases in Medicare and Medicaid rolls. Anthem CEO Gail Boudreaux said on the earnings call the overall membership trends are outpacing internal expectations.
The payer also reported a $594 million payment in Q3 toward a federal antitrust settlement reached with Blue Cross Blue Shield plans that is still awaiting approval by a judge. Other terms include nixing the “best efforts” rule that required member plans to generate at least two-thirds of their annual revenue from Blues brands and allowing employers to request a second bid from a non-local Blues plan, Boudreaux said, adding “we don’t see this changing our strategy.”

There is a clear overlap between specialties that are using telemedicine the most, and those specialties that manage chronic illnesses, such as endocrinology and rheumatology. Treating long-term chronic conditions like diabetes and arthritis require frequent patient visits, but they don’t always need to be in-person. For patients that require long-term care, telemedicine tools can reduce taxing trips to hospitals or clinics.

Doximity is a professional network for physicians.

  • Medpage Today lets us know that

Screening for colorectal cancer (CRC) should begin at age 45 for all average-risk adults in the United States, the U.S. Preventive Services Task Force (USPSTF) recommends in a guideline draft. Screening should continue at recommended intervals until age 75, the draft states. For patients ages 76 to 85, the decision to continue screening should be based on an individualized assessment of the benefits and harms associated with screening.

Currently FEHB plans are required to cover CRC screening with no member cost sharing for members beginning at age 50. If this guideline is finalized in 2020, the no cost sharing coverage requirement would drop to age 45 on January 1, 2022 pursuant to the Affordable Care Act’s requirements.

Here is a list of all of the USPSTF Grade A and B preventive service for adults recommendations which are eligible for cost free coverage starting in the plan year that begins on or after exactly one year from the issue date. FEHB plan years follow the calendar year, but not all health plans do.

Tuesday Tidbits

David Ermer–COVID-19, OPM, U.S. Healthcare, Uncategorized–
Photo by Patrick Fore on Unsplash

Federal News Network called the FEHBlog’s attention to the fact that the OPM Inspector General has released his annual report on top management challenges that OPM faces, a number of which as always concern the FEHBP.

The IRS yesterday released a boatload of 2021 tax information —

  • Rev. Proc. 2020-45 provides inflation-adjusted items for 2021. Of note the Society for Human Resource Management points out that

For 2021, the dollar limit for employee contributions to health flexible spending accounts (health FSAs), made pretax through salary reductions, remains unchanged at $2,750, the IRS announced on Oct. 27 when it issued Revenue Procedure 2020-45.

The limit also applies to limited-purpose FSAs that are restricted to dental and vision care services, which can be used in tandem with health savings accounts (HSAs).

For health FSA plans that permit the carryover of unused amounts, the maximum carryover amount for 2021 is $550, an increase of $50 from the original 2020 carryover limit.

  • IRS Notice 2020-79 provides inflation-adjustments “affecting dollar limitations for 401(k), pension plans and other retirement-related items for tax year 2021. The contribution limit for employees who participate in 401(k), 403(b), most 457 plans, and the federal government’s Thrift Savings Plan remains unchanged at $19,500.”

Medscape reports that

Eli Lilly announced it will halt its ACTIV-3 trial evaluating the antibody bamlanivimab in combination with remdesivir for people hospitalized with COVID-19, after new evidence regarding efficacy emerged. The new data from the National Institutes of Health suggest that the experimental neutralizing antibody therapy does not offer significant clinical benefit for people with more advanced COVID-19 illness, according to a company statement. Eli Lilly also announced it plans to continue its other trials evaluating the antibody, including those assessing a potential role in treating people in the earlier stages of COVID-19.

A friend of the FEHBlog called his attention to this interesting NCQA publication on social determinants of health. Check it out.

Health Affairs provides a useful perspective on low value care in the age of COVID-19. In short,

There is the chance to use surveys or qualitative methods to compare the diverse harms experienced by patients who did and did not receive a low-value service because of the COVID-19 pandemic. It will be important to examine harms both across and within potentially high-risk or vulnerable subpopulations, as the distribution of harms may differ by demographics, social determinants, and presence of comorbid illnesses.

And to close the loop, the Senate confirmed Judge Amy Coney Barrett to be an Associate Justice of the U.S. Supreme Court last evening, and Justice Barrett was sworn in soon thereafter. The Senate has joined the House of Representatives on the campaign trail.

Monday Roundup

David Ermer–ACA, COVID-19, OPM, Rx coverage, U.S. Healthcare–
Photo by Sven Read on Unsplash

Healthcare Dive reports that Utah-based “Intermountain Healthcare and South Dakota-based Sanford Health announced Monday that the two had signed a letter of intent to merge. Together the two will operate 70 hospitals — many of which will be located in rural communities across the country — and 435 clinics and insure 1.1 million people.” Intermountain participates in the FEHB under the name of its affiliate SelectHealth.

The Labor Department’s Employee Benefit Security Administration (“EBSA”) released its 2020 edition of its federal mental health and substance use disorder parity self compliance tool for health plans. The first edition was released in April 2018. What’s more on Thursday October 29 at 2 pm ET EBSA will hold a free compliance assistance webcast on this complicated law.

Here’s a link to OPM’s third quarter 2020 report on the development of its Master Enrollment Index for the FEHBP.

The Centers for Medicare and Medicaid Services posted information today about the ACA federal marketplace open enrollment period which begins on Saturday November 1 and ends on December 15, 2020.

Over the weekend, the FEHBlog read in the Wall Street Journal’s Numbers column about COVID-19 mortality predictions. The author explains that

Now, as many as 50 different research groups make predictions, but one of the most accurate assembles all of the individual models, calculates the median value and looks no more than four weeks into the future.

The ensemble forecast was founded by the Reich Lab at the University of Massachusetts, Amherst, in collaboration with the Centers for Disease Control and Prevention and is based in part on models previously developed to forecast influenza and other infectious diseases.

In the next four weeks, it predicts the total number of deaths attributed to the new coronavirus will surpass 240,000—adding roughly 17,000 deaths to the current tally.

Such projections help policy makers and health-care officials decide how to manage resources and implement or relax interventions intended to curb the spread of the disease.

On the brighter side —

  • The Wall Street Journal reports that

A Covid-19 vaccine being developed by the University of Oxford and AstraZeneca AZN 2.06% PLC showed a promising immune response and low levels of adverse reactions in the elderly and older adults, according to an interim analysis that the drugmaker said was encouraging.

The vaccine, now in late-stage human trials aimed at showing its efficacy and safety, is a front-runner in the global sprint for a shot to protect lives and jump-start economies hobbled by the pandemic. Trials in the U.K. could produce results before year-end, fueling hopes among scientists and government leaders that a vaccine might be available for high-risk groups here by early 2021.

  • Fierce Healthcare informs us that “CVS views its pharmacists as playing a key role in assuaging fears, CEO Larry Merlo said Friday. Merlo, speaking at an event hosted by The Washington Post, said that pharmacists “are among the most trusted professionals” in the industry and as such will be able to educate patients about the safety and efficacy of the vaccine.”
  • Fierce Healthcare also recognizes “ten women who have risen to the challenges posed by COVID, as well as played a role in positioning their respective companies to be where they are today.” For example, Anthem Blue Cross’ Liz Kwo M.D. is scaling digital products to improve outcomes. Bravo to all of the winners.

Weekend update

David Ermer–AHRQ, Congress, COVID-19, Mental health care, Telehealth, U.S. Healthcare–
Lincoln Memorial in the Fall

The House of Representatives is on the campaign trail. The Senate will join them tomorrow after a confirmation vote on Judge Amy Coney Barrett’s nomination to the Supreme Court. Her nomination narrowly cleared a cloture vote at the Senate today. If you want to understand why the Supreme Court will not strike down the Affordable Care Act this term even with Judge Barrett on its illustrious bench, click here.

There is only one Congressional hearing this week — a Senate Commerce Committee hearing on Wednesday morning, October 28, about the federal internet liability shield. The witnesses will be the CEOs from Twitter, Alphabet/Google, and Facebook, large companies that currently benefit from this shield. Congress returns to its legislative business on November 16 following the Presidential and Congressional election on November 3.

Today, the Department of Health and Human Services shared news on how States and the District of Columbia will use the rapid COVID-19 BinaxNOW tests that the federal government purchased on their behalves. “HHS also provided all CLIA-certified nursing homes over 11 million rapid, point-of-care tests. The tests include the following FDA-authorized antigen diagnostic tests: Abbott BinaxNOW and either a Quidel Sofia 2 or Becton, Dickinson and Company (BD) Veritor™ Plus System instrument(s).”

The Washington Post’s Lily website offers an interview with a 14 year young lady, Anika Chebrolu, who was awarded a $25,000 prize “for her discovery: a compound that can bind to the coronavirus [COVID-19-, inhibiting its ability to infect people. She beat out nine other finalists — whose own projects ranged from a robotic glove to a device that detects invisible particles in water — to be named America’s top young scientist.” Ms. Chebrolu modestly explains that “my effort to find a spike protein binder isn’t unique in its methodology, and it may appear to be a drop in the ocean, but it adds to all these efforts and therefore is quite substantial.” Congratulations.

It’s also worth pointing out this Healthcare Dive article informing us that

Medical device funding hit a new high in the third quarter, growing 63% year on year to top $5 billion for the first time in CB Insights’ dataset. Investments in robotic surgery startups was a major driver of the increase. The analysts listed the progress of neuromodulation devices and Medtronic’s deals in diabetes and neurosurgery as other medical device highlights of the quarter.

The Mayo Clinic explains that “Robotic surgery, or robot-assisted surgery, allows doctors to perform many types of complex procedures with more precision, flexibility and control than is possible with conventional techniques. Robotic surgery is usually associated with minimally invasive surgery — procedures performed through tiny incisions.”

The International Modulation Society further explains that

Neuromodulation is technology that acts directly upon nerves. It is the alteration—or modulation—of nerve activity by delivering electrical or pharmaceutical agents directly to a target area.

Neuromodulation devices and treatments are life changing. They affect every area of the body and treat nearly every disease or symptom from headaches to tremors to spinal cord damage to urinary incontinence. With such a broad therapeutic scope, and significant ongoing improvements in biotechnology, it is not surprising that neuromodulation is poised as a major growth industry for the next decade.

Most frequently, people think of neuromodulation in the context of chronic pain relief, the most common indication. However, there are a plethora of neuromodulation applications, such as deep brain stimulation (DBS) treatment for Parkinson’s disease, sacral nerve stimulation for pelvic disorders and incontinence, and spinal cord stimulation for ischemic disorders (angina, peripheral vascular disease).

Cochlear implants to treat deafness, for example, are intermodulation devices.

The FEHBlog noticed on Twitter today that the HHS Agency for Healthcare Quality and Research has made available in the Apple Store and Google Play an app to help patients to develop questions for the doctor visits.

On the healthcare survey and report front

The top 12 reasons for using telehealth, according to the 2020 survey, are listed below, with the 2019 ranking and percentages in parentheses:

  1. Convenience, 51 percent (1, 64 percent)
  2. Safety, 46 percent (12, 13 percent)
  3. Speed – ability to receive care quickly, 44 percent (2, 53 percent)
  4. Quality care, 30 percent (6, 25 percent)
  5. Condition covered by telehealth visit, 28 percent (7, 22 percent)
  6. Ease of access to health information, 27 percent (3, 34 percent)
  7. Convenient communication channels, 26 percent (4, 33 percent)
  8. Lower overall cost, 23 percent (5, 30 percent)
  9. Difficult to travel to medical office, 21 percent (7, 20 percent)
  10. Recommendation, 19 percent (7, 20 percent)
  11. Reputation, 19 percent (11, 14 percent)
  12. Past experience, 17 percent (9, 19 percent).
  • Health Payer Intelligence reports that

Around a third of Millennials [ages 24 – 39] have a behavioral health condition, emphasizing a greater need for behavioral healthcare options and coverage as well as a new approach to millennial member engagement, the latest Blue Cross Blue Shield Association (BCBSA) report revealed. * * * Not only do Millennials have a high percentage of behavioral health conditions but their rate of developing a behaioral health condition is rising by double digits. Over five years from 2014 through 2018, the prevalence of major depression rose by 43 percent, ADHD rose by 39 percentage percent, and psychotic disorders rose by 26 percent among Millennials.”

Friday Stats and More

David Ermer–COVID-19–

Based on the CDC’s Cases in the U.S. website, here is the FEHBlog’s chart of new weekly COVID-19 cases and deaths over the 20th through 42nd weeks of this year (beginning May 14 and ending October 21; 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 noted 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 COVID-19 deaths over the same period (May 14 through October 21):

The Wall Street Journal explains that

Epidemiologists and public-health researchers have said a number of factors, from pandemic fatigue to the return of college students to campuses and more social gatherings, are contributing to the latest rise in cases [as reflected in the top chart]. The recent increases are affecting broader swaths of the U.S. than the spring and summer surges, when outbreaks were heavily concentrated in a handful of states. “Outbreaks spread just like a fire,” said Emily Landon, an infectious-disease expert at the University of Chicago Medicine. “The more people are sick, the more people will be sick the next day.”

In the it could be worse department, the CDC also reports that “Seasonal influenza activity in the United States remains low.”

Thursday Miscellany

David Ermer–COVID-19, Employee Wellness Programs, Federal employment benefits, SCOTUS, U.S. Healthcare–
Photo by Juliane Liebermann on Unsplash

The Senate Judiciary Committee sent Judge Amy Coney Barrett’s Supreme Court nomination to the Senate floor today. The Senate will confirm the nomination on Monday and Judge Barrett will be sworn in soon thereafter. Consequently, Judge Barrett will be sitting on Supreme Court bench when the Court hears the Affordable Care Act constitutionality case on November 10. The FEHBlog predicts a 9-0 decision in favor of the law’s constitutionality with the exception of the zeroed out individual mandate.

On the COVID-19 front, Medscape reports as follows:

  • The Food and Drug Administration gave marketing approval to Gilead Science’s “remdesivir (Veklury) today as a treatment for hospitalized COVID-19 patients age 12 and up, making it the first and only approved treatment for the disease.”
  • The Centers for Disease Control updated its COVID-19 social distancing guidance: “Previously, the CDC cautioned against spending 15 minutes or longer in close proximity to an infected person, particularly in enclosed indoor spaces. In a new report published online October 21 in Morbidity and Mortality Weekly Report, however, investigators ‘determined that an individual who had a series of shorter contacts that over time added up to more than 15 minutes became infected.'”
  • Dr. Anthony Fauci predicts that “People will likely need to wear masks and follow social distancing guidelines through the end of 2021 and into 2022.”

Healthcare Dive informs us about four healthcare story lines that COVID-19 has overshadowed this year — — 1. Price transparency going strong; 2. Companies rush to go public; 3. Surprise billing efforts slow to a crawl, and 4. preference for healthcare at home. The FEHBlog is pleased to reflect that he has been discussing these matters and COVID-19 this year.

Govexec reports on the eight most important birthdays for federal employees from a federal employee retirement standpoint — the birthdays range from ages 50 to 72

The Society for Human Management provides a comprehensive update on employer and health plan sponsored wellness programs which is worth a gander.

Beckers Hospital Review alerts us that “Healthgrades named the recipients of its 2021 Specialty Excellence Awards Oct. 20, which include the top hospitals for critical care.” The article lists the 214 award winners by state.

Saturday October 24 is National Prescription Drug Take Back Day. “Check DEA’s official Take Back Day website for more information and to find year-round collection sites near you.”

Finally in a man bites dog story, the Wall Street Journal headlines tonight on its website that “Walmart sued the federal government in an attempt to strike a pre-emptive blow against what it said is an impending opioid-related civil lawsuit from the Justice Department.” Best defense, etc. The article notes that “Quicken Loans Inc. tried a similar tactic against the federal government in 2015 to avoid being pegged with mortgage fraud, but the Justice Department sued weeks later in a case Quicken settled last year.” The FEHBlog expects the same outcome with this lawsuit.

Midweek update

David Ermer–Congress, COVID-19 vaccine, Telehealth–
Photo by Manasvita S on Unsplash

The Hill brings us up to date on the status of bipartisan negotiations over a COVID-19 relief bill. At least the negotiated bill may be teed up for the lame duck session of Congress next month.

On Monday, Healthcare Dive reported the CVS Health is hiring 10,000 pharmacy technicians to administer vaccinations and today, and today

the U.S. Department of Health and Human Services (HHS), through the Assistant Secretary for Health (ASH), issued guidance under the Public Readiness and Emergency Preparedness Act (PREP Act) authorizing qualified pharmacy technicians and State-authorized pharmacy interns to administer childhood vaccines, COVID-19 vaccines when made available, and COVID-19 tests, all subject to several requirements. This guidance clarifies that the pharmacy intern must be authorized by the State or board of pharmacy in the State in which the practical pharmacy internship occurs, but this authorization need not take the form of a license from, or registration with, the State board of pharmacy.

Smart move, CVS.

On Monday, NCQA released the results of its Spring 2020 telehealth questionnaire. Check it out.

On the opioid front, the Wall Street Journal reports today that

Purdue Pharma LP agreed to plead guilty to three felonies related to its marketing and distribution of powerful painkiller OxyContin, as part of an $8.34 billion settlement that caps yearslong federal investigations into tactics the government said helped fuel the opioid crisis.

The Justice Department unveiled the settlement Wednesday, alongside a deal with Purdue’s owners, members of the Sackler family. The price tag for Purdue, however, is largely symbolic: The bankrupt company’s assets fall well short of $8 billion. It will pay the federal government $225 million, and much of the rest of the fines will be waived to allow more money to flow to states, counties and tribes that accuse Purdue of sparking widespread opioid addiction and deaths.

The Sacklers, meanwhile, resolved civil charges for a separate $225 million, but prosecutors made clear criminal investigations into the family continue.