Thursday Miscellany

Thursday Miscellany

The Centers for Medicare Services plans to start a new pilot program known as ET3 that allows certain ambulance companies to take traditional Medicare patients who call 911 to less acuity health care facilities than the usual hospital emergency room.

Under the ET3 Model, Medicare will pay participating ambulance suppliers and providers to: 

Transport a beneficiary to an alternative destination (such as a primary care doctor’s office or an urgent care clinic), or

Initiate and facilitate treatment in place by a qualified health care practitioner, either in-person on the scene or via telehealth. 

Upon arriving on the scene of a 911 call, participating ambulance suppliers and providers may triage Medicare beneficiaries to one of these Model’s interventions. 

The ET3 program will begin later this year for a two year period.

One of OPM’s heaviest weighted HEDIS measures turns on whether a pregnant woman visits her obstetrician in the first trimester of her pregnancy. Interestingly, Health Affairs Blog explains that

Prenatal care has been largely left out of the growing national conversation about the rise in maternal morbidity and mortality and the stark racial disparities in maternal health outcomes. This notable absence may be a consequence of how little is understood about the content and quality of prenatal care services and their relationship to maternal and infant health. Increased understanding of what happens during labor, delivery, and the postpartum period is essential to improving outcomes: the Centers for Disease Control and Prevention (CDC) estimates that roughly two-thirds of maternal deaths occur during childbirth and the first year thereafter. The remaining third of deaths occur during pregnancy. Prenatal care—spanning most of a year and consuming substantial time and resources from patients and providers alike—may represent an important opportunity to prevent these deaths, as well as to identify and mitigate risks of subsequent mortality or morbidity. 

There are three primary impediments to rigorous research in this area:

Reliance on blunt quality metrics that do not reflect important dimensions of care;

Limited access to data on what occurs during prenatal care; and

Empirical challenges to evaluating the impact of prenatal care on maternal and infant outcomes.

In other words, it’s complicated.

Fierce Healthcare reports on a survey about the extent to which patients lie to their physician and offers tips to doctors on how to encourage their patients to be truthful. If patients lie to their doctors, then members may well lie to their health plan too so the tips in the article should be generally helpful.

Turnabout is fair play

Federal News Network reports tonight that “The White House has tapped Michael Rigas, the newly-appointed acting director of the Office of Personnel Management [and Senate confirmed OPM Deputy Director], to serve concurrently as the acting deputy director for management at the Office of Management and Budget.” This means that Margaret Weichert is leaving the federal government for a consultancy. Ms. Weichert who was the Senate confirmed OMB Deputy Director for Management served as OPM Acting Director between Senate confirmed yet temporary OPM Directors Jeff Pon and Dale Cabaniss.

Government Guidance Tuesday

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

Weekend Update

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

On the COVID-19 front —

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

Friday’s Stats and more

COVID-19 CasesMarch 6March 13March 20
Travel36138290
Person to Person18239310
Cause of Infection
Under Investigation
1103629,842
Total Cases164162910,442
Total Deaths150

These statistics are drawn from Centers for Disease Control’s COVID-19 Situation Summary in the U.S. website. The CDC indicates that there statistics may be understated. The FEHBlog is using the CDC’s website in the interest of consistency and reliability.

The COVID-19 virus is present in all 50 states with the highest concentration of case in New York State, California, and Washington State.

From the CDC’s latest Fluline (March 14),

  • Nationally, the percent of specimens testing positive for influenza at clinical laboratories continued to decrease while ILI activity increased for the second week in a row after declining for three weeks. Due to the ongoing COVID-19 pandemic, more people may be seeking care for respiratory illness than usual at this time.
  • Laboratory confirmed influenza-associated hospitalization rates for the U.S. population overall remain moderate compared to recent seasons, but rates for children 0-4 years and adults 18-49 years are now the highest CDC has on record for these age groups, surpassing rates reported during the 2009 H1N1 pandemic. Hospitalization rates for school-aged children (5-17 years) are higher than any recent regular season but remain lower than rates experienced by this age group during the pandemic.
  • Pneumonia and influenza mortality levels have been low, but 149 influenza-associated deaths in children have been reported so far this season. This number is higher than recorded at the same time in every season since reporting began in 2004-05, except for the 2009 pandemic.
  • CDC estimates that so far this season there have been at least 38 million flu illnesses, 390,000 hospitalizations and 23,000 deaths from flu.

In other news,

  • SHRM offers more details on the Family and Medical Leave Act and new COVID-19 related paid leave created by this week’s Families First Coronavirus Response Act.
  • Govexec.com reports on OPM’s latest guidance regarding COVID-19 related telework for federal employees. “OPM on Thursday wrote that agencies can more quickly implement mass telework by formally evacuating employees’ worksites in connection with a pandemic. By using evacuation pay authority, agencies can mandate that federal employees use telework, regardless of whether they already have a telework agreement.”
  • FCW informs us about an interview with OMB Deputy Director Margaret Weichert about the government’s COVID-19 communications strategy for its agencies and workforce.
  • The IRS has moved this year’s tax day from April 15 to July 15 due to the COVID-19 emergency. Check with your tax advisor generally and on whether your state is following the IRS’s lead.
  • Healthcare Dive reports that telehealth companies are scrambling to add doctors to their platforms. That’s a good sign. Mhealthintelligence.com adds that “The national network of 36 independent BCBS companies announced Thursday that it would boost connected health coverage for the next 90 days, in response to the Coronavirus (COVID-19) pandemic. This will include waiving cost-sharing for telehealth services for fully-insured members, and it applies to all in-network providers and clinically appropriate services.”

Thursday Miscellany

On the COVID-19 front —

  • The President signed the Families First Coronavirus Response bill (H.R. 6021) into law last night. The Society for Human Resource Management discusses the HR aspects of the new law.
  • The FEHBlog ran across this Worldometer COVID-19 monitor. The FEHBlog finds it easier to decipher than the Johns Hopkins dashboard.
  • A company called Everlywell will start selling an at home COVID-19 tests on Monday. The testing floodgates finally may be opening.
  • Currently telehealth doctors must be licensed in the state where the patient resides. MHealthIntelligence reports that the federal government is about to override this state law requirement. That action would give quite a boost to telehealth and would help staffing hospitals in cities with adjoining states like New York City and Washington DC.

Finally, here’s a link to the Politico article that broke the story about Dale Cabaniss’s resignation as OPM Director on Tuesday. The FEHBlog is disturbed that a federal agency director would resign over personal differences with White House officials in the midst of a national emergency. Can’t we all get along?

Midweek update

On the COVID-19 front —

  • The Senate this afternoon approved H.R. 6021, the Families First Coronavirus Response bill. HR Dive explains the paid leave revisions that the House made to the bill first passed last Saturday before sending the bill to the Senate. Three attempts in the Senate to further amend the bill were rejected. The President has indicated that he will sign the bill.
  • H.R 6021 will mandate all types of health plans, including FEHB plans, cover FDA approved COVID-19 testing without cost sharing or medical management by the health plan. OPM already has required this for FEHB plans. However, the no cost sharing aspect of this coverage does not extend to treatment of the COVID-19 disease. A recent survey “of nearly 600 individual and family health insurance enrollees released today by eHealth, Inc. more than two thirds (69%) feel they lack a basic understanding of how testing and treatment of coronavirus (COVID-19) would be covered by their health insurance plan.” A word to the wise, etc.
  • Federal News Network reports “Federal agencies have 48 hours [until tomorrow] to review, modify and start implementing policies and procedures that will realign critical resources to slow the spread of the coronavirus. This includes offering “maximum telework flexibilities” for the federal workforce and may even include mandatory telework orders, the Office of Management and Budget said Tuesday night.”
  • The Wall Street Journal’s Journal podcast offers an interesting 20 minute long take on the race for a cure to the COVID-19 disease. One of the drugs discussed on the podcast is a Regeneron arthritis drug Kevazara that acts to calm the body’s immune system. Severe cases of COVID-19 cause lung inflammation. The FEHBlog read in the Great Influenza that the flu pandemic caused a spike in the death rate for healthy young adults. This flu struck deep in the lungs where the alveoli tissues transfer oxygen to the blood stream. The body’s immune system took great umbrage with this type of attack and threw everything at the disease. The body’s immune system attack often was the cause of death in young adults who have the strongest immune systems. The modern treatment is to try to calm the immune system and use a ventilator, options that didn’t exist in 1918.
  • Verily Health, the Google / Alphabet affiliate, issued an update on its development of a COVID-19 testing platform for patients. The Washington Post reports on COVID-19 testing sites in the DC metropolitan area.
  • Medicare has expanded the availability of telehealth for traditional Medicare beneficiaries during the COVID-19 emergency. HHS has issued guidance to health care providers on how to maintain HIPAA Privacy and Security rule compliance in the brave new world of telehealth.

In other news–

  • The Labor Department’s Employee Benefits Security Administration has released its latest report to Congress on improving health plan compliance with the federal mental health parity law and its report and an appendix on EBSA enforcement of that law in 2019.
  • Healthcare Dive reports that “The Trump administration is considering pushing back the timeline for payers, providers and health IT vendors to come into compliance with its two sweeping rules to promote interoperability as the healthcare system struggles with the novel coronavirus outbreak.” It would make sense to slow down the effort to ensure that it is done correctly, in the FEHBlog’s opinion.
  • AHRQ wisely points out the need to rethink the role of primary care in reducing hospital readmissions. Check it out.
  • Fierce Healthcare reports that

Aetna is linking Unite Us, a social care coordination platform, with its Guardian Angel program for members who have suffered an opioid overdose. The insurer, owned by CVS Health, will roll out the joint effort first in North Carolina, it announced this week. Using the Unite Us platform, care managers will be able to more effectively link members with social supports and other nonclinical options to aid in recovery, such as housing and healthy food.

Bravo.

The OPM Director has resigned

Federal News Network reports this evening that

“OPM has received the resignation of OPM Director Dale Cabaniss,” an agency spokesperson said in an email to Federal News Network.

Michael Rigas, OPM’s deputy director, will lead the agency on an acting basis, the spokesperson added.

Ms. Cabaniss was in office for around six months. Stunning.

Federal News Network adds that

[Ms.] Cabaniss joined OPM back in September, replacing Margaret Weichert, who had served as the agency’s acting director and permanent deputy director for management at the Office of Management and Budget for nearly a year. [Ms.] Weichert, who was supposed to leave on March 13, is staying on at OMB for the short term, sources confirmed to Federal News Network. It’s unclear what the resignation of Cabaniss would mean for [Ms.} Weichert’s length of stay in government.

Midweek Update

The Office of Personnel Management issued a guidance letter to FEHB carriers on the COVID-19 virus today.

The Internal Revenue Service today issued a Notice 2020-15 which permits high deductible health plans used with health savings accounts (under Internal Revenue Code Section 223) to cover COVID-19 testing on a first dollar basis. To its credit, OPM references the IRS notice in the above linked carrier letter.

The U.S. Labor Department also issued FAQ guidance on COVID-19 or Other Public Health Emergencies and the Family and Medical Leave Act.

As noted on Monday, this is Patient Safety Awareness week. The patient safety organization ECRI Institute released a list of top 10 patient safety concerns. The Safety Week’s key sponsor HHS’s Agency for Healthcare Quality and Research issued

Making Healthcare Safer III, a comprehensive report whose pages are filled with practical information on how today’s clinicians can keep patients free from harm.

The report reviews roughly four dozen practices that target patient safety improvement across a variety of settings. If appropriately applied, many of these practices can dramatically reduce high-impact healthcare-related harms.

The 47 patient safety practices and evidence highlighted in the report include technological and staffing-related practices, a series of specific hygiene and disinfection interventions for reducing healthcare-associated infections, and several practices designed to prevent medication errors and reduce opioid misuse and overdoses.

Monday Musings

The U.S. Office of Personnel Management issued additional COVID-19 guidance and FAQs on Saturday March 7. The Federal News Network summarizes OPM’s issuances here.

Here are the Centers for Diseases Control’s March 9 COVID-19 statistics for the U.S.

  • Travel-related 72
  • Person-to-person spread 29
  • Under Investigation 322
  • Total cases 423

The CDC has issued guidance for people at risk of contracting serious illness from COVID-19. According to the CDC,

Early information out of China, where COVID-19 first started, shows that some people are at higher risk of getting very sick from this illness. This includes:

  • Older adults
  • People who have serious chronic medical conditions like:
  • Heart disease
  • Diabetes
  • Lung disease

Becker’s Hospital News reports on a study recently published in the Journal of American Medical Association. The study which was conducted in Singapore finds that from a contagion standpoint the COVID-19 virus does not linger in the air but it does contaminate surfaces.

As predicted, the Trump Administration released its final electronic health record interoperability and data blocking rules today. The objective of the rules is to give patients better access to their health records. The rules take effect as early as January 1, 2021. The implementation of the interoperability rule is staged over time.

Here are links to the government fact sheets on the final interoperability rule and the final data blocking rule. WEDI, which an information technology advisor to the HHS Secretary, prepared a helpful comparison of the proposed and final data blocking rules.

Healthcare Dive reports on industry reaction to the final rules. Healthcare Dive explains

The CMS rule requires Medicaid, the Children’s Health Insurance Program, Medicare Advantage plans and Affordable Care Act exchange plans to provide their collective 125 million patients with free electronic access to their personal health data, including medical claims and encounter information including cost, by 2021.

MA plans, state Medicare and CHIP programs, CHIP managed care entities, Medicaid managed care plans and qualified health plans in the federal exchanges now have to “implement, test, and monitor” a Health Level Seven FHIR-compliant API, which the government has selected as the new national standard.

Those plans also have to make their provider directories available to current and potential enrollees through the API technology, too (excepting the federal exchanges, which already do so), by 2021, with the hope insurers will carry over those practices to private plans as well.

Finally it’s worth noting that HHS’s Agency for Healthcare Quality and Research has deemed this to be Patient Safety Awareness Week.

Our firm is closely monitoring the impacts of COVID-19. Effective 3/16/20, Ermer & Suter has implemented telework for all of our staff to encourage social distancing and help contain the virus. We remain fully operational and are readily available from our telework locations with no change in telephone numbers or email addresses.