U.S. Healthcare Archives - Ermer and Suter PLLC

President nominates an OPM Director

David Ermer–Congress, COVID-19 vaccine, OPM, U.S. Healthcare–February 23, 2021February 23, 2021

OPM Headquarters a/k/a the Theodore Roosevelt Building

The Federal Times, Govexec, and Federal News Network all report on today’s announcement that the President is nominating Kiran Ahuja to be OPM Director. Ms. Ahuja led the President’s transition review team lead for the agency. “Ahuja has over 20 years of public service and philanthropy experience. She’s currently the CEO of Philanthropy Northwest, and she spent several years as a career civil rights attorney at the Justice Department.” Her nomination is subject to Senate confirmation. In due course, the President also is expected to nominate an OPM Deputy Director and an OPM Inspector General.

Healthcare Dive reports on the first confirmation hearing for the President’s nominee for Secretary of Health and Human Services, Xavier Becerra. Mr. Becerra “told senators on the health committee Tuesday morning he would continue work he did as California attorney general to combat anticompetitive practices in healthcare and go after providers that ‘unfairly jack up prices on patients.'” According to the report, Mr. “Becerra will be back in the hot seat Wednesday for his second confirmation hearing, this one in front of the Senate Finance Committee. That will be the committee voting on whether to send his nomination to the full Senate for a vote.”

Tomorrow, the Senate Homeland Security and Governmental Affairs Committee at 10 am and the Senate Budget Committee at noon each will hold a business meeting on whether to advance to the Senate floor the President’s nomination of Neera Tanden to be Director of the Office of Management and Budget.

Tomorrow at 10 AM, the House Oversight and Reform Committee will hold a hearing on “Legislative Proposals to Put the Postal Service on Sustainable Financial Footing.” The Committee Staff explains in a memorandum,

the Committee will hold a hybrid hearing to review legislative proposals to place the Postal Service on a more sustainable financial footing. The Committee will consider a discussion draft that includes several provisions to relieve the financial burdens under which the Postal Service is currently operating and to enhance transparency regarding performance. That draft is being circulated with this memo. The discussion draft includes provisions on Medicare integration [for Postal annuitants participating along with Postal employees in a separate program within the FEHB] , repealing a requirement for the Postal Service to pre-fund retiree health care, and service performance standards.”

Earlier today, the Oversight and Investigations Subcommittee of the House Energy and Commerce Committee held a hearing on the availability of COVID-19 vaccinations. The hearing featured testimony from executives at the companies manufacturing those vaccines. Fierce Healthcare reports that “Pfizer, Moderna and Johnson & Johnson execs say [at the hearing] they’re working all the angles on increasing COVID-19 vaccine production and expect to amp up weekly deliveries by tens of millions by the end of March.”

In that regard, a friend of the FEHBlog pointed him to this NIH Director’s blog entry released today

For the millions of Americans now eligible to receive the Pfizer or Moderna COVID-19 vaccines, it’s recommended that everyone get two shots. The first dose of these mRNA vaccines trains the immune system to recognize and attack the spike protein on the surface of SARS-CoV-2, the virus that causes COVID-19. The second dose, administered a few weeks later, boosts antibody levels to afford even better protection. People who’ve recovered from COVID-19 also should definitely get vaccinated to maximize protection against possible re-infection. But, because they already have some natural immunity, would just one shot do the trick? Or do they still need two?
A small, NIH-supported study, published as a pre-print on medRxiv, offers some early data on this important question [1]. The findings show that immune response to the first vaccine dose in a person who’s already had COVID-19 is equal to, or in some cases better, than the response to the second dose in a person who hasn’t had COVID-19. While much more research is needed—and I am definitely not suggesting a change in the current recommendations right now—the results raise the possibility that one dose might be enough for someone who’s been infected with SARS-CoV-2 and already generated antibodies against the virus.

Encouraging news.

Monday Roundup

David Ermer–Congress, COVID-19, U.S. Healthcare–February 22, 2021February 22, 2021

The Wall Street Journal reports from Capitol Hill that

The House Budget Committee approved the $1.9 trillion coronavirus relief package Monday, setting up a vote in the full House later this week.
The Budget Committee on Monday officially fused together different portions of the legislation that had advanced earlier this month in nine different House committees. A full House vote is expected Friday or Saturday.
The bill moving through the House would provide $400-a-week unemployment benefits through Aug. 29, send $1,400 per-person payments to most households, provide billions in funding for schools and vaccine distribution, expand the child tax credit, broaden child-care assistance and bolster tax credits for health insurance. It would also increase the federal minimum wage to $15 an hour over four years, a point of division among Democrats.

From the COVID-19 front:

The Hill reports that “Johnson & Johnson said Monday [February 22] that it plans to have enough doses of its vaccine for more than 20 million Americans by the end of March if its vaccine is authorized by the Food and Drug Administration.”
The Wall Street Journal informs us that

The Food and Drug Administration said Monday it will quickly analyze any vaccine booster shots against Covid-19 variants such as those from South Africa and the U.K., and won’t require further large clinical trials of the new shots’ effectiveness.
The agency issued new guidance for vaccine manufacturers as it looks to establish speedier procedures to deal with virus mutations that could worsen the pandemic. Acting FDA Commissioner Janet Woodcock said in a statement the agency is seeking ‘efficient ways to modify medical products that either are in the pipeline or have been authorized for emergency use to address emerging variants.’”

Federal News Network points out that federal agencies have been issuing new COVID-19 safety plans for employees and visitors. Here is a link to OPM’s plan.

Healthcare Dive informs us that “The Biden administration [officially] nominated Chiquita Brooks-LaSure as CMS administrator Friday [February 19]. A press release touted her more than 20 years of experience in health policy and previous work guiding the ACA through passage and implementation.” This position requires Senate confirmation. The White House sent her nomination to the Senate today.

Health Payer Intelligence discusses a Health Action Council and UnitedHealth Group report about the following five conditions other than COVID-19 that fuel costs for employer sponsored health plans: (1) asthsma, (2) diabetes, (3) hypertension, (4) back disorders, and (5) mental health / substance use. Check it out.

Earlier this month, the Health Care Cost Institute announced

the launch of its new health care claims dataset for research. The new dataset is more than 25% larger than the original HCCI dataset, containing more than 1 billion claims per year for more than 55 million people who receive health care coverage from their employers. Researchers will initially have access to data from 2012 to 2018, with 2019 and 2020 information being added as soon as possible. The data is sourced from Aetna/CVS, Humana, Kaiser Permanente and more than 30 non-profit health plans included in the Blue Health Intelligence^®national dataset , enabling researchers to conduct analysis at the national, state, and sub-state level. HCCI’s patient-, provider-, and payer-deidentified dataset contains comprehensive diagnostic, procedure, site of care and cost information, including payments made by insurers as well as what patients pay out of pocket.
“This rich new claims data enables the critical research and reporting that will be needed in the coming years, to understand the impact of the COVID-19 pandemic and other challenges facing the health care system as the US approaches spending 20% of GDP on health care,” said Niall Brennan, President and CEO of HCCI. “HCCI is a critical national resource for researchers, policymakers, employers, journalists, and the public to understand trends in health care access, spending and utilization.”

Good luck.

Thursday Miscellany

David Ermer–CDC, COVID-19, Employee Wellness Programs, U.S. Healthcare–February 18, 2021February 19, 2021

In a welcome spurt of cautious optimism, Bloomberg reports this evening

The U.S. vaccine supply is poised to double in the coming weeks and months, according to an analysis by Bloomberg, allowing a broad expansion of doses administered across the country. * * * A review of drugmakers’ public statements and their supply deals suggests that the number of vaccines delivered should rise to almost 20 million a week in March, more than 25 million a week in April and May, and over 30 million a week June. By summer, it would be enough to give 4.5 million shots a day. * * * The analysis assumes drugmakers will meet their new delivery targets — not a guarantee in a year-old pandemic where much has gone wrong.

The FEHBlog’s bet, for what it’s worth, is that Bloomberg’s analysis proves correct.

The urgency of rapid COVID-19 vaccine distribution is reinforced by the Centers for Disease Control’s report today that U.S. life expectancy dropped by one year during the first six months of last year.

For perspective, take a look at the American Medical Association’s interview of John Barry, the author of the Great Influenza. To wit –

In 1918, people didn’t buy the government’s take on the pandemic. They saw what was happening. The disease was much more virulent, killing between 50 million and 100 million people. That would be between 225–450 million people today after adjusting for population. In Philadelphia, Barry said, priests would drive horse-drawn carts down the street calling for people to bring out their dead.

Mr. Barry urges truth telling by all parties holding public trust. By the way, the Great Influenza is fascinating reading.

In regulatory news —

Fierce Healthcare informs us that “President Joe Biden has chosen Chiquita Brooks-LaSure to lead the Centers for Medicare & Medicaid Services (CMS), according to a report in The Washington Post.” This post requires Senate confirmation.
The National Law Journal reports that “The U.S. Equal Employment Opportunity Commission (EEOC) announced last Friday that it was withdrawing two proposed rules regarding the incentives employers can provide their employees as part of a wellness program without violating the Americans with Disabilities Act (ADA) or Genetic Information Nondiscrimination Act (GINA). Originally, the proposed rules had stated that, for the most part, employers could offer only “de minimis” incentives for employees participating in a wellness program—incentives that potentially could apply to employees receiving a coronavirus (COVID-19) vaccine. With the withdrawal of those rules, employers have little guidance in terms of what incentives, if any, they may offer employees”
The Health and Human Services Inspector General announced a court ordered delay in effective date of the Trump Administrations’ rule banning prescription drug rebates in Medicare Part D (but not the FEHBP) to January 1, 2023.
The Internal Revenue Service issued guidance implementing the following cafeteria plan changes created by the Consolidated Appropriations Act, 2021. The new law

Provides flexibility with respect to carryovers of unused amounts from the 2020 and 2021 plan years;
Extends the permissible period for incurring claims for plan years ending in 2020 and 2021;
Provides a special rule regarding post-termination reimbursements from health FSAs during plan years 2020 and 2021;
Provides a special claims period and carryover rule for dependent care assistance programs when a dependent “ages out” during the COVID-19 public health emergency; and
Allows certain mid-year election changes for health FSAs and dependent care assistance programs for plan years ending in 2021.
This notice also provides additional relief with respect to mid-year elections for plan years ending in 2021.

OPM Call Letter Released

David Ermer–COVID-19, COVID-19 testing, COVID-19 vaccine, OPM, U.S. Healthcare–February 17, 2021February 17, 2021

Happy OPM Call Letter Day. The call letter is OPM’s call for 2022 benefit and rate proposals from FEHB carriers. Here’s the letter’s summary:

OPM maintains its focus on improving quality and affordability in the FEHB Program, as well as supporting the Biden Administration’s priority focus on health care access and equity. We expect FEHB Carriers to continueto offer forward-thinking proposals that focus onthe strategicprioritiesdescribed in this Call Letter. Our quality initiatives for the 2022 plan year relate to the COVID-19 pandemic, mental health and substance use disorder services, opioids, and prior authorizations for prescription drugs. We also remain focused on enhancements to price and quality transparency, as well as addressing surprise billing and low-value care. We are encouraging FEHB Carriers to expand coverage of certain medical foods for those affected by Inborn Errors of Metabolism (IEM), and to cover fertility preservation related to infertility caused by medical treatment (iatrogenic infertility).

The FEHBlog has provided links to topics that he does not routinely cover. The proposals are due on May 31, 2021. Good luck carriers.

On the COVID-19 front, MedScape encouragingly reports that

Researchers know by now the available COVID-19 vaccines prevent people from getting COVID around 95% of the time. But the million-dollar question remains: Are people less likely to spread the illness after they get the vaccine? According to preliminary data, the odds are good.
“The looming question is, if the person who’s been vaccinated gets infected, does that person have the capability to transmit it to another person,” Anthony Fauci, MD, the White House COVID-19 Response Team’s chief medical adviser, said during a White House briefing Wednesday. “Some studies are pointing in a very favorable direction.”
Fauci cited studies from Spain and Israel published this month, showing the amount of viral load — or the amount of the COVID-19 virus in someone’s body — is significantly lower if someone gets infected after they’ve been vaccinated, compared with people who get infected and didn’t have the vaccine. Lower viral load means much lower chances of passing the virus to someone else, Fauci says.
“There’s a direct correlation with viral load and transmission,” he says. “In other words, higher viral load, higher transmissibility; lower viral load, very low transmissibility.”

Also, the Department of Health and Human Services announced today “new actions to expand COVID-19 testing capacity across the country. These actions will improve the availability of tests, including for schools and underserved populations; increase domestic manufacturing of tests and testing supplies; and better prepare the nation for the threat of variants by rapidly increasing virus genome sequencing.”

From Capitol Hill, this Congressional Budget Office report to the House Ways and Means Committee on the COVID-19 budget reconciliation bill provides a useful overview of the healthcare and employee benefit proposals in the bill. The Speaker intends to pass the $1.9 trillion relief measure by the end of this month.

Health Payer Intelligence discusses a recent Health Affairs article positing that “whether care is affordable for members depends on more than just pricing; affordability is also tied to how clustered healthcare events—and, by extension, healthcare spending—are in a single year.”

The conclusion of this study has clear implications for payers. When members skip care due to affordability, they miss key preventive care services which can result in higher healthcare spending downstream in the members’ healthcare journeys. During the pandemic, payers have waived primary care costs in order to incentivize members to continue receiving care for this very reason. The researchers called on payers, employers, and lawmakers to explore methods for spreading members’ healthcare costs out over time [e.g. monthly deductibles rather than annual deductibles, low copays for essential medicines like insulin].

As we reach the end of the 4th Quarter 2020 financial reporting season, Healthcare Dive summarizes the reports from major health insurers.

Tuesday Tidbits

David Ermer–ACA, AHRQ, COVID-19 vaccine, OPM, U.S. Healthcare–February 16, 2021February 16, 2021

Happy Mardi Gras!

As the FEHBlog has noted, the FEHB Program has unique demographics compared to other employer sponsored health plans because the federal government offers generous FEHB annuitant coverage to its employees. FEHB enrollment is roughly 52% active employees and 48% annuitants. The average age of federal and postal employees is late forties and the FEHBlog understands that average age of an FEHB enrollee is sixty. (OPM offers detailed demographic statistics on its workforce but not on its retirement system members. No complaints, just stating a fact.)

Today HHS’s Agency of Healthcare Research and Quality issued a fascinating report titled “Concentration of Healthcare Expenditures and Selected Characteristics of High Spenders, U.S. Civilian Noninstitutionalized Population, 2018.” Here are the report’s highlights:

In 2018, the top 1 percent of persons ranked by their healthcare expenditures accounted for about 21 percent of total healthcare expenditures, while the bottom 50 percent accounted for only about 3 percent.
Persons ages 65 and older and whites were disproportionately represented in the top spending tiers.
Inpatient hospital care accounted for 36 percent of spending for persons in the top 5 percent of the spending distribution.
About three-quarters of aggregate expenses for persons in the top 5 percent of spenders were paid for by private insurance or Medicare.

In 2018, the top 1 percent of persons ranked by their healthcare expenditures accounted for 21 percent of total healthcare expenditures (100 minus 79 percent; figure 1), with an annual mean expenditure of $127,284 (figure 2). The group within the top 1 percent is defined as persons who spent $72,212 or more during the year. Cut points for additional percentile groups are shown in table 1 [immediately below]. The top 5 percent of the population accounted for 48.3 percent of total expenditures (100 minus 51.7 percent), with an annual mean expenditure of $58,609. The bottom 50 percent accounted for only 3.2 percent of total healthcare expenditures. Every person in this group spent less than $1,317 during the year (table 1), with an average annual expenditure of $384 (figure 2).

Percentile of population	2018 Expenditure
Top 1%	$72,212 or more
Top 5%	$26,355 or more
Top 10%	$14,651 or more
Top 30%	$3,776 or more
Bottom 50%	Less than $1,317

But given the FEHB’s demographics, this figure particularly caught the FEHBlog’s eye:

Figure 4: Percentage of persons by age group and percentile of spending, 2018

Age group	Overall percentage	Bottom 50%	Top 50%	Top 10%	Top 5%
0–17	22.6	30.6	14.5	6.4	5.8
18–44	35.2	43.2	27.3	20.8	18.9
45–64	25.4	20.1	30.7	33.4	36.3
65+	16.8	6.0	27.5	39.4	39.0

It is a credit to OPM and the FEHB carriers that they are able to hold premiums rather stable.

On the COVID-19 vaccination front —

NPR updates us with encouraging COVID-19 vaccination distribution statistics.
Federal News Network tells us that “The Biden administration’s Safer Federal Workforce Task Force has new details on how agencies should handle [COVID-19 vaccination] leave, labor unions and mask mandates during the ongoing pandemic.”
The Centers for Disease Control now offers guidance on how to arrange COVID-19 vaccinations for home-bound individuals.

Healthcare Dive reports on CVS Health’s fourth quarter 2020 earnings report. The headline is that CVS Health’s payer arm Aetna plans to return to the Affordable Care Act marketplace for 2022.

CVS’ fourth quarter revenue of $69.6 billion, up 4% year over year, was mostly due to growth in the benefits segment. Healthcare benefits reported quarterly revenue of $19.1 billion, up 11% year over year, driven primarily by membership growth in Medicaid and Medicare products and partially offset by a drop in commercial membership and COVID-19 costs.
As of the end of 2020, CVS covered 23.4 million lives. Despite fluctuating membership and utilization due to COVID-19 over the course of last year, overall utilization in the fourth quarter was generally back to normal, executives said. The company’s medical loss ratio, a marker of how much it’s reinvesting in patient care, was 86.7% in the quarter, compared to 85.7% same time last year.

JDSupra includes this employment law article titled “Employees Starting to Receive the COVID-19 Vaccine – Now What?” which is worth a gander in the FEHBlog’s opinion.

Happy Presidents’ Day

David Ermer–ACA, COVID-19, COVID-19 vaccine, U.S. Healthcare–February 15, 2021February 15, 2021

It turns out that MountVernon.org takes offense at the use of the designation Presidents’s Day because the official federal holiday is Washington’s Birthday. The FEHBlog expects that it would be a bigger deal if George Washington had not been our first President.

On the COVID-19 vaccine front —

The Wall Street Journal reports that

A study by Clalit, Israel’s largest healthcare provider, showed a 94% drop in symptomatic Covid-19 infections among 600,000 people who received two doses of Pfizer’s vaccine.
The vaccinated group was also 92% less likely to develop severe illness from the disease, according to the study. It compared 600,000 people who got the vaccine with a group of the same size and similar medical histories that didn’t.
Clalit said the study, which was carried out with a team from Harvard University, included 430,000 people who were between 16 and 59 years of age, and 170,000 who were over 60. It was the first of its kind to show such a high level of efficacy for Pfizer’s vaccine for those aged 70 and higher due to the limited scope of the clinical trials.

Federal News Network reports that “To date, the Pentagon vaccinated a little more than 800,000 employees. Since Dec. 14, DoD received about one million doses and delivered about 996,000 of them to military installations. DoD spokesman John Kirby said Thursday [February 11] on a call with reporters that the efficiency rate of delivered vaccines to getting them in arms is around 82%.”

Govexec.com informs us that

The U.S. Postal Service has also reached out to employees, alerting them that they should be eligible for vaccine doses once their states get to the Phase 1B, essential worker stage. In a message to workers last month, USPS encouraged its staff to seek the vaccine by any means available. They cautioned their employees against waiting to get a shot through their workplace. Still, behind the scenes postal management is working with states and other jurisdictions receiving vaccine distributions to set up mass vaccination events at their large plants. To date [last Friday February 12], however, the agency has announced no such plans and employees have voiced frustrations with the lack of communication and sense that they have been left to their own devices. A USPS spokesman recently told Government Executive it was working toward a “standardized priority opportunity” for its workers in conjunction with federal, state and local stakeholders.

In other news —

The special enrollment period for the ACA marketplace began today for “consumers in the 36 states that use the HealthCare.gov platform * * * and will continue through Saturday, May 15. At least 13 States plus the District of Columbia, which operate their own Marketplace platforms, have decided to offer a similar opportunity.” USA Today provides more information on the state marketplaces.
Health Payer Intelligence discusses at length “How Payer Forecasting Is Shifting Towards Real-Time Data Analytics.”
Employee Benefit News discusses the following four workplace policies that employer should be re-evaluating in 2021 —

Human Resources policies and procedures
Risk management – measurement, management and mitigation
Training, education and development
Workplace culture

Friday Stats and More

David Ermer–AHRQ, CDC, COVID-19, U.S. Healthcare–February 12, 2021February 12, 2021

Image result for abraham lincoln birthday

Happy Lincoln’s Birthday.

Based on the Centers for Disease Control’s COVID-19 Case Tracker website, here is the FEHBlog’s chart of new weekly COVID-19 cases and deaths over the 14th week of 2020 through the 6th week of this year (beginning April 2, 2021, and ending February 10, 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 noticed 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 weekly COVID-19 deaths over the period April 2, 2020, through February 10, 2021):

Finally here is a COVID-19 vaccinations chart from December 17, 2020, through February 10, 2021, which also uses Thursday as the first day of the week:

The Wall Street Journal sums it up well for this week :

U.S. Covid-19 deaths [a lagging indicator] appear to finally be slowing, following a broad and steep decline in both newly reported cases and hospitalizations in recent weeks.
While daily deaths remain near record highs, the average number of coronavirus-related fatalities has broadly fallen in recent days, dropping from a seven-day average of 3,172 on Feb. 1 to 2,765 on Wednesday, according to a Wall Street Journal analysis of Johns Hopkins University data.
Vaccinations, meanwhile, appear to be increasing, with about two million shots administered Thursday, according to a Wall Street Journal analysis of data from the Centers for Disease Control and Prevention.

In other vaccination news —

Medpage Today informs us about CDC changes to its adult and children vaccination recommendations which were released yesterday.
HR Dive reports that

The Society for Human Resource Management and 41 other business groups including the U.S. Chamber of Commerce have asked the U.S. Equal Employment Opportunity Commission (EEOC) to clarify “the extent to which employers may offer employees incentives to vaccinate.”
In a Feb. 1 letter to EEOC Chair Charlotte Burrows HR Dive obtained from the HR Policy Association, a signee, the groups wrote that incentives may aid in coronavirus vaccine distribution. But many employers are concerned about the liability they could create in offering such incentives, the letter said.
The signees asked EEOC to clarify how they might offer vaccination incentives without infringing upon the boundaries established by the Americans with Disabilities Act and other laws enforced by the agency. Specifically, the groups requested that the agency issue guidance that defines “what qualifies as a permissible incentive as broadly as possible.” An EEOC spokesperson said the agency appreciates “input from all stakeholders and will review the letter carefully.”

From the seeking public comment front —

The National Committee for Quality Assurance is seeking “feedback on proposed new measures, changes to existing measures and proposed measures for retirement. Public comment is now open for HEDIS^® Measurement Year 2022.” The public comment deadline is March 11, 2021.
HHS’s Agency for Healthcare Research and Quality “encourage [interested parties] to review the draft report [titled “Strategies to Improve Patient Safety: Draft Report to Congress for Public Comment and Review by the National Academy of Medicine”] and send comments to [email protected] no later than Feb. 16. We’ll review feedback in developing a final report for Congress later this year.” That’s not much time as the notice was posted today.

Thursday Miscellany

David Ermer–COVID-19, U.S. Healthcare, Uncategorized–February 11, 2021February 11, 2021

Today the Department of Health and Human Services (“HHS”) announced that

HHS and Department of Defense (DOD) have purchased an additional 100 million doses of COVID-19 vaccines from both Pfizer Inc. and Moderna Inc. to help meet demand for COVID-19 vaccines in the United States. The orders placed today bring the vaccine purchased by the U.S. government from these two companies to a total of 600 million doses, enough to vaccinate 300 million people. Each company is delivering 300 million doses in regular increments through the end of July 2021. Each company will leverage U.S.-based manufacturing capacity to fill, finish and ship vials as the bulk material is produced.”

The current U.S. population is 333 million and roughly 60 million of those people under age 16 and therefore currently are ineligible for either vaccine. Consequently the government has purchased more than enough of these two vaccines to vaccinate the entire eligible population with both doses. What’s more, 34 million Americans (10% of the entire U.S. population) already has received the first dose of one of these vaccines and another 11 million have received both doses. Also the Johnson and Johnson single dose vaccine should be available early next month. It’s becoming a matter of logistics.

The Wall Street Journal which was the first paper to legally crack into Medicare pricing records has now figured out how to find transparent hospital pricing required by the new HHS rule.

Mayo Clinic offers a search interface at https://costestimator.mayoclinic.org/. The nonprofit hasn’t posted a file covering all of its negotiated rates and says it is working to have one online by this spring.
The hospital chain Sutter Health, on the other hand, is offering downloadable data for all of its hospitals on a single webpage labeled “Healthcare Cost Transparency,” here: https://www.sutterhealth.org/for-patients/healthcare-cost-transparency
Efforts to pull together and standardize data from many hospitals are emerging. Turquoise Health Co. has scoured the websites of every known hospital in the country—more than 6,000 providers—and found disclosures that at least partially meet the requirements for 1,700 hospitals, according to Chris Severn, a co-founder of the company. Consumers can search the data on Turquoise’s website at https://turquoise.health/
“This data was hard to find but it’s incredibly useful and, overall, a large amount of the industry has complied,” Mr. Severn said. “This is a huge step towards cost-informed decision making in health care.”

The American Hospital Association points out that

Leading health providers have come together in unprecedented fashion to unite around the goal of improving the lives of those they serve through data insights. Health provider innovators AdventHealth, Advocate Aurora Health, Baptist Health of Northeast Florida, Bon Secours Mercy Health, CommonSpirit Health, Hawaii Pacific Health, Henry Ford Health System, Memorial Hermann Health System, Northwell Health, Novant Health, Providence health system, Sentara Healthcare, Tenet Health, and Trinity Health have formed Truveta, a new company with a vision to save lives with data.
Through structuring, normalizing, and de-identifying data from these health providers, a new data platform will be built, with careful protection of patient privacy and security. This new platform, using the power of AI and machine learning, will enable unprecedented insights as providers are able to learn from each other with statistically significant scale and representation of diverse populations.
Together, these 14 health providers care for tens of millions of patients and operate thousands of care facilities across 40 states. The health providers will govern Truveta’s ethical pursuit of insights from this unprecedented de-identified data set.

Interesting.

Also the Blue Cross Blue Shield Association announced that

Today, a broad coalition of health care and employer groups called for achieving universal health coverage by expanding financial assistance to consumers, bolstering enrollment and outreach efforts, and taking additional steps to protect those who have lost or are at risk of losing employer-based coverage because of the economic downturn caused by the COVID-19 pandemic.
The Affordable Coverage Coalition encompasses groups representing the nation’s doctors, hospitals, employers and health insurance providers that collectively serve hundreds of millions of American patients, consumers and employers. The joint commitment by such a broad array of interests is a significant milestone on the path toward universal coverage, which has remained an elusive goal within the U.S. healthcare system.
The organizations support the following steps to make health coverage more accessible and affordable:
Protect Americans who have lost or are at risk of losing employer-provided health coverage from becoming uninsured.
Make Affordable Care Act (ACA) premium tax credits and cost-sharing reductions more generous, and expand eligibility for them.
Establish an insurance affordability fund to support any unexpected high costs for caring for those with serious health conditions or to otherwise lower premiums or cost-sharing for ACA marketplace enrollees.
Restore federal funding for outreach and enrollment programs.
Automatically enroll and renew individuals eligible for Medicaid and premium-free ACA marketplace plans.
Provide incentives for additional states to expand Medicaid, in order to close the low-income coverage gap.

Good luck. (Not to be confused with the Council for Affordable Health Coverage which appears to have similar goals.)

Midweek update

David Ermer–Congress, COVID-19, U.S. Healthcare–February 10, 2021February 10, 2021

From Capitol Hill —

Katie Keith helpfully provides more detail on the healthcare provisions found in the draft House of Representative’s COVID-19 relief budget reconciliation bill.
Govexec.com reports on the federal employee related provisions of the same draft bill.
FedSmith informs that “Some Members of Congress are asking the Office of Personnel Management to give federal employees administrative leave for any time they spend getting vaccinated for COVID-19. The letter was sent to OPM by Reps. Don Beyer (D-VA), Eleanor Holmes Norton (D-DC), Gerald E. Connolly (D-VA), Anthony Brown (D-MD), Jamie Raskin (D-MD), David Trone (D-MD), and Jennifer Wexton (D-VA). They state in the letter that mandating that federal agencies provide administrative leave to federal employees is necessary to fight the pandemic. “…it is imperative that the federal government take every possible step to encourage federal employees to receive the vaccine, including providing them with the administrative time to do so,” reads the letter.”
Politico reports on Office of Management and Budget Director nominee’s confirmation hearing this morning before the Senate Budget Committee.
The Brookings Institute released a report with recommendations on making Capitol Hill a better place to the work. This recommendation caught the FEHBlog’s eye:

Since 2014, members and certain congressional staff have been required to use Washington, D.C.’s small-business marketplace established by the Affordable Care Act to obtain insurance, rather than having their health benefits provided via the Federal Employees Health Benefits Program that insures other federal employees. As the HSCMC’s final report noted, “The transition to the D.C. exchange has been particularly challenging for some district-based staff as finding local health providers who accept patients covered by the D.C. exchange is difficult.” The HSCMC recommended that Congress eliminate this setup, allowing both D.C.- and district-based staff to either enroll in standard federal health plans or to use their relevant local marketplace to purchase coverage.

OPM could implement the “local marketplace” fix via regulation. An interim regulation would be nice as the federal ACA marketplace is about to reopen for three months.

While on the topic of the Affordable Care Act, the Biden Administration’s Justice Department filed a very sensible letter today with the U.S. Supreme Court regarding the California v. Texas case concerning the ACA’s constitutionality. It states that it is now the Justice Department’s position that zeroing out the individual mandate did not render the ACA unconstitutional. “[T]he 2017 amendment preserved the choice between lawful options and simply eliminated any financial or negative legal consequence from choosing not to enroll in health coverage.” How true.

From the COVID-19 front —

MedCity News reports that “An Eli Lilly therapy comprised of two antibodies given together has been awarded FDA emergency authorization for treating Covid-19, providing yet another option for patients diagnosed with the disease. The decision comes two weeks after Indianapolis-based Lilly reported clinical trial data showing that given together, the antibodies bamlanivimab and etesevimab reduced Covid-19 patients’ risk of hospitalization and death by 70 percent. The FDA authorization, issued late Tuesday, covers adults and children 12 and older with mild-to-moderate Covid-19 whose cases are at high risk of progressing to severe disease. The authorization also includes patients 65 and older who have certain chronic medical conditions.

Fierce Healthcare informs us that

New data from the Blue Cross and Blue Shield Association (BCBSA) take a look at just how much COVID-19 cases are costing insurers.
BCBSA studied more than 90,000 confirmed cases of the novel coronavirus pulled from a diverse selection of its membership. The group found COVID-19 cases treated in an outpatient setting cost between $500 and $1,000 per member on average, with the average age of patients seeking such care being 34.
When members were hospitalized with the virus, however, costs were 45 times higher than for cases treated on an outpatient basis. For members who needed a stay in the intensive care unit, costs jumped another 2.5 times compared to other hospitalizations, BCBSA found. The average age for members hospitalized with COVID-19, including in the ICU, was 54, according to the analysis.

The Wall Street Journal tonight adds more detail to yesterday’s report on the World Health Organization of the spread of COVID-19 in China.

About 90 people were hospitalized with Covid-19-like symptoms in central China in the two months before the disease was first identified in Wuhan in late 2019, according to World Health Organization investigators, who said they pressed Beijing to allow further testing to determine whether the new virus was spreading earlier than previously known. * * * If the 90 cases included Covid-19 infections, it could help explain suspected coronavirus cases that researchers believe occurred in Europe and possibly the U.S. in November and December 2019. * * * The U.S. said Tuesday it saw no potential origin other than in China and wanted to examine the underlying data from the WHO’s four-week mission.

Finally, Health Payer Intelligence provides its perspective on fourth quarter financial reports from health insurers. “Payers anticipate that increased membership, lower utilization, potentially a higher federal medical assistance percentage, and other factors could offset healthcare spending as it returns to normal levels.”

Tuesday Tidbits

David Ermer–Congress, COVID-19, Rx coverage, U.S. Healthcare, Uncategorized–February 9, 2021February 9, 2021

The Wall Street Journal reports tonight that

The most severe surge of the Covid-19 pandemic in the U.S. has weakened significantly, according to key metrics, though public-health experts and epidemiologists urge caution, given the spread of highly contagious new variants.
Newly reported cases have dropped 56% over the past month, based on a seven-day average, marking a significantly steeper fall than the U.S. saw after the spring and summer surges. Hospitalizations have declined 38% since Jan 6. The seven-day average of Covid-19 tests returning positive fell over the past week to 6.93%, the lowest since Oct. 31.
“The concern right now is that while we’re seeing a decline in cases from the holiday surges, as we identify more transmission of the variants within the U.S., this could lead to another surge,” said Saskia Popescu, an assistant professor at the Schar School of Policy and Government at George Mason University.

The American Medical Association reports

[A]s part of its “Understanding Coronavirus in America” study, researchers from the University of Southern California Center for Economic and Social Research recently analyzed data from 6,000 members drawn from its “Understanding America Study.” Data was collected between March 10, 2020, and Jan. 6, 2021, and found that 83% of adults surveyed view wearing a mask as an effective way to stay safe from COVID-19, but that their behavior is inconsistent.
The analysis found:
Two-thirds reported being within less than six feet of someone outside their household in early December, but only half mostly or always wore a mask while doing so.
White people were the least likely to consistently wear a mask when in close contact with people from other households, with 46% reporting wearing a mask compared to 67% of black people, 63% of Latinos and 65% of people of other races.
In rural areas, 42% reported always wearing a mask or wearing one most of the time when they were with people outside of their household. In suburban areas, the number jumped to 52% and it was highest in urban areas at 57%.
Among the 81% who said they went grocery shopping in early December, 90% reported wearing a mask.

This is why the vaccination campaign is so important.

On the Capitol Hill front

The Hill explains Sen. Ron Wyden’s plans as the new Chair of the Senate Finance Committee. The Senator has been a critic of high prescription drug prices.
The Hill also reports the House of Representatives is developing a COVID-19 relief budget reconciliation bill that would increase and expand the availability of Affordable Care Act subsidies as well as offer 85% subsidies for employer sponsored plan continuation coverage, i.e., COBRA and TCC, during 2021 and 2022.

On the Biden Administration transition front —

NPR discusses Office of Management and Budget Director nominee * Neera Tanden’s confirmation hearing before the Senate Homeland Security and Governmental Affairs Committee today. Ms Tanden has a second confirmation hearing scheduled before the Senate Budget Committee tomorrow morning.
Federal News Network informs us that President “Biden recently appointed Pam Coleman as OMB’s new associate director for performance management, the agency’s point person on federal workforce issues. * * * Coleman comes from the New Mexico state government, where she led the personnel office for the last two years. Coleman had multiple roles in the Obama administration, including as a leadership development team lead in the White House Presidential Personnel Office and as a liaison to DHS. The OMB associate director for performance management is usually the agency’s go-to on everything from federal pay and benefits to hiring and labor relations. Biden hasn’t yet nominated a new director for the Office of Personnel Management.”
STAT News compares the two leading contenders for Food and Drug Administration Dr. Janet Woodcock, the current acting commissioner, “and Josh Sharfstein, a vice dean at the Johns Hopkins Bloomberg School of Public Health who served as the FDA’s second-in-command during the Obama administration.” Dr. Woodcock is an FDA vet while Dean Sharfstein would be “only the second FDA commissioner in modern history to serve as a local public health official. While most FDA commissioners typically come from backgrounds in academic medicine or from other federal agencies, and thus tend to focus primarily on the regulation of drugs, Sharfstein has been far more outspoken about the FDA’s lesser known responsibilities, like regulating cigarettes and food.”

In other tidbits —

Beckers Hospital Review lists the HealthGrades top fifty U.S. hospitals for January 2021.
Govexec reports on the Postal Service’s latest quarterly financial report and a looming Postal Board of Governors power shift from Republicans to Democrats.
The Society for Human Resource Management seeks to keep us up to date on “evolving COVID-19 testing and safety guidelines [for employers] as the pandemic persists.”