Tuesday Tidbits

Mental health care

Tuesday Tidbits

David Ermer–HIPAA Privacy and Security Rules, Mental health care, OPM, U.S. Healthcare–
Photo by Patrick Fore on Unsplash

Surprise! The FEHBlog mentioned the other day that he considered the Trump Administration’s proposed HIPAA Privacy Rule amendments to be a dead letter because they had not been scheduled to be published in the Federal Register today, the last day of the Trump Administration’s Federal Register. Well, as it turns out, that proposed rule showed up in the Federal Register public inspection list today with a Federal Register publication date of Thursday January 21. In any event. as the FEHBlog mentioned, the Biden Administration will be decide the fate of this rule making, which for what it’s worth the FEHBlog considers to be a helpful improvement.

Also today, OPM released a preview of the 2020 Federal Employee Viewpoint Survey results. “A preview of the governmentwide results are heartening,” said Acting Director Michael Rigas. “Through the toughest times, employees have been resilient and motivated while supervisors and senior leaders alike have served employees well by embracing their roles to keep employees safe and informed.”  Well done, OPM and federal agency employers and employes.

The FEHBlog is a fan of new health plan designs. Fierce Healthcare reports that

UnitedHealthcare is launching a new, virtual primary care option as part of an effort to expand access to local clinicians in its employer-sponsored plans.

Virtual primary care will be available to members in certain employer plans across 11 states, UnitedHealthcare said in an announcement. The insurer expects to expand the offering to additional states over the course of the year.

The goal, UnitedHealth said, is to make it easier for patients to establish and maintain an ongoing relationship with a primary care provider.

“The UnitedHealthcare Virtual Primary Care service and updated policy help expand the use of virtual care from delivering care to people who are sick, to now also focusing on preventing and detecting disease before it starts and, if needed, helping people more conveniently manage certain chronic conditions,” said Anne Docimo, M.D., chief medical officer at UnitedHealthcare,” in a statement.

Creative.

In another creative move, Fierce Healthcare calls our attention to the following:

As healthcare continues to evolve, legacy players are aiming to be the first to gain access to the latest innovations.

At Anthem, that effort has meant launching its own Digital Incubator, which pairs financial backing with mentorship and opportunities for partnerships with universities and corporations.

“Essentially, we are looking to get access to cutting-edge healthcare products,” said Kate Merton, staff vice president and head of Anthem Digital Incubator, in an interview with Fierce Healthcare. “We work with our entrepreneurs early in the cycle to make sure they’re developed with the mindset of the payer, of the consumer and the provider all in one.”

ADI offers a number of pathways for innovators to take and operates in both digital and physical platforms, with its first incubation space opening in Palo Alto, California.

On the mental healthcare front —

  • IFEBP informs us that the Department of Labor’s Employees Benefit Security Administration, which enforces ERISA, “released the Fiscal Year (FY) 2020 Mental Health Parity and Addiction Equity Act (MHPAEA) fact sheet on investigations.”
  • “The U.S. Department of Health and Human Services (HHS) and the Office of the Surgeon General (OSG)—in collaboration with the National Action Alliance for Suicide Prevention (Action Alliance)—released The Surgeon General’s Call to Action to Implement the National Strategy for Suicide Prevention. This new report outlines the actions that communities and individuals can take to reduce the rates of suicide and help improve resilience.”

Friday Stats and More

David Ermer–COVID-19, COVID-19 vaccine, Mental health care–

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 14th week of 2020 through 1st week of this year (beginning April 2, 2020, and ending January 6, 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 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 period April 2, 2020 through January 6, 2021.

Because this week the CDC began to update its COVID-19 vaccinations data on a daily basis the FEHBlog was able to create this vaccines distributed and initially administered over the 51st week of 2020 through the first week of 2021 (December 23, 2020 through January 6, 2021):

Over the past four daily reports, the number of initial COVID vaccines administered increased steadily from 273,209 doses on January 4 to 748,313 doses yesterday. Per the AMA’s Morning Rounds

USA Today (1/6, Weintraub) reports HHS Secretary Alex Azar told governors to vaccinate as many people against SARS-CoV-2 as possible and warned to not let “perfection be the enemy of the good,” referring to priority plans. Azar said that with up to 70% of distributed vaccines still on shelves, states should focus on vaccinating the most people rather than prioritizing certain groups.

Today’s Fluview continues to report that “Seasonal influenza activity in the United States remains lower than usual for this time of year.”

UPI reports today that

At least half of COVID-19 transmission globally may have been caused by symptom-free infected people unknowingly spreading the virus to others, a study published Thursday by JAMA Network Open found.

In addition, nearly one in four cases of virus spread involves infected people who remain asymptomatic, the researchers estimated.

The findings highlight the importance of public health measures such as social distancing, mask-wearing and hand-washing — even for people who don’t feel sick — in preventing the spread of the virus, they said.

Mercer writes about the most pressing requirement of the Consolidated Appropriations Act – preparing and document comparative analyses to document compliance with the non-quantitative treatment limitations requirements under the federal mental health parity law. Mercer notes that

In case plan sponsors need more motivation to step up compliance efforts, we’re also seeing more litigation against plan sponsors and insurers alleging MHPAEA violations and breach of fiduciary duties under ERISA. In late 2020, in Wit v United Behavioral Health (UBH), a class action lawsuit ended with a decision by a federal court granting the plaintiffs the full extent of relief they requested and requiring UBH to reprocess nearly 67,000 mental health and substance use disorder (MH/SUD) benefit claims that were denied between 2011 and 2017. The federal court held that UBH breached its fiduciary duty to plan participants based on its use of overly restrictive medical necessity guidelines that resulted in the improper denial of more than 67,000 MH/SUD claims. This is just one example of the more than 100 lawsuits filed in the past several years alleging various MHPAEA and ERISA claims review violations relating to exclusions for ABA therapy, coverage for residential and other treatment facilities, medical necessity standards, and other items.

Tuesday Tidbits

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

The Wall Street Journal reports tonight that

The Trump administration made a $916 billion coronavirus relief offer to Democrats, opening yet another front in the multi-track effort to reach an agreement in talks that rank-and-file lawmakers have been leading in the final weeks of the year. The proposal, announced in a brief statement by Treasury Secretary Steven Mnuchin, came after Democrats rejected an effort by Senate Majority Leader Mitch McConnell (R., Ky.) to narrow the scope of a coronavirus relief bill by excluding aid for hard-hit state and local governments prioritized by Democrats and liability protections sought by Republicans. 

The President’s proposal reportedly includes $600 per person direct payments. The FEHBlog will be surprised if the COVID-19 relief bill negotiations are unsuccessful, but it would be hardly be the first time that Congress surprises the FEHBlog.

Also according the Wall Street Journal, the House of Representatives tonight passed the FY 2021 National Defense Authorization Act by a veto proof 335-78 margin. As the FEHBlog noted last week this bill includes goodies for federal employees. Federal News Network identifies policy winners and losers in this must pass bill which now goes over to the Senate.

Federal News Network columnist Mike Causey touts the FEHBlog’s personal favorite health plan design the high deductible health plan with health savings account (“HSA”). Mr. Causey aptly describes the HSA as a “Roth IRA on steroids” because and HSA is triple tax favored — tax exempt on the way in and out and grows tax free while in the account. The Federal Benefits Open Season ends on Monday December 14.

Fierce Healthcare informs us that

The FDA has released its internal review documents ahead of the closely watched COVID-19 vaccine advisory committee meeting scheduled for Thursday [December 10] —and they bode well for Pfizer and partner BioNTech’s prospects for securing a quick emergency use authorization (EUA). The FDA meeting briefing, published (PDF) on Tuesday, confirmed the efficacy and safety profile of Pfizer and BioNTech’s BNT162b2, reiterating that the shot was 95% effective at preventing COVID-19 after two doses with no serious safety concerns.

The Moderna vaccines turn before this panel occurs one week later on December 17.

Healthcare Dive reminds us that

Hospitals are readying for Jan. 1, [2021] when they expect they will have to publicly disclose the negotiated prices they reach with insurers for services performed inside their facilities — barring any intervention from a federal appeals court. [Such intervention in the FEHBlog’s humble opinion, is highly unlikely.]

The policy requires hospitals to share two streams of information. First, hospitals will have to share a machine-readable format of its negotiated prices with every insurer and every insurance product — a sizable pool of information. 

Then they will also have to prepare a list of 300 “shoppable services.” A total knee replacement would be a good example. It’s a procedure a consumer likely has time to plan and prepare for, unlike an emergency surgery due to an accident or failing health. The idea is to provide the price information so consumers can shop around for the best deal. 

The FEHBlog attended the second day of the American Bar Association’s Washington Health Law Summit (“WLS”). It’s worth noting that every panelist (six or seven in total) who has opined on the outcome of the Supreme Court’s California v. Texas case on the ACA’s constitutionality shares the FEHBlog’s opinion that the Supreme Court will preserve the ACA expect perhaps for the individual mandate which Congress effectively repealed in 2017.

The FEHBlog listened to three hours of discussion about behavioral telehealth and artificial intelligence during the WLS. It turns out that two types of healthcare AI exist admin AI and operational AI. AI can be assistive to the user’s decision making or can yield autonomous decisions. The Food and Drug Administration oversees the AI devices and the operational devices typically are used with imaging procedures. The FDA has approved two autonomous operational AI devices. The radiologists however has doubts about those devices.

The most interesting thing that the FEHBlog heard during this discussion was a remark from a Doctors on Demand speaker that telehealth companies are facing challenges in filling provider slots for psychiatrists and psychologists because of the enormous demand for mental health telemedicine. That’s a good thing. He noted that the explosion in telehealth use in 2020 is principally due to the government permitting a doctor or psychiatrist licensed in state A to treat a telehealth patient in state B.

The other speakers added that healthcare providers were quick to pick up on telehealth due to the licensing flexibilities and Medicare equivalent payments. They expressed their understanding that telehealth changes the personal dynamics between doctors and patients. Patients feels more in charge in a tele heath setting than they do in the office setting, and providers get social determinants of health data from seeing where the patient lives.

Tuesday Tidbits

David Ermer–ACA, COVID-19, Mental health care, U.S. Healthcare–
Thanks to Aaron Burden for sharing their work on Unsplash.

Happy Election Day!

The FEHBlog enjoyed reading this American Medical Association article about the five things that doctors should tell their patients about the COVID-19 vaccines currently under development. This could be good information for health plans to share with their members.

Fierce Healthcare reports that

Nearly half the nation’s hospitals, many of which are still wrestling with the financial fallout of the unexpected coronavirus, will get lower payments for all Medicare patients because of their history of readmitting patients, federal records show.

The penalties are the ninth annual round of the Hospital Readmissions Reduction Program created as part of the Affordable Care Act’s broader effort to improve quality and lower costs. The latest penalties are calculated using each hospital case history between July 2016 and June 2019, so the flood of coronavirus patients who have swamped hospitals this year were not included.

The number and severity of penalties were comparable to those of recent years, although the number of hospitals receiving the maximum penalty of 3% dropped from 56 to 39.

Beckers Hospital Review provides a list of those 39 hospitals here.

Healthcare Dive informs us that

Humana bested Wall Street expectations as it gained more members during the third quarter, generated higher revenue and beat earnings estimates, according to its quarterly results released Tuesday morning.

The payer’s medical utilization continued to trend slightly below pre-COVID levels during the third quarter, though still well above the severe dip in March and April. The lower levels of utilization were partially offset by higher COVID-19 testing and treatment costs as cases began to tick back up.

Executives warned during Tuesday’s call with investors that they expect a loss in the fourth quarter due to a number of issues, including COVID-19 testing and treatment and rebounding utilization.

It’s the last bullet that caught the FEHBlog’s attention.

Finally, Kaiser Health News offers a nice story about seniors forming friendship pods to ward off the loneliness of the great hunkering down.

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.”

Monday Round-up

David Ermer–Federal employment benefits, Mental health care, OPM, U.S. Healthcare–
Photo by Sven Read on Unsplash

For fun, the FEHBlog went down the OPM.gov rabbit hole to find the dates on which the the following year’s FEHB and FEDVIP premiums were announced. Since 2004 (the FEHBlog could not find the 2009 and 2010 press releases), the announcement was made eleven times in September and four times in October. The latest date was October 7 in 2014. Since that date the release dates range from September 28 (in 2015 and 2018) to October 7. So OPM has not set a new record yet.

In this regard, the Society for Human Resources Management reports today that

Employers expect a moderate health plan cost increase next year of 4.4 percent, on average, compared to this year, according to early results from HR consultancy Mercer’s National Survey of Employer-Sponsored Health Plans 2020.

The increase, based on 1,113 employer responses since early July, is marginally lower than a recent forecast by the nonprofit Business Group on Health, which in August expected a 5.3 percent increase in health plan premiums for 2021. But Mercer’s projection is within the broad range of 4 percent to 10 percent forecast by consultancy PwC’s Health Research Institute over the summer.

Mercer projects that 2020 will end with a 3.3 percent health benefit cost increase, which is still largely in line with the average annual cost growth over the past several years. Still, health benefit cost growth is now far outpacing the consumer price index and wage growth, both of which have slowed significantly.

The President, who returned to the White House from Walter Reed National Military Medical Center this evening, signed an executive order on Saturday. The executive order concerns “Saving Lives Through Increased Support For Mental- and Behavioral-Health Needs. It establishes a “Coronavirus Mental Health Working Group (Working Group) is hereby established to facilitate an ‘all-of-government’ response to the mental-health conditions induced or exacerbated by the pandemic, including issues related to suicide prevention. The Working Group will be co-chaired by the Secretary of Health and Human Services, or his designee, and the Assistant to the President for Domestic Policy, or her designee.”

It’s a bit of surprise to the FEHBlog that as Federal News Network reports the federal government has not yet given affected employees the option to decline the Administration’s temporary payroll tax deferral.

Friday Stats and More

David Ermer–CDC, Congress, COVID-19, Mental health care, U.S. Healthcare, Uncategorized–

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 32nd weeks of this year (beginning May 14 and ending August 19; 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:

It looks like we are on another downswing of COVID-19 cases and hopefully we all understand now the importance of social distancing, mask wearing, avoiding super spreader events so that the number of cases continues to trend down (in contrast to June and July).

The Salt Lake City Tribune reports that “Doctors from University of Utah Health and ARUP Laboratories announced Thursday that they will offer saliva testing for COVID-19 by September — after completing a study that found the spit test detected the virus as well as the traditional, and famously uncomfortable, nasal swab.”

Bill Phillips, founder of Spectrum Solutions, a company in Draper that manufactures saliva test kits, said the U.-ARUP study is in line with other research that shows the effectiveness of the spit test for detecting COVID-19. Such research, Phillips said, should promote broader acceptance of the saliva test over the nasopharyngal swab, both in and out of the medical community. Spectrum Solutions manufactures 100,000 saliva test kits a day in its Draper plant, Phillips said. The company is ramping up to produce 500,000 kits a day, using contractors in Wisconsin, North Carolina and California. Phillips’ company boasts a client list that includes the U.S. Senate, the U.S. Ski and Snowboard team, the Olympics, and several sports leagues. Last week, Spectrum Solutions became the test-kit supplier to Major League Baseball, with plans to produce 275,000 kits for the pandemic-shortened season.

Whoopee.

On the flip side, the Centers for Disease Control released a survey disclosing that during late June 2020 40% of Americans were struggling with mental illness or substance abuse due in large part to the great hunkering down.

No bueno.

The Peterson-KFF Health System Tracker has issued a report on how insured health plans are covering COVID-19 treatment during this public health emergency.

Yesterday, the FEHBlog wrote about Uber Health. Today, he points out a Fierce Healthcare story about its mega-competitor Lyft Health.

In a new study released Wednesday, Lyft offers a look at the performance of its partnership with AmeriHealth Caritas DC, which was facilitated by Access2Care. Lyft rides were made available to 11,400 for routine visits and urgent care, and between April 2018 and April 2019 emergency department visits dropped by 40% and ambulance utilization decreased by 12%. Amerigroup Tennessee, an Anthem company, similarly signed on with Lyft, launching a pilot in 2019 in Memphis. To date, it has seen a 44% increase in primary care visits and a 50% decrease in primary care gaps.

Finally Federal News Network reports on the Postmaster General’s testimony today before the Senate Homeland Security and Governmental Affairs Committee. The House is scheduled to consider a Postal Service bill (HR 8015) tomorrow. Here’s the version of the bill which the House Rules Committee approved today. The bill seeks to maintain the status quo in Postal Service operations retroactive to January 1, 2020 and provide the Postal Service with $25 billion. $15 million of this sum will go to the Postal Service Inspector General. House passage of this bill may lead to a compromise COVID-19 relief measure.

Friday Stats and More

David Ermer–COVID-19, Mental health care–

Happy Juneteenth!

According to the CDC’s COVID-19 cases in the U.S. website, which the FEHBlog tracks, over the past five weeks the numbers of new cases had taken a downward path for the first three weeks and then turned up for the past two weeks. New deaths have seen consistent weekly reductions over the same time span.

Week endingNew CasesNew Deaths
May 22159,4968,160
May 29148,2107,561
June 5142,8296,553
June 12155,3715,850
June 19161,2894,865

The FEHBlog had been wondering when the current COVID-19 emergency period expires. The American Hospital Association informs us that the expiration date is July 25. The AHA is seeking an extension.

In other news —

  • The Labor Department’s Employee Benefits Security Administration released “a proposed Self-Compliance Tool intended to help improve compliance with the Mental Health Parity and Addiction Equity Act (MHPAEA) and additional related requirements under the Employee Retirement Income Security Act of 1974 (ERISA). The tool [which was last updated in 2018[ will enable group health plans, plan sponsors, plan administrators, health insurance issuers and other parties determine whether a group health plan or a health insurance issuer complies with the provisions in both laws. EBSA is requesting public comments on the MHPAEA’s Self-Compliance Tool proposed revisions by July 24, 2020
  • The Labor Department’s Occupational Safety and Health Administration released non-essential business re-opening guidance.

Thursday Miscellany

David Ermer–CDC, COVID-19, Mental health care–

Regrettably, the Wall Street Journal reported today a spike in COVID-19 cases in States, like Texas, Utah, Arizona, and Arkansas, that were not hard hit early on in the COVID-19 emergency.

Experts analyzing states with worrisome trends in serious cases are largely pointing to the onset of summer, when people began to congregate in resort spots. [FEHBlog note: Super-speader events are risky.]

Some also suspect that officials who allowed businesses to reopen after a relatively calm few weeks might have sent an inadvertent message that the problem had largely passed.

As if responding to the suspicious “some,” the Centers for Disease Control has released a social media toolkit to spread COVID-19 related advice on Facebook, Instagram, Twitter etc.

It’s worth noting that the Wall Street Journal editorial page’s observation that “More infections are inevitable as states reopen, and there will be much trial and error. States need to be vigilant for outbreaks and protect high-risk areas and the vulnerable. But the costs of shutting down the economy are so great, in damage to lives and livelihoods, that there is no alternative to opening for the broader public good.”

In other news —

A new study published in the Journal of the American Medical Association found that one-fifth of patients who read ambulatory care notes reported finding a mistake in those notes, and 40% of those regarded the error as serious.

“Among patient-reported very serious errors, the most common characterizations were mistakes in diagnoses, medical history, medications, physical examination, test results, notes on the wrong patient, and sidedness,” the study authors explained.

That’s worrisome for patient healthcare as well as for other doctors and health plans who rely on these reports.

  • Health Payer Intelligence offers a thought provoking article on four data points that illustrate mental health parity. The rub is that “Mental and behavioral healthcare parity is about more than just equal reimbursement with similar medical and surgical services. It includes ensuring access to care by having enough providers in-network and making sure that the right types of specialists are available for members.”

Tuesday Tidbits

David Ermer–COVID-19, Medicare, Mental health care, Telehealth–

While the FEHBlog has been discussing the progress of convalescent plasma to treat COVID-19, its time to turn to the Gilead drug remdesivir Fierce Pharma discusses today a recently released peer reviewed study that shows that the drug works well with patients suffering from moderate severity COVID-19.

The 1,063-patient study showed remdesivir’s benefits appear greatest for hospitalized patients in the middle of the disease-severity spectrum. For those who required oxygen supplementation but were not mechanically ventilated, remdesivir cut the time to recovery by 47% compared with placebo. But remdesivir didn’t much help patients with mild or moderate disease, and outcomes for patients on invasive ventilation or extracorporeal membrane oxygenation were nearly the same in both arms of the study.

According to the article, studies are continuing on the efficacy of the drug for patients with mild severity COVID-19.

The Wall Street Journal reports today that physicians are concerned over fact that anti-anxiety and anti-depression prescriptions have spiked during the great hunkering down. “Many physicians have a low threshold for prescribing them. It’s very problematic,” says Bruce J. Schwartz, deputy chair and professor of psychiatry and behavioral sciences at Montefiore Medical Center in New York. “Many people do develop a dependency on these medications.” The article offers alternate approaches, and FEHB plans now usually offer coaching services to help with the problems.

Speaking of healthcare coaching programs, CNBC reports that the great hunkering down has been good for companies that provide coaching or telehealth / digital health programs.

The Centers for Medicare and Medicaid Services announced that their 2021 pilot program to lower insulin costs for Medicare beneficiaries is bearing fruit.

Based on CMS’s estimates, beneficiaries who use insulin and join a plan participating in the model could see average out-of-pocket savings of $446, or 66 percent, for their insulins, funded in part by manufacturers paying an estimated additional $250 million of discounts over the five years of the model. With a robust voluntary response from Part D sponsors, CMS anticipates beneficiaries will have Part D plan options in all 50 states, the District of Columbia, and Puerto Rico, through either a standalone prescription drug plan (PDP) or a Medicare Advantage plan with prescription drug coverage. Beneficiaries will be able to enroll during Medicare open enrollment, which is from October 15, 2020 through December 7, 2020, for Part D coverage that begins on January 1, 2021.

Well done. Hopefully the Medicare approach will be translatable to employer sponsored coverage like the FEHBP.