Tuesday Tidbits

Tuesday Tidbits

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

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

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

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

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

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

Monday Roundup

On the COVID-19 front

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

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

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

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

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

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

Thursday Miscellany

Earlier this month, the National Center for Health Statistics released a report on 2019 births in our country. Here are some notable snippets from that report:

  • The provisional number of births for the United States in 2019 was 3,745,540, down 1% from the number in 2018 (3,791,712). This is the fifth year that the number of births has declined after the increase in 2014, down an average of 1% per year, and the lowest number of births since 1985.
  • The birth rate for teenagers in 2019 was 16.6 births per 1,000 females aged 15–19, down 5% from 2018 (17.4), reaching another record low for this age group. The rate has declined by 60% since 2007 (41.5), the most recent period of continued decline, and 73% since 1991, the most recent peak.
  • The low-risk cesarean delivery rate, or cesarean delivery among nulliparous (first birth), term (37 or more completed weeks based on the obstetric estimate), singleton (one fetus), vertex (head-first) births, also decreased to 25.6% of births in 2019 from 25.9% in 2018.
  • The percentage of infants born preterm (births at less than 37 completed weeks of gestation) fell 8% from 2007 (the most recent year for which national data are available based on the obstetric estimate of gestation) to 2014, but has risen 7% from 2014 (9.57%) to 2019.

Healthcare Dive reports that

The number of Medicare beneficiaries using telehealth skyrocketed in the early weeks of the pandemic as the Trump administration relaxed regulations to virtual care.

The looser regulations are only in place for the extent of the national public health emergency, but myriad groups have called on HHS to permanently relax the barriers. Top administration health officials have said they’re exploring the possibility.

Here’s hoping.

Health IT Security informs us about Verizon’s latest data breach investigations report.

For healthcare, there were 798 security incidents and 521 confirmed data breaches in 2019, compared to 304 incidents in the previous year. While miscellaneous insider errors, privilege misuse, and web applications were the leading causes 2018 healthcare data breaches, external threats outpaced insiders in this year’s report.

In fact, 51 percent of healthcare data breaches were caused by external actors, and insider-related breaches fell to 48 percent. Despite the slight increase in external-related breaches, healthcare does remain the leading industry for internal bad actors.

It’s not always a good thing to be in first place.

Let’s wrap it up with a story about responsible corporate citizenship. Becker’s Hospital CFO Report informs us that

CMS automatically sent out the first slice of federal funding under the Coronavirus Aid, Relief and Economic Security Act based on historical Medicare fee-for-service reimbursement. Now, several companies are returning the relief aid.

[Healthcare companies] Cigna, CVS Health, DaVita, Encompass and Walmart are among the companies sending back federal grants they received under the CARES Act, which are meant to reimburse healthcare providers for expenses or lost revenues tied to the COVID-19 pandemic, according to Business Insider. The companies are returning a total of nearly $574 million.

The common reason for returning these large amounts of money was aptly stated by CVS Health:

“We have made the decision to return the funds and forgo participation in subsequent disbursements,” CVS Health President and CEO Larry Merlo wrote in a May 19 letter to HHS Secretary Alex Azar. “In doing so, we hope to help HHS provide additional support to other providers who are facing significant financial challenges as a result of the pandemic.”


Monday Roundup

Fierce Biotech reports on today’s positive but not definitive results from Moderna’s early COVID-19 vaccine testing. “With eyes on a phase 3 study this summer, Moderna posted promising early data for its COVID-19 vaccine. The jab prompted an immune response similar to those seen in patients who have recovered from the disease.” Fingers crossed.

CVS Health, Walgreen’s and Rite Aid / Verily continue to expand their drive up COVID-19 testing capabilities. Healthcare Dive reports that the Food and Drug Administration (“FDA”) last Friday “authorized multiple laboratories to test for coronavirus in nasal samples collected by consumers using an at-home kit” produced by Everlywell. This is the second FDA approved at home kit.

What’s more, Fierce Biotech reports that Verily’s Project Baseline “has launched a new clinical research effort focused on COVID-19 antibody testing and exploring the body’s immune response to the novel coronavirus.” Fierce Healthcare adds that the American Medical Association is offering guidance on COVID-19 antibody testing for physicians. “Although many are using these tests to determine whether an individual had COVID-19, we encourage physicians to only use antibody tests authorized by the FDA and only for the purposes of population-level studies [like the Project Baseline study], evaluating recovered individuals for convalescent plasma donations, or along with other clinical information as part of a well-defined testing plan for groups or individuals.”

A friend of the FEHBlog called his attention to this federal government list of top ten routinely exploited cybersecurity vulnerabilities and mitigations over the period 2016 through 2019 and this year.

Weekend update

Happy Mother’s Day.

Just like last week, the Senate will be in session this week while the House continues to fully hunker down. The Hill discusses five factors influencing when the House will return to Capitol Hill. It’s funny that the article does not list the Presidential election as a sixth factor. (Even the FEHBlog is entitled to have an occasional “DJT” moment. Lo siento.)

The FEHBlog forgot last Thursday to provide a link to the Senate Health Education Labor and Pension Committees “shark tank” on new tests for COVID-19. Here you go. This Committee will be holding a hearing on how to pull out of the great hunkering down on Tuesday.

For the past two months, the FEHBlog has been tracking a simplified infection fatality rate (IFR) for COVID-19 based on the CDC’s statistics. The FEHBlog is not an epidimeologist but he figured things would be looking up if the rate plateaued. The FEHBlog’s statistics do show the IFR increase slowing down over the past month. In any event, here’s a new Health Affairs article on the COVID-19 IFR for your information.

CIGNA’s PBM Express Scripts has created a program called ParachuteRX which offers reasonably priced prescription drugs to the uninsured. Cool.

The FEHBlog has been a fan of genetics-based personalized medicine. It therefore was sobering for the FEHBlog to read in the Wall Street Journal that the popular focus on personalized medicine has detracted from public health efforts. The article explains that

the first national initiative launched to try to treat today’s severely ill patients is the National Covid-19 Convalescent Plasma Project. The project originated with a small nucleus of people who, it turns out, have been prominent critics of personalized medicine over the years, including Arturo Casadevall of Johns Hopkins University, Michael Joyner of the Mayo Clinic and Nigel Paneth of Michigan State University.

The idea of using antibody-rich plasma from recovered patients to try to neutralize a virus in those who are ill was first used more than 100 years ago. The project is designed to buy time and save lives until a vaccine can be developed and deployed or more targeted therapies can be identified and tested. It also offers a real-world test case for ideas that had largely been confined to academic journals and debates between scientists.

Indeed the FEHBlog learned in the Great Influenza book that small scale efforts to use this antibody approach found success in the 1918-19 pandemic. It’s encouraging to read that a large scale effort is underway now. In the aftermath of the great hunkering down, a Goldilocks compromise must be reached between personalized medicine and public health efforts.

Finally, Health IT Security does a good job putting the government’s COVID-19 related flexibilities with regard to enforcing the HIPAA Privacy Rule into focus.

Person using a laptop

Thursday Miscellany

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

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

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

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

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

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

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

Person using a laptop

Thursday Miscellany

As the FEHBlog discussed COVID-19 death rates yesterday, it’s only meet and right to post STAT’s story which seeks to put COVID-19 death projections into perspective.

On the flip side, STAT reports on Pfizer’s decision to accelerate by three months human testing on a potential treatment for COVID-19 and local WTOP news reports on COVID-19 vaccine development efforts by a company in the Maryland suburbs of D.C., Novovax. Best of luck.

Healthleaders Media discusses a Guidehouse study finding

A major factor hampering the financial situation for rural providers is the migration of patients to care options outside of the community, with over 75% of patients bypassing local hospitals to receive care elsewhere. These levels are much higher compared to the outmigration patterns of suburban and urban patients.

More than 350 rural hospitals [one in four], accounting for $8.3 billion in total patient revenue, are at the greatest financial risk of closure, according to Guidehouse. The five states most likely to be impacted by hospital closures include Tennessee, Oklahoma, Mississippi, Alabama, and Kansas, according to the analysis.

Guidehouse adds that “Of these hospitals, 81%, or 287 hospitals, are considered highly essential to the health and economic well-being of their communities.” What is really troubling about this study is that it was conducted before the COVID-19 emergency which must be exacerbating these financial problems.

The Centers for Medicare and Medicaid Services today issued additional guidance loosening the regulatory reins on healthcare providers so that “so that hospitals, clinics, and other healthcare facilities can boost their frontline medical staffs” necessary to treat COVID-19 patients and others. Among other steps,

Doctors can now directly care for patients at rural hospitals, across state lines if necessary, via phone, radio, or online communication, without having to be physically present. Remotely located physicians, coordinating with nurse practitioners at rural facilities, will provide staffs at such facilities additional flexibility to meet the needs of their patients.

Similarly, the HHS Office for Civil Rights which enforces the HIPAA Privacy and Security Rules promised not to impose HIPAA penalties on good faith rule violations that occur at COVID-19 testing sites.

Drug Channels offers an interesting take on the CMS actuary’s recent healthcare spending projections for the U.S. Adam Fein observes that ” The coronavirus is upending our healthcare system and putting enormous pressure on hospitals. Despite increased costs of treatment, I expect that spending [that CMS estimated before the COVID-19 emergency] will be lower than the CMS projections.”

On the technology front, the federal government’s cybersecurity authorities released a detailed alert on a variety of cyberscams that have arisen during the COVID-19 emergency.

Weekend update

Congress remains on a State / district work period this week with the exception of one Senate Armed Services Committee hearing. The Wall Street Journal reports that

The [coming] week will be “the hardest and saddest week of most Americans’ lives,” Surgeon General Jerome Adams said on Fox News Sunday, drawing comparisons with the 1941 attack on Pearl Harbor and the Sept. 11, 2001, terrorist attacks.

Officials again urged Americans to stay home. “This is the moment to not be going to the grocery store, not going to the pharmacy, but doing everything you can to keep your family and your friends safe,” coronavirus response coordinator Deborah Birx said at a White House news briefing over the weekend.

HHS’s Office for Civil Rights, which enforces the HIPAA Privacy and Security Rules, called attention today to the Federal Bureau of Investigation’s guidance “on defending against video-teleconferencing (VTC) hijacking (referred to as ‘Zoom-bombing’ when attacks are to the Zoom VTC platform). Many organizations and individuals are increasingly dependent on VTC platforms, such as Zoom and Microsoft Teams, to stay connected during the Coronavirus Disease 2019 (COVID-19) pandemic.” This guidance is applicable to both business and personal users of these virtual meeting platforms.

And as this is the FEHBlog, not the COVIDblog, the FEHBlog wants to call attention to this FEDSmith article on how federal employees and annuitants can extend their FEHBP coverage post-mortem to their surviving spouses and children (under age 26 except in the case of total disability.) This unique federal employment benefit should be a top consideration in estate planning for federal employees and annuitants. Here is a link to the OPM website’s discussion of continued FEHB coverage for survivor annuitants. Here are OPM’s survivor annuity websites for the federal government’s legacy retirement system CSRS and its current retirement system, FERS.

Hang in there, my friends.

Thursday Miscellany

Healthcare Dive helpfully reviews the benefit improvements that large health insurers have made in response to the COVID-19 emergency.

Hospitals say that’s not enough, and are calling on the biggest payers to follow actions taken by Congress and CMS to help resolve cash flow issues, by accelerating payments or opting into releasing interim periodic payments. The American Hospital Association also is urging payers to eliminate administrative burdens such as prior authorizations.

The more things change, the more they stay the same.

Beckers Hospital Review reports that “Peak demand for hospital resources due to COVID-19 is expected by mid-April in the U.S., according to an analysis from the University of Washington’s Institute for Health Metrics and Evaluation in Seattle.” The report provides an expect peak demand date for each State in the Union and DC.

The HHS Office for Civil Rights which enforces the HIPAA Privacy and Security Rules loosened another Privacy Act provision for the duration of the COVID-19 emergency —

As a matter of enforcement discretion, effective immediately, the HHS Office for Civil Rights (OCR) will exercise its enforcement discretion and will not impose potential penalties for violations of certain provisions of the HIPAA Privacy Rule against covered health care providers or their business associates for uses and disclosures of protected health information by business associates for public health and health oversight activities during the COVID-19 nationwide public health emergency.

Although this is really inside the Beltway, the FEHBlog, as a lawyer, finds it noteworthy to relate that, according to Govexec.com, the Office of Management and Budget “is not directing agencies to extend the amount of time alloted for public feedback on regulation changes during the coronavirus outbreak, despite calls from [House Democrat] lawmakers to do so.”

Finally, the FEHBlog notes that according to the Boston Globe’s Stat News, rumblings about masking the American public continue.

In a draft document obtained by STAT, the CDC recommended that the public use homemade face coverings when in public, reserving higher-grade protective equipment like N95 masks for hospitals and health care workers, who have faced severe shortages in personal protective equipment as the coronavirus pandemic has accelerated through the United States.

Such face coverings, according to the draft guidance, would not be intended to protect the wearer, but rather prevent the wearer from unknowingly spreading the disease when in public. Individuals should wear face coverings in public settings like grocery stores, the guidance said. Children under the age of 2 and people experiencing trouble breathing would be excluded from the mask guidelines.

Friday Stats and More

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

Person to Person181293101326
Cause under invest.1101362984283,318
Total Cases164162910,44285,356
Total Deaths1501246
Deaths over cases1.44%1.46%

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

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

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

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

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

Our firm is closely monitoring the impacts of COVID-19. Effective 6/08/20, Ermer & Suter has reopened its physical offices for business, however for the continued safety of our staff, in-office capacity will not exceed 40%. We remain fully operational and are readily available from both our office and telework locations.