Friday Stats and More

U.S. Healthcare

Friday Stats and More

David Ermer–CDC, Congress, COVID-19, COVID-19 vaccine, Medicare, U.S. Healthcare–

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 37th weeks of this year (beginning May 14 and ending September 16; 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:

Because the FEHBlog does look at his charts which are intended to show trends, he realized that new deaths chart is flat because new cases greatly exceed new deaths. Accordingly here is a chart of new COVID-19 deaths over the same period (May 14 through September 16 (basically four months).

In other COVID-19 news:

  • The Wall Street Journal reports “

U.S. hospitals expect to be better prepared if a second wave of Covid-19 cases hits in coming months, doctors and administrators say, after gaining a better understanding how to triage patients, which drugs to use and what supplies are needed. When the new coronavirus first struck, beds filled up at record speed, ventilators were in short supply and proven treatments were scant. Since then, doctors say, they have developed a better understanding of who needs a ventilator and how quickly a patient can be discharged, and studies have pointed to a few drugs like the antiviral remdesivir and the steroid dexamethasone that can help

The FEHBlog heartily agrees that the country is better prepared but he believes that the Journal is assuming facts not in evidence when it speaks about a second wave because we really are still in the first wave.

  • Medscape offers an MD’s perspective on the leading COVID-19 vaccine candidates.
  • The Wall Street Journal reports that the Centers for Disease Control withdrew last month’s highly criticized advice that people who had contact with asymptomatic COVID-19 patients don’t need a COVID-19 test. “The Sept. 18 updated recommendation now says that close contacts of a person with a confirmed Covid-19 infection need a test even in the absence of symptoms. The changes were described as a clarification, rather than a revision, on the CDC website.”
  • Speaking of COVID-19 testing, Mercer Consulting offers advice on how to cover COVID-19 testing which Congress made unnecessarily complicated.

In other news,

  • Govexec.com reports that “House Democrats are preparing to vote [next week] on a six-week stopgap spending bill that would keep agencies open through Dec. 11, according to Democratic aide.” From reading the article, it looks like the continuing resolution which is not fully backed will be enacted thereby avoiding what would be the craziest government shutdown in American history.
  • Speaking of criticism, Fierce Healthcare reports that “the American Academy of Family Physicians, which represents about 135,000 physicians, said the recommendations miss the mark and skew toward virtual-only telehealth vendors and large medical systems with established telehealth infrastructure. The task force’s report doesn’t address the needs of independent practices that need guidance, support and payment advocacy, wrote Stephanie Quinn, AAFP senior vice president of advocacy, practice advancement and policy in a blog post Tuesday.” The most encouraging tele heath acceleration that the FEHBlog witnessed during the great hunker down is patients holding telehealth visits with their own doctors. That FEHBlog agrees with AAFP that this trend that should be strongly encouraged.
  • Healthcare Dive reports that “Privately insured patients pay 247% more at hospitals on average than Medicare patients for the same care, according to a new study by nonprofit think tank RAND. The study, based on 2018 data, shows the gap is increasing from 2017 and 2016, which saw disparities of 230% and 224%, respectively. If private payers had paid Medicare rates over the three-year study period, they would have saved $19.7 billion, RAND determined. The study could provide fodder for proponents of a government-run public option, a key tenet of Democratic presidential nominee Joe Biden’s healthcare agenda, which — like Medicare — would negotiate prices with hospitals and other providers.

Hey, Healthcare Dive, in contrast to health plans which do negotiate with healthcare providers Medicare imposes prices on providers. Government price fixing leads to disparities like this and it’s far from a good thing.

Thursday Miscellany

David Ermer–CDC, Congress, COVID-19, COVID-19 testing, COVID-19 vaccine, U.S. Healthcare–
Photo by Juliane Liebermann on Unsplash

The FEHBlog heard on a webinar today that the House of Representatives will be releasing their FY 2021 continuing resolution tomorrow. That resolution according to press reports will be acceptable to the Senate and the White House. The FEHBlog will keep an eye out.

In COVID-19 news

  • Fierce Pharma reports that “Moderna reached human testing for its COVID-19 vaccine candidate in record time, and now with its phase 3 trial moving right along, the company is expecting efficacy data in November—likely after Pfizer and BioNTech, but before everyone else.”
  • Fierce Healthcare reports that “CVS Health is planning to double the number of its drive-thru testing sites by mid-October, the healthcare giant announced on Thursday [September 17]. CVS intends to add more than 2,000 sites at its pharmacies in the next several weeks, bringing its total to more than 4,000 nationwide. The new locations will be opened in waves, beginning with 400 new sites opening on Friday. CVS currently offers testing in 33 states and the District of Columbia.”
  • Medscape reports that “Eli Lilly and Co said on Wednesday interim trial data showed its experimental monoclonal antibody treatment reduced the need for hospitalization and emergency room visits for patients with moderate COVID-19. The company said it will discuss the interim results, which have not yet been reviewed by outside experts, with global regulators. A Lilly spokeswoman said discussions with the U.S. Food and Drug Administration are expected to range from additional clinical trials to the possibility of an emergency use authorization.”

Progress. Also a Centers for Disease Control study has confirmed an earlier Wall Street Journal report that widespread flu immunization plus continued use of social measures to prevent the spread of COVID-19 , e.g., social distancing, mask wearing, etc, should lead to an easy flu season in the United States this winter.

In other news, Healthcare Dive provides health insurer CEO insights on 2021. “Though there’s significant uncertainty around the future of the insurance industry, many remarks can be summed up in a line from Cigna CEO David Cordani: ‘We feel bullish on 2021.’ And despite the major role of government in regulating healthcare, most officials seemed agnostic on the presidential election looming in less than two months.” That is certainly encouraging.

Midweek update

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

The Federal Times and Govexec.com report that the Senate Homeland Security and Governmental Affairs Committee postponed voting this morning on John Gibbs’ nomination to be Office of Personnel Management Director. Federal employee organizations have publicly opposed his nomination.

It occurs to the FEHBlog that OPM has not had a long acting director since Ambassador John Berry who served in that role for President Obama’s entire first term. Before Mr. Berry the OPM Directors usually lasted one Presidential term. So for the past eight years OPM has mirrored the Washington Football Team’s approach to head coaches and quarterbacks.

Healthcare Dive reports that

Cigna is rebranding its growing health services segment, including pharmacy benefit manager Express Scripts, as Evernorth, the Connecticut-based payer announced Wednesday. The new umbrella brand will encompass Express Scripts, specialty pharmacy Accredo, medical benefit manager Evicore and Cigna’s other health service product lines starting in the third quarter. The rebranding, which has been in the works for months pre-pandemic, is the next evolution of the Cigna-Express Scripts tie-up completed in late 2018, as the combined entity looks to spur more interest in its products from third parties in the industry.

The late U.S. Navy Admiral and Arctic explorer Robert Peary would be pleased.

Healthcare Dive also reports that

  • “CVS Health has struck a deal with Apple to give temporary free access for the health giant’s clients, customers and employees to Apple’s new subscription fitness service.
  • Beneficiaries enrolled in Aetna’s commercial or CVS Caremark’s prescription plans will be offered a free one-year subscription to the feature, called Apple Fitness+. A free two-month subscription will be offered to CVS Pharmacy ExtraCare members and all CVS employees after the service is launched, per Tuesday {September 15]’s release.
  • The announcement coincided with Apple’s unveiling of the subscription service, which offers virtual fitness classes. The tech giant on Tuesday also released the latest model of its Apple Watch, which includes a new blood oxygen level tracker.”

The National Committee for Quality Assurance released yesterday the final report of its Task Force on Telehealth. Here are the task force’s recommendations:

Policymakers should make permanent the following specific COVID-19 policy changes:

Lifting geographic restrictions and limitations on originating sites. Allowing telehealth for various types of clinicians and conditions. Acknowledging, as many states now do, that telehealth visits can meet requirements for establishing a clinician/patient relationship if the encounter meets appropriate care standards or unless careful analysis demonstrates that, in specific situations, a previous in-person relationship is necessary. Eliminating unnecessary restrictions on telehealth across state lines.

Policymakers should look closely at the effect of expanding prescribing authority to telehealth, as authorized by the PHE. They should evaluate what policies and guidelines could be applied to virtual prescribing to ensure patient safety and avoid adverse outcomes.

Policymakers should fully reinstate enforcement of Health Insurance Portability and Accountability Act (HIPAA) patient privacy protections that was suspended at the start of the public health emergency.

The Department of Health and Human Services and the Defense Department announced their COVID-19 vaccine distribution strategy today.

The strategic overview lays out four tasks necessary for the COVID-19 vaccine program:

  • Engage with state, tribal, territorial, and local partners, other stakeholders, and the public to communicate public health information around the vaccine and promote vaccine confidence and uptake.
  • Distribute vaccines immediately upon granting of Emergency Use Authorization/ Biologics License Application, using a transparently developed, phased allocation methodology and CDC has made vaccine recommendations.
  • Ensure safe administration of the vaccine and availability of administration supplies.
  • Monitor necessary data from the vaccination program through an information technology (IT) system capable of supporting and tracking distribution, administration, and other necessary data.

Federal News Network helpfully has created an online payroll deferral calculator for this federal employees and military members who are subject to this COVID-19 relief action.

Monday Roundup

David Ermer–Congress, COVID-19, COVID-19 testing, COVID-19 vaccine, Rx coverage, Telehealth, U.S. Healthcare–
Photo by Sven Read on Unsplash

Becker’s Health IT offers 20 bold health IT predictions for the next five years. Here are the FEHBlog’s favorites:

1. Joel Klein, MD. Senior Vice President and CIO of University of Maryland Medical System (Baltimore): I think at least half of all healthcare in America will be virtual within five years. There are two barriers:

• Payers. They might pay less but if they pay enough, it will be enough. If we can figure out how to solve emergency department visits with widespread, cost effective on-demand care, that will make a difference.
• ‘But I want to see my doctor.’ That might be true for some things, but the convenience factor (especially for tertiary care… especially for millennials…) once you really start doing it overwhelms most of the physical presence upsides.

Edward Lee, MD. CIO of The Permanente Federation (Oakland, Calif.): In five years, physicians will no longer need to manually document their notes into the EHR. Instead, artificial intelligence will capture all the pertinent information from the patient-physician encounter. This will enable physicians to spend quality time with their patients instead of worrying about writing their notes or placing orders in a computer system. Joy and meaning for physicians will increase, physician burnout will decrease, and above all, patient care will improve.

Michael Pfeffer, MD. Assistant Vice Chancellor and CIO of UCLA Health: Health IT will enable each patient to have a unified, interactive view of their health information regardless of place of care or type of clinical data (i.e. phenotypic, genomic, imaging). AI-based apps will help make sense of their data, taking into account social determinants of health and potential health disparities to improve health equity and health literacy. This intelligence will be paired with personal health preferences and data on health provider quality, access, pricing and satisfaction to help patients make truly informed decisions about their care.

Fierce Biotech reports that “Just under a week after it stopped its key phase 3 pandemic vaccine test [due to a safety concern], AstraZeneca and the University of Oxford have been given the green light to restart in the U.K.” What’s more

While AZ and Oxford have been highlighted as [COVID-19 vaccine] race leaders, so too have Pfizer and BioNTech, which said they now want to boost their phase 2/3 trial for one of their five mRNA vaccines, BNT162b2, from around 30,000 to 44,000.

Also over the weekend, the companies said they have asked the FDA for the extra participants in order to include a broader patient population and with plans to include adolescents as young as 16 and people with chronic, stable HIV (human immunodeficiency viruses), hepatitis C or hepatitis B infection to “provide additional safety and efficacy data.”

It said it’s on track to hit its original target of 30,000 patients this week; despite wanting more people, Pfizer said in a statement that it was still on course to deliver data by the end of next month.

CVS Health announced last week that in response to demand created by children returning to school, it has made “children age 12 years and older eligible for testing at the more than 2,000 test sites located at select CVS Pharmacy drive-thru testing locations, starting last Friday, September 11.”

In other news

  • The Washington Post reports that commuting in the Washington DC metropolitan area may not be back to normal until next summer.

Some 430 employers representing about 275,000 workers in the greater-Washington region — stretching from Baltimore to Richmond — participated in the survey conducted Aug. 10 to 28. Their responses offer a snapshot of what companies are thinking as they weigh resuming in-office operations.
A clear majority of Washington-area employers said they are adopting a phased approach to returning to the office, although many said they remain uncertain about the timing of that return. A third of the region’s employers said they don’t know whether they will have their workers back on site by next summer.

  • Govexec.com reports that “The Office of Personnel Management issued a proposed rule [today] that would enable federal agencies to appoint employees in STEM jobs, or positions on temporary or new projects or organizations, for a decade. OPM said the change would give agencies more flexibility when tackling long-term science, technology, engineering and mathematics projects and other non-permanent work. Current regulations require agencies to get special permission from OPM to keep any term employee on staff for longer than four years.” The public comment deadline is November 10, 2020.
  • The House Oversight and Reform subcommittee on government operations held a postal update hearing today. It turns out that the subcommittee’s objective was to be to call the Postmaster General’s qualifications into question. A bipartisan Postal Service Board of Governors selects the Postmaster General, rather than following the usual Presidential appointment followed by Senate confirmation route.

Thursday Miscellany

David Ermer–Congress, COVID-19 testing, COVID-19 vaccine, U.S. Healthcare–
Photo by Juliane Liebermann on Unsplash

The Wall Street Journal reports that the entire Senate Republican caucus, with the exception of Sen. Rand Paul, voted for the scaled down $500 billion (is that an oxymoron?) COVID-19 relief bill, but the bill failed to receive the 60 votes necessary for cloture because the Democratic caucus lined up in opposition. So we have another political issue for the election.

Thankfully, the Congress and the White House have agreed on a continuing resolution to fund the federal government into the new federal fiscal year. The House will be holding votes next week so the FEHBlog expects that the House will pass the continuing resolution and then peace out for the campaign trail. The Senate will hang around as long as it can to approve more nominations. Following the election Congress will hold a lame duck session at which point another COVID-19 relief bill is likely to be enacted.

In healthcare news —

  • The National Academies of Sciences has a detailed web page about social determinants of health that is worth a look.
  • Humana has launched value based hearth surgery and shoulder replacement programs. “””The value-based care models are part of a portfolio of payment bundles created by Humana including a Maternity Episode-of-care Model and an Oncology Model of Care. Humana also offers a Hospital Incentive Program for acute care inpatient admissions. About 2.4 million MA members and 115,000 commercial members are enrolled in value-based models, Humana has said.”
  • Fierce Biotech reports that quick, inexpensive saliva based COVID-19 tests are being piloted at Heathrow Airport in London, England. Send the tests over here.
  • The Wall Street Journal informs us that “health experts say it’s increasingly likely that several [COVID-19] vaccines could pass muster in clinical trials and become available in phases over a period of weeks and months.”

The Centers for Disease Control and Prevention sent documents last week to state officials that lay out various scenarios, including availability of a limited number of doses of two vaccines by the end of October with more doses by the end of the year. The CDC document doesn’t name the two vaccines that could become available but describes characteristics that match those of the vaccines from Pfizer and Moderna.

Experts say multiple vaccines will be needed because no single company can make enough for the whole world. Several companies have signed contracts with the federal government to supply at least 100 million doses of each vaccine in the U.S., and are planning to produce larger global supplies.

Progress.

Tuesday Tidbits

David Ermer–Congress, U.S. Healthcare–

Photo by Patrick Fore on Unsplash

The President’s latest OPM Director nominee John Gibbs will receive a confirmation hearing before the Senate Homeland Security and Governmental Affairs Committee on Wednesday September 9, 2020, at 3:30 pm ET.

In other Senate news, the Majority Leader Mitch McConnell is working his caucus to gain support for a scaled down COVID-19 relief bill according to the Hill. “The GOP proposal includes a $300 per week federal unemployment benefit, another round of Paycheck Protection Program (PPP) funding, $105 billion for schools and an additional $16 billion for coronavirus testing.” “’It’s something I hope 53 Republican senators vote yes on,’ said Sen. Ron Johnson (R-Wis.), adding that Treasury Secretary Steven Mnuchin ‘accommodated’ some of his concerns about the initial GOP bill.”

As for healthcare tidbits:

  • The Centers for Disease Control has posted an extensive set of FAQs on this year flu vaccination program. For example

Q. Are there delays in the availability of flu vaccine?

A. Currently, vaccine manufacturers are not reporting any significant delays in distributing flu vaccine this season. Because a record number of flu vaccine doses are being manufactured this year, the time to produce and distribute them will be longer. CDC will continue to provide weekly updates on total flu vaccine doses distributed throughout the 2020-2021 flu season. Use the VaccineFinder to find out where to get vaccinated near you.

EHR data collected during a patient visit can be leveraged to develop an EHR registry of patients with excessive alcohol use that can be optimized and updated in real-time, Kaiser Permanente researchers reported in the Journal of Medical Internet Research. An EHR registry consisting of patient data could medical professionals address specific high-risk patients. In this case, researchers can utilize the registry to assess alcohol use and recovery methods. Although alcohol abuse is a significant problem in the US, there were no current EHR-integrated registries that assessed these issues.

That was an important gap to fill. It’s good to see the government’s investment in EHR’s paying off.

Weekend update

David Ermer–Congress, COVID-19, COVID-19 vaccine, U.S. Healthcare, Uncategorized–
Photo by Dane Deaner on Unsplash

The FEHBlog hopes that all of his readers are enjoying the Labor Day Weekend. The FEHBlog whose home state Maryland was removed from the COVID-19 travel ban list for New York, New Jersey and Connecticut last month skedaddled up to the Nutmeg State to visit family and friends. He is headed back to his Bethesda hacienda inside the Capital Beltway tomorrow morning.

The House of Representatives and the Senate have full committee schedules in the week ahead. The Senate will also engage in floor business this week while the House will not resume floor votes until next week.

The FEHBlog was pleased to read this Wall Street Journal report that

Several drug makers developing Covid-19 vaccines plan to issue a public pledge not to seek government approval until the shots have proven to be safe and effective, an unusual joint move among rivals that comes as they work to address concerns over a rush to mass vaccination.

A draft of the joint statement, still being finalized by companies including Pfizer Inc., PFE -0.11% Johnson & Johnson JNJ -0.64% and Moderna Inc. MRNA -3.45% and reviewed by The Wall Street Journal, commits to making the safety and well-being of vaccinated people the companies’ priority. The vaccine makers would also pledge to adhere to high scientific and ethical standards in the conduct of clinical studies and in the manufacturing processes.

As President Reagan would say trust but verify.

Health Payer Intelligence provides a 2020 perspective on health plan network centers of excellence. Centers of excellence generally are payer designated facilities that have worthy track records in costly surgeries like transplants. The article explains how payers have branched out this approach to other medical specialties:

Payers can boost their quality of care by working with a COE with particular specialty care providers. For example, Premera Blue Cross recently expanded its own COE strategy in order to improve its quality of care for radiology. Previously, radiology was not part of Premera Blue Cross’s COE strategy, but the payer recognized the need for better quality of care around this service.

“Establishing COEs around the highest quality radiology practices ensures patients are on the most direct treatment path back to health and reduces the high costs associated with misdiagnoses, which are surprisingly common,” explained the press release. At least a third of MRIs and CT scans produce erroneous diagnoses, the release stated.

Healthcare Dive reports that MEDPAC, a nonpartisan legislative branch agency that provides the U.S. Congress with analysis and policy advice on the Medicare program, has concluded that COVID-19 cash from the federal government saved most hospitals from the bleakest financial forecasts made last April. MEDPAC “Commissioners at Thursday’s meeting commended the administration for the speed of getting loans and grants out the door to providers, but said it was time for an in-depth review to make sure the money went to where it was needed most.”

Federal News Network provides an update on the Administration’s plan on the President’s payroll tax deferral program.

All active-duty military members as well as federal civilian employees will be subject to the president’s upcoming payroll tax deferral, a senior administration official told Federal News Network Friday evening.

The president’s payroll tax deferral, which the administration said all payroll providers will launch in unison later this month, has left federal employees, their unions and members of Congress scrambling this week for more details about the policy and its impact on the workforce.

The changes in payroll tax deductions are temporary, and federal employees will have to pay back deferred taxes starting in January. They’ll have until April to do so before penalties and interest may accrue, the IRS has said.

The FEHBlog congratulates OPM’s “Human Resources Solutions because its “USA Staffing® Onboarding platform is the winner of the 2020 Igniting Innovation Awards, hosted by the American Council for Technology and Industry Advisory Council (ACT-IAC). The awards recognize groundbreaking technologies that enhance services for citizens and government operations. USA Staffing Onboarding won with 68% of the vote. * * * Designed to efficiently onboard new hires in ordinary times, this fully online, automated solution proved instrumental in helping Federal agencies adapt to COVID-19.”

Thursday Miscellany

David Ermer–Congress, COVID-19, COVID-19 testing, Medicare, U.S. Healthcare–
Photo by Juliane Liebermann on Unsplash

Healthcare Dive informs us about the American Hospital Association’s reaction to yesterday’s final FY 2020 inpatient prospective payment system rule.

The American Hospital Association quickly criticized the price transparency element of the final rule Wednesday night.

“By continuing to focus on negotiated rates rather than expanding access to a patient’s out-of-pocket costs, the Administration fails to meet the goal it set for itself — assisting consumers in becoming more prudent purchasers of health care,” the group said in a statement. “We once again urge the agency to focus on what is really important to patients — ready access to their out-of-pocket costs.”

Evidently, the hospitals seek to dump the entire transparency burden on the health plans. The FEHBlog thinks that consumers would better informed by requiring hospitals and all providers to publicly announce the health plan network(s) in which they participate, an analog to the summary of benefits and coverage that health plans must distribute to members.

Speaking of comparison tools, the Centers for Medicare and Medicaid Services today launched

Care Compare, a streamlined redesign of eight existing CMS healthcare compare tools available on Medicare.gov. Care Compare provides a single user-friendly interface that patients and caregivers can use to make informed decisions about healthcare based on cost, quality of care, volume of services, and other data. With just one click, patients can find information that is easy to understand about doctors, hospitals, nursing homes, and other health care services instead of searching through multiple tools.

CMS notes that “Although the tool was created for people with Medicare in mind, many of the measures shown here apply to people who may not have Medicare. Information on this site isn’t an endorsement or advertisement for any provider type.”

Speaking of FY 2020, the Hill reports

Treasury Secretary Steven Mnuchin and Speaker Nancy Pelosi (D-Calif.) have informally agreed to pursue a clean, short-term stopgap measure to avert a government shutdown at the end of the month, sources in both parties confirmed Thursday. That means the continuing resolution (CR) needed to keep the government open past Sept. 30 would be free of controversial policy riders that have bogged down previous funding bills, significantly lowering the odds of a shutdown leading up to the crucial Nov. 3 elections.

That my friends is good news for the country.

In other news —

  • The Wall Street Journal brings us up to date on the cost, accuracy, and turnaround times for popular (?) COVID-19 testing methods.
  • The Department of Human Services released an action plan for improving rural healthcare in the United States.
  • Beckers Hospital Review reports that Walmart will be bringing Oak Health primary care centers into their super centers located in Arlington, Benbrook and Carrollton, Texas, later this year.
  • HR Dive discusses recent back to school guidance from the Labor Department regard the federal relief acts COVID-19 paid leave program. It’s complicated just like COVID-19.

Midweek update

David Ermer–ACA, COVID-19, Medicare, Rx coverage, U.S. Healthcare–

Section 1557 is the individual non-discrimination provision of the Affordable Care Act. In June 2020, the Department of Health and Human Services issued a final rule making numerous changes to the Obama Administration’s rule. Both rule makings sparked lawsuits challenging their legality.

Last time around, the lead case, Franciscan Alliance v. HHS, was filed in the Northern District of Texas. That case is still pending on appeal before the U.S. Court of Appeals for the Fifth Circuit.

This time around, the lead case, Whitman-Walker Clinic v. HHS, was filed in Washington, D.C. Roughly one month following oral argument in the case, U.S. District Judge James Boasberg this afternoon denied the plaintiffs’ motion for a preliminary injunction against enforcement of HHS’s revised Section 1557 rule with two exceptions:

  • The Court preliminarily enjoined the revised rule’s repeal of the sex discrimination definition found in the replaced Obama Administration rule. That definition afforded express protection to transgendered people.
  • The Court also preliminarily enjoined the revised rule’s religious organization exception to the law’s sex discrimination restrictions.

Here is a link to the lengthy yet illuminating opinion and the implementing order. The decision called to the FEHBlog’s attention another interesting civil rights provision of the ACA — Section 1554. This provision places limits on the HHS Secretary’s broad reaching regulatory powers under the ACA.

Judge Boasberg’s decision expands on the Brooklyn federal court decision issued August 17, 2020, that stayed enforcement of the sex discrimination definition repeal. While the federal government has not appealed the Brooklyn decision, the plaintiffs in the FEHBlog’s opinion are likely to appeal the denial of their preliminary injunction motion in the Whitman-Walker Clinic case. And so it goes.

The Centers for Medicare and Medicaid today released its final Medicare Part A inpatient prospective payment system rule for the government fiscal year beginning October 1, 2020.

The increase in operating payment rates for general acute care hospitals paid under the IPPS that successfully participate in the Hospital Inpatient Quality Reporting (IQR) Program and are meaningful electronic health record (EHR) users is approximately 2.9 percent. This reflects the projected hospital market basket update of 2.4 percent and a 0.0 percentage point productivity adjustment. This also reflects a +0.5 percentage point adjustment required by legislation.

Hospitals may be subject to other payment adjustments under the IPPS, including:

— Penalties for excess readmissions, which reflect an adjustment to a hospital’s performance relative to other hospitals with a similar proportion of patients who are dually eligible for Medicare and full-benefit Medicaid
— Penalty (1 percent) for worst-performing quartile under the Hospital-Acquired Condition Reduction Program
— Upward and downward adjustments under the Hospital Value-Based Purchasing Program

Medicare is one complicated program. Medicare is relevant to the FEHBP because the program impact the prices that FEHB plans pay for patient care and there is a large cadre of annuitant enrollees with Medicare Part A coverage.

In other healthcare related news —

  • Reuters reports that “President Donald Trump said on Tuesday he planned to meet with pharmaceutical companies this week regarding his so-called most- favored-nation executive order aimed at lowering drug prices paid by the U.S. federal government.”
  • STAT News reports that

A new analysis of several studies in which [inexpensive] steroid drugs were used to treat severely ill Covid-19 patients found the drugs significantly helped reduce patient deaths, bolstering earlier, preliminary evidence for the benefit of these medications. In multiple studies involving a total of 1,700 patients, a number of corticosteroids—anti-inflammatory drugs that can damp the effects of an overactive immune system—helped reduce deaths from Covid-19 by about a third, compared with patients who didn’t receive steroids, according to the analysis published Wednesday in the Journal of the American Medical Association.

  • HHS’s Office for Civil Rights, which enforces the HIPAA Privacy and Security Rules, has created a consolidate website regarding HIPAA and Health Apps. The site includes links to generally helpful technical information on cloud computing and HIPAA and HIPAA and health IT. Check it out.

Monday Roundup

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

The Wall Street Journal provides a roundup on the status of the front runners in the race for a safe and effective COVID-19 vaccine. “Nine of these have advanced into Phase 3, which tests whether the dose that would be given to the public works safely.” The Phase 3 candidates fall into one of the following three vaccine approaches

Genetic-code vaccines deliver specific genetic instructions teaching the body’s cells to make a protein from the targeted virus, which in turn induces an immune response. One type incorporates a synthetic, engineered version of messenger RNA, or mRNA. These are molecules in the body that ferry DNA instructions for making immune-inducing proteins. Other gene-based vaccines use DNA itself.

A virus-based vaccine uses a killed or weakened form of the targeted virus to induce an immune response.

Viral vector vaccines use a modified virus different from the targeted virus to serve as a carrier of the vaccine teaching the body’s cells to make a protein from the targeted virus.

Candidates at the Phase 2 trial level are also using a protein-based approach that “incorporates a protein from the virus, or something resembling it, that will trigger an immune response.” The more, the merrier, right?

With respect to other COVID-19 ramifications:

  • Healthcare Dive discusses CDC surveys on the estimated 40% of Americans experienced a reduction in access to healthcare during the great hunkering down while Fierce Healthcare discusses how hospital systems are reacting to the drop.
  • The Healthcare Dive article also points out a “”separate CDC RANDS survey found that nearly 37% of people said their provider now offers a form of telehealth, compared to about 14% who said it was offered before the pandemic” while Health Payer Intelligence discusses what it takes to for health plans to build upon the uptick in virtual care.

In other healthcare news:

  • Fierce Healthcare reports on a new Aetna plan design for mid-sized and large employers in the Kansas City metropolitan area. “While the PPO plan will offer access to many regional providers, CVS’ HealthHubs and MinuteClinics are deeply embedded in the plan design, Aetna said.”
  • The Health Care Cost Institute released a study of its voluminous health plan claims data finding that “commercial [health plan] prices paid for the average professional service were 122% of what would have been paid under the Medicare Physician-Fee-Schedule.” The report looks at this comparison from several different angles.
  • Drug Channel analyzes GoodRx’s decision to make public stock offering. GoodRx offers prescription drug savings to consumers.

In follow up news:

  • Federal News Network reports on another National Finance Center announcement hitting the brakes on its earlier announced plan to implement the President’s August 8 executive order permitting employers to defer payroll taxes for certain employees as early as the first paycheck in September.
  • A Delaware Chancery Court judge, according to Fierce Healthcare, has decided that neither Anthem nor Cigna should receive damages as a result of the 2017 breakup of their planned merger. Hopefully that’s the end of this saga.