Thursday Miscellany

U.S. Healthcare

Thursday Miscellany

David Ermer–COVID-19 testing, OPM, U.S. Healthcare–

The Wall Street Journal reports “The Trump administration unveiled Thursday a $750 million deal to buy 150 million rapid Covid-19 tests from Abbott Laboratories, a move that would substantially expand the nation’s capacity for rapid testing.” As noted in yesterday’s post, this $5 antigen test, which received Food and Drug Administration emergency use authorization on Wednesday, ” is roughly the size of a credit card. The test could be administered in a doctor’s or school nurse’s office and uses technology similar to home pregnancy tests. It returns results in about 15 minutes.”

While on the subject of COVID-19 testing, Fierce Healthcare informs us that

Out-of-network costs for COVID-19 testing far outpace the costs for in-network tests, according to a new report from America’s Health Insurance Plans. The results suggest that price gouging is a significant problem under the pandemic, the group argues. The AHIP analysis finds that a test for the novel coronavirus costs on average $130 for commercial insurers. However, out-of-network providers charged more than $185 for 40% of diagnostic test and 25% of antibody tests, the lobby organization found.

Shameful. Congress should step in on this one.

In encouraging developments,

Fierce Biotech lets us know that

As the world scrambles to develop diagnostics, treatments and vaccines for COVID-19, one big question looms: How will we face the next pandemic? Johnson & Johnson and the U.S. Biomedical Advanced Research and Development Authority (BARDA) are teaming up once again to answer that.

Through a joint effort dubbed Blue Knight, the duo aims to boost innovation and “amplify” scientific and technological advancements to prepare for potential health threats—starting with COVID-19. They’ve picked seven startups from J&J’s global JLABS network to participate. The startups will receive up to $500,000 in support, as well as mentorship from BARDA and J&J to help them navigate R&D challenges and regulatory pathways and get medicines and tools to patients and healthcare workers as soon as possible.

and Healthcare Dive reports that

Aetna is partnering with WellBe Senior Medical, a relative newcomer, to deliver primary care services to about 10,000 high-risk seniors in their homes, according to WellBe CEO Jeff Kang, who is also a physician. The program launched in Atlanta last month and is now available for certain seniors in the Chicagoland area. For eligible seniors, this means access to at-home care 24 hours, seven days a week, lessening the burden of getting a ride to an appointment or venturing to a medical facility amid the pandemic. Even COVID-19 testing can be done in their homes. Aetna assigns eligible high-risk patients to WellBe, which is then responsible for managing their care and receives capitated payments from Aetna. Those eligible are typically seniors in their 80s with multiple chronic conditions, including diabetes, heart failure, osteoarthritis and dementia, Kang said in an interview with Healthcare Dive.

There are plenty of elderly annuitants in the FEHBP although most of them have primary Medicare coverage.

Finally in Office of Personnel Management new:

Office of Personnel Management acting Director Michael Rigas [considerately] has issued a new memorandum to agency heads Aug. 27 informing them that [under a new regulation] employees will no longer have to pre-schedule their annual leave prior to the third pay period before the end of the year, so that the agency can then cancel and restore it. [A]ny leave that is forfeited at the end of the year due to a national emergency where the employee was deemed essential and not able to take leave would automatically be considered “scheduled in advance” and restored into a separate leave account for later employee use.

and Govexec.com updates us on the upcoming Combined Federal Campaign. This annual charity drive for federal employees runs from Sept. 21 through Jan. 15, 2021.

Midweek update

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

On the COVID-19 healthcare front –

  • The Wall Street Journal reports this evening that

The U.S. Food and Drug Administration has granted emergency-use authorization to Abbott Laboratories for a $5 rapid-response Covid-19 antigen test that is roughly the size of a credit card. The low-cost, rapid-response test could be administered in a doctor’s or school nurse’s office and uses technology similar to home pregnancy tests. It returns results in about 15 minutes. * * *Abbott’s new test, called the BinaxNOW COVID-19 Ag Card, searches for virus proteins and is intended to be used for patients within seven days of feeling coronavirus symptoms. It involves a nasal swab administered by a health-care professional such as a doctor, school nurse or pharmacist. The swab is inserted into the card-like test.

  • Beckers Hospital Review reports that to the consternation of outside experts, the Centers of Disease Control (CDC) has advised that “people without symptoms don’t always need to be tested. The original guidelines recommended testing for all close contacts of known COVID-19 patients. The updated version says known contacts “do not necessarily need a test” if they don’t have symptoms. Exceptions can be made for vulnerable individuals and if clinicians or public health officials recommend testing.”
  • MedPage Today informs us that “Patients with COVID-19 should delay getting their influenza vaccine, not because of any evidence about how the virus affects vaccination, but in order to ensure others in the healthcare setting are not exposed unnecessarily, CDC officials said on a call with clinicians on Thursday [August 20].”
  • National Committee for Quality Assurance leaders discuss in the Health Affairs blog how the NCQA’s new digital quality measures are responsive to the COVID-19 public health emergency. In the FEHBlog’s view these digital changes which tie in with electronic health record interoperability advances, e..g., HL7’s FHIR API, will lead to health care quality improvements generally.

The Abbott Labs test is an important development from the FEHBlog’s perspective.

In COVID-19 developments outside of healthcare —

  • Bloomberg Government notes, as the FEHBlog expected, that “Representatives of Rite Aid Corp, Walgreens Pharmacy, OptumRx Inc., and Express Scripts Inc., all major pharmacy and pharmaceutical benefit manager chains, said they aren’t seeing major disruptions to order times for prescriptions this year.”
  • HR Dive discusses three COVID-19 workplace trends that are likely here to stay — expanded paid leave access, increased attention to employee and customer safety, and telework as an accommodation.
  • The Society for Human Resource Management summarizes new Labor Department guidance on tracking hours worked by teleworking employees who are subject to the Fair Labor Standards Act.

In other news —

  • The FEHBlog registered this evening for the FREE Health Payment Action and Learning Network’s virtual summit scheduled for October 13. You can register here. The FEHBlog has been attending this interesting event for a few years.
  • Healio reports that according to a new CDC report on teen vaccination rates in our country, “HPV and meningococcal vaccination coverage among adolescents aged 13 to 17 years in the United States continues to improve, although geographical disparities persist, according to findings published in MMWR. Researchers found that adolescents at or above the poverty line who lived outside a metropolitan statistical area (MSA) were less likely to have received an HPV or meningococcal vaccine than adolescents living in MSA principal cities.”
  • Health Payer Intelligence reports that “To further discover trends in COVID-19 mortality and the spread of the virus, researchers are increasingly leveraging geographic and population data for new insights on how the disease operates.” Investigations of all wide spread health problems can benefit from this geographic approach because after all healthcare is local.

Monday Roundup

David Ermer–Congress, COVID-19, HIPAA Privacy and Security Rules, U.S. Healthcare–

Federal News Network reports on the Postmaster General’s testimony before the House Oversight and Reform Committee today. The article explains

The Postal Service has dealt with staffing issues as a result of the coronavirus pandemic. About 40,000 postal employees have contracted COVID-19 or have shown symptoms that have required them to quarantine. Several dozen employees have died.

[Postmaster General] DeJoy said employee availability during the pandemic peaked in July, but warned that staffing has been down by about 3-4% on average. The Philadelphia and Detroit metro areas, he added, are “significantly below normal route run rates” — in some cases 20% below normal staffing rates.

The Wall Street Journal discusses new thinking on public health measures to control the infection rate without shutting down businesses. Better late than never.

The experience of the past five months suggests the need for an alternative: Rather than lockdowns, using only those measures proven to maximize lives saved while minimizing economic and social disruption. “Emphasize the reopening of the highest economic benefit, lowest risk endeavors,” said [Harvard epidemiologist] Dr. [Michael] Mina.

In other words use social distancing, good hygiene and mask wearing and avoid super spreader events.

Research by Dr. Mina and others has shown that “super-spreader” events contribute disproportionately to infections, in particular dense indoor gatherings with talking, singing and shouting, such as at weddings, sporting events, religious services, nightclubs and bars.

Dr. Mina wrote this month on the importance of is “a shift in [COVID-19 testing] strategy toward a cheap, daily, do-it-yourself test that he says can be as effective as a vaccine at interrupting coronavirus transmission — and is currently the only viable option for a quick return to an approximation of normal life [pending a vaccine]. He advocates applying the nasal or saliva sample to a paper strip that would tell you whether or not you have the COVID-19 infection. This is a step beyond this month’s saliva test advances that must be delivered to a lab. Forbes provides more background here.

Here are a couple of updates on progress being made in the COVID-19 vaccine development process from Fierce Healthcare and MedCity News.

The Department of Health and Human Services announced today that its Office for Civil Rights (“OCR”), which enforces the HIPAA Privacy and Security Rules,

issued amended guidance on how the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rule permits covered health care providers (e.g., hospitals, pharmacies, laboratories) and health plans to contact their patients and beneficiaries who have recovered from COVID-19 to inform them about how they can donate their plasma containing antibodies (known as “convalescent plasma”) to help treat others with COVID-19. OCR added health plans to the June 2020 guidance that explains how HIPAA permits covered health care providers and health plans to identify and contact patients and beneficiaries who have recovered from COVID-19 for individual and population-based case management or care coordination. The guidance also emphasizes that, without individuals’ authorization, the providers and health plans cannot receive any payment from, or on behalf of, a plasma donation center in exchange for such communications with recovered individuals.

Let’s wrap up the round up with two healthcare provider survey stories —

Hospital operating margins are severely depressed, down 96% since the start of the year through July compared with the first seven months of last year, not including the financial aid from the federal government, according to the latest report from Kaufman Hall.
When factoring in federal relief funds, operating margins were down 28% for the January to July period compared with the same period last year.
However, there appear to be signs of recovery. When zeroing in on operating metrics month-over-month from June to July, operating margins did improve 24%, which the consultant group said is likely due to a backlog in patient demand.

  • A friend of the FEHBlog called to his attention this Healthcare Innovation Group report on a Physicians’ Foundation survey of physician sentiments about COVID-19.

Weekend update

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

Yesterday, the House passed H.R. 8015 by a 257-150 vote. This bill would require a roll back of certain management changes at the Postal Service and provide the Postal Services with a $25 billion grant. The New York Times reports that

Senator Mitch McConnell of Kentucky, the majority leader, said plainly on Saturday that he did not plan to bring up a stand-alone bill in the Senate when lawmakers are at a stalemate over broader coronavirus relief legislation.

“The facts show the U.S.P.S. is equipped to handle this election, and if a real need arises, Congress will meet it,” he said in a statement. “The Senate will absolutely not pass stand-alone legislation for the Postal Service while American families continue to go without more relief.”

We shall see whether this House action leads to further talks between the House leadership and the White House.

No legislative action is scheduled to occur in either House of Congress this coming week, but some committee activity is scheduled. For example, the Postmaster General, among others, will testify before the House Oversight and Reform Committee tomorrow morning at 10 a.m. ET.

Forbes reminds us that tomorrow is the deadline for the prescription drug industry to provide feedback to the White House on its most favored nation drug pricing order.

President Trump postponed moving ahead with the executive order on drug pricing until Monday, August 24th, giving time to pharmaceutical manufacturers to come up with an alternative pricing proposal. In this respect, the executive order appears to be a one-month ultimatum to establish a bargaining position. If the Trump Administration isn’t satisfied with the alternative plan, it says it would push forward with the executive order. However, as of Saturday, August 22nd, drug makers have yet to offer an alternative pricing plan, and there’s no indication that the Trump Administration will reveal precise details of the executive order, let alone implement it in the next 48 hours. If the Trump Administration were to go ahead with, say, the IPI pilot program, it would likely face strong legal challenges.

Let’s face it in order to maintain the decreasing number of COVID-19 cases pending Food and Drug Administration (“FDA”) approval of a COVID-19 vaccine, we need (1) to maintain public health protections like social distancing, mask wearing, and avoiding super spreader events, (2) to be able to practically use a reliable, inexpensive COVID-19 test like the Yale saliva test, and (3)trust in medical researchers to bring more COVID-19 treatments on line.

With regard to the third point

Covid-19 clinical trials are now under way for 10 new monoclonal antibodies, known as mAbs in industry jargon, according to the Antibody Society, a professional association of researchers.

The most advanced are already in mid- and late-stage studies in newly diagnosed as well as hospitalized patients, and in people who haven’t yet been infected. If they clear testing, the drugs might be available as soon as early in the fourth quarter, according to Geoffrey Porges, an SVB Leerink LLC analyst.

In August, late-stage studies were launched evaluating Lilly’s lead antibody in hospitalized and nonhospitalized patients, and these could be completed before the end of the year, depending on how quickly patients are enrolled.

Regeneron expects to have the first data from its study of a monoclonal antibody in hospitalized and nonhospitalized patients by the end of September. The company could seek an emergency authorization based on the data if there is a strong indication the drug is blocking the virus.

  • The Wall Street Journal also reports this evening that that FDA ultimately gave emergency use authorization to convalescent plasma therapy treatment for hospitalized patients from COVID-19. This therapy also relies on antibodies. “For Covid-19 patients and the doctors who treat them, the designation opens up the possibility for faster and easier access to a promising treatment, while studies and clinical trials continue to explore who is helped and how much.”
  • Two former FDA commissioners, Doctors Scott Gottlieb and Mark McClellan offered an opinion piece published in the Wall Street Journal. They observe that

The development of drugs to treat Covid-19 is moving at a remarkable pace. The use of steroids is a major advance that is reducing the risk of death in hospitalized patients. Novel drugs, including manufactured antibodies that mimic the body’s immune response to the virus [referring to the monoclonal antibodies], are in late-stage development and could be available by the fall. There are about 750 drugs in screening studies (Phase II) or in large, definitive clinical trials (Phase III).

The challenge is to develop evidence as quickly as possible without compromising standards. Anytime there’s an unmet medical need, the tendency is to blame the Food and Drug Administration’s regulatory process. But if we don’t know what works, and what doesn’t, we’ll waste time and money on treatments that won’t help and may harm. Even if a vaccine is discovered and approved, the pandemic won’t end unless most Americans get vaccinated, which will require confidence in the product’s safety and efficacy.

Heartily agreed.

The FEHBlog ran across this interesting Health Payer Intelligence story about how Blue Cross and Blue Shield of Kansas City has created a social needs referral network.

The social needs referral network is a collection of community-based organizations that have partnered with Blue KC and that target social determinants of health needs in the Kansas City area. When Blue KC employees and provider partners come across a patient with a social determinants of health barrier, they can refer patients to these organizations.

In the spring of 2020, Blue KC launched an electronic platform to unify organization efforts, streamline social determinants of health screening data, and help Blue KC employees and provider partners more easily identify nearby community-based organizations that can meet particular patient needs.

Creative move.

Friday Stats and More

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

Based on the CDC’s Cases in the U.S. website, here is the FEHBlog’s chart of new weekly COVID-19 cases and deaths over the 20th through 32nd weeks of this year (beginning May 14 and ending August 19; using Thursday as the first day of the week in order to facilitate this weekly update):

and here is the CDC’s latest overall weekly hospitalization rate chart for COVID-19:

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

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

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

Whoopee.

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

No bueno.

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

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

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

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

Midweek update

David Ermer–CDC, COVID-19, SCOTUS, U.S. Healthcare–

Healthcare Dive reports on the National Business Group on Health’s (“NBGH”) 2021 Large Employer Health Care Strategy and Plan Design Survey. This squib caught the FEHBlog’s eye:

Beyond expanding online mental health resources, respondents also mentioned interest in virtual care for musculoskeletal management conditions. Musculoskeletal conditions were most frequently cited by employers as contributing to rising health care costs, and 29% of those surveyed said they will offer musculoskeletal management virtually next year.

[NBGH President Ellen] Kelsay said virtual treatments for common joint conditions can help stave off unnecessary surgical interventions, and “now that we have a workforce that for many months has been working at home and probably not in the most ideal of ergonomic situations, we expect to see musculoskeletal conditions continue to worsen.”

If the FEHBlog were an employer in northeastern Ohio, he would jump at the new accountable care organization (“ACO”) that Aetna and the Cleveland Clinic have announced today. Here’s Beckers Payer Issues report on the arrangement. The FEHBlog loves the ACO concept.

The FEHBlog also has been intrigued by the research effort to develop convalescent plasma therapy for COVID-19. The AP reports today that the FDA is not ready to give emergency use authorization to this treatment because reliable evidence of efficacy has not emerged from currently reported studies. The FEHBlog was encouraged to find that yesterday “the National Institutes of Health awarded Albert Einstein College of Medicine and Montefiore a $4.3 million grant to support a randomized, double-blind, placebo-controlled phase 2 clinical trial that launched in April to evaluate the efficacy of convalescent plasma to treat COVID-19.” The public will be better served by waiting for the results of this study.

The FEHBlog ran across this CDC site on COVID-19 contact tracing, a topic that has been in the news lately. It may be helpful for health plans to share this information with their members.

Finally, the U.S. Supreme Court calendared the Texas v. California case for oral argument on November 10, 2020. This is the third case to present the issue of the Affordable Care Act’s constitutionality. In the FEHBlog’s legal opinion, the Supreme Court unanimously will support the ACA’s constitutionality in this case. The Supreme Court took this case to stop the Fifth Circuit court of appeals from slicing up the law based on a flawed severability analysis, not to strike the law down. The proof is in the pudding — the ACA marketplace did not fall apart without the individual mandate.

Tuesday Tidbits

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

Happy 100th anniversary of American women’s suffrage to all. It seems to the FEHBlog that the British women’s suffrage movement overshadows the American women’s suffrage movement in history. (Perhaps the FEHBlog watch too much English television). The FEHBlog was favorably struck by the fact that American women got the same right to vote as men about ten years before British women did.

The FEHBlog discovered today that the OPM Inspector General has posted his semi-annual report to Congress for the period ended March 31, 2020, and OPM has posted its management response thereto. The first page of the Inspector General’s report following the cover is particularly flashy.

The Department of Health and Human Services released today its Health People 2030 report which “features 355 core – or measurable – objectives with 10-year targets, new objectives related to opioid use disorder and youth e-cigarette use, and resources for adapting Healthy People 2030 to emerging public health threats like COVID-19. For the first time, Healthy People 2030 also sets 10-year targets for objectives related to social determinants of health.” Check it out.

In a related action, the Wall Street Journal reports that the federal government is in the midst of crafting its five year plan for American diets. The alcohol committee is proposing that men meet the same daily consumption standard set for women — one alcoholic beverage per individual. This reminds the FEHBlog of another action that happened a century ago but only lasted a thirteen years — prohibition. The Department of Agriculture will finalize the five year diet plan later this year.

On the prescription drug front —

  • Medscape offers a description of the 35 prescription drugs that the Food and Drug Administration has approved so far in 2020.
  • Drug Channels to the FEHBlog’s surprise informs us that “nine out of ten large hospitals now operate a specialty pharmacy. Hospitals and other healthcare providers account for one-third of all U.S. accredited specialty pharmacies. Clinical and general financial motivations are driving hospitals’ DIY specialty pharmacy growth. The enormous profit opportunities from the 340B Drug Pricing Program offer further encouragement for hospitals. In-house specialty pharmacies are also a valuable hedge against the potential loss of contract pharmacies.”

Speaking of hospitals, Beckers Hospital Review reports that the Centers for Medicare and Medicaid Services announced yesterday that “Hospitals will get a [20%] payment boost on Sept. 1 for caring for Medicare beneficiaries diagnosed with COVID-19. A positive COVID-19 laboratory test must be documented in the patient’s medical record for the hospital to receive the higher payment.”

Finally, on the Postal Service front, the Federal News Network reports that “Postmaster General Louis DeJoy says the Postal Service will hold off on ‘longstanding operational initiatives’ to reduce costs until after this November’s election.” The Wall Street Journal adds that

The House plans to vote Saturday on a bill that would give $25 billion in additional funding to the agency, which is what the Postal Service requested to meet budget shortfalls and costs related to the coronavirus pandemic. The bill would also prohibit the agency from implementing any changes to operations or service levels it had in place on Jan.1 until the end of the Covid-19 emergency or Jan. 1, 2021, whichever comes later.

Senate Republicans are preparing a pared-down coronavirus aid package that would include $10 billion for the Postal Service as well as money for the unemployed and for testing and combating the coronavirus.

The Postmaster General will appear before the Senate Homeland Security and Governmental Affairs Committee on Friday August 21 at 9 am and the House Oversight and Reform Committee on Monday August 24 at 10 am.

Monday Roundup

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

The Wall Street Journal reports that House of Representatives Speaker Nancy Pelosi (D CA) has decided to bring the House back for a vote later this week on a bill to protect the Postal Service. Of course because the House has approved remote voting during the continuing COVID-19 emergency members will not be required to return to DC.

It appears to the FEHBlog that the legislative vehicle for this action will be HR 8015 which House Oversight and Government Reform Committee Chair Carolyn Maloney introduced last Tuesday. The bill’s title / purpose reads “To maintain prompt and reliable postal services during the COVID-19 health emergency, and for other purposes.” It has 37 co-sponsors. The Congressional Research Service summary and the text of the bill are not yet available but the FEHBlog has signed up for alerts on congress.gov.

This afternoon, a federal district court judge from Brooklyn, NY, issued a decision enjoining the recently revised ACA Section 1557’s rule’s “repeal” of the sex discrimination definition found in the Obama Administration’s Section 1557 rule. That definition offered express protection to transgendered people. The federal district court in Washington, DC, which is considering a challenge to the legality of the entire rule, hasn’t issued a ruling today. The rule’s effective date is tomorrow. Perhaps the Brooklyn district court’s action will cause HHS to re-evaluate the rule. In the FEHBlog’s view that would be the most sensible course of action in the wake of the Supreme Court’s Bostock County decision.m

On the COVID-19 front —

  • STAT News recounts what we know and don’t know about the COVID-19 virus from its standpoint. The article is worth a skim.
  • The Centers for Disease Control has released updated guidance on the duration of isolation and precautions for people who have been infected with COVID-19.
  • Managed Healthcare Executive reports that “The report on Deloitte’s biennial Center for Health Solutions Survey of U.S Consumers shows a significant increase in virtual care visits versus pre-pandemic trends, and a reversal in consumers’ willingness to share health data following the COVID-19 pandemic.” Silver lining?
  • Fierce Healthcare discusses “the unexpected ways [Artificial Intelligence] AI is impacting the delivery of care, including for COVID-19.” For example,

[A team lead by] Paul Friedman, M.D., the chairman of the cardiovascular department at Mayo Clinic * * * has trained an AI-algorithm embedded into standard electrocardiogram tests to detect which patients have weak heart pump, Friedman said speaking during a recent Fierce AI Week event. Five years later, the team discovered that the algorithm had made accurate predictions. “The physiological signals are affecting the electrocardiogram in subtle ways,” Friedman said. * * * So it looks like it’s looking into the future.”

Groovy.

Weekend update

David Ermer–Congress, COVID-19, COVID-19 testing, U.S. Healthcare, Uncategorized–

Because Congress is out of town until after Labor Day. let’s lead with the story that caused the FEHBlog to levitate out of his easy chair yesterday. The Yale News headline says it all — “Quick and affordable saliva-based COVID-19 test developed by Yale scientists receives FDA Emergency Use Authorization.”

A couple weeks ago the FEHBlog mentioned a USA Today story about an Xprize competition to find a quick and inexpensive COVID-19 test that would facilitate going back to work, school, etc. The Xprize competition’s first round closes next week and we already have one winner.

Check this out:

Wide-spread testing is critical for our control efforts. We simplified the test so that it only costs a couple of dollars for reagents, and we expect that labs will only charge about $10 per sample. If cheap alternatives like SalivaDirect can be implemented across the country, we may finally get a handle on this pandemic, even before a vaccine,” said [Yale Assistant Professor of Public Health Nathan] Grubaugh.

One of the team’s goals was to eliminate the expensive saliva collection tubes that other companies use to preserve the virus for detection. In a separate study led by Wyllie and the team at the Yale School of Public Health, and recently published on medRxiv, they found that SARS-CoV-2 is stable in saliva for prolonged periods at warm temperatures, and that preservatives or specialized tubes are not necessary for collection of saliva.

The Yale researchers validated their test with the cooperation of the National Basketball Association. It was interesting to watch this season’s opening Hard Knocks show on HBO which showed how NFL teams similarly are focused both on the team’s schedule and COVID-19.

In litigation news —

  • Last Friday, as Healthcare Dive reports, the U.S. Court of Appeals for the Federal Circuit handed health insurers participating in the ACA’s marketplace another win against the federal government. This time the unpaid amounts involve reimbursable cost sharing reductions for low income marketplace participants.
  • On Tuesday, August 18, the Health and Human Services Department’s revised rule on the ACA’s individual non-discrimination provision, Section 1557, takes effect. The federal government, as requested by the Court, filed a sur-reply on the standing issue last Monday, and one of the plaintiff’s advised the Court on Wednesday that the U.S. Court of Appeals for the Fifth Circuit has revived the dormant Franciscan Alliance case which is the granddaddy of challenges to the 1557 rule (although it was filed in an effort to challenge the Obama Administration’s versions of the rule.)

In other news, Health Payer Intelligence reports that

Payers can play a significant role in decreasing the expense and complexity of serious illness care for patients through whole person care and palliative care, a study from America’s Health Insurance Plans (AHIP) found.

“Recognizing the difficulties of serious illness, health insurance providers have set out to help, support, and ease the journey for patients, caregivers and loved ones,” the AHIP study stated.

“Ensuring access to tools, education, and services for patients and their loved ones during a difficult time can provide the opportunity to plan, allow patients to maintain their dignity and choice, and support loved ones to know their role and how best they can help.”

Check it out.

Finally, the Federal News Network informs us that the General Services Administration made no changes to the current standard per diem rates for hotels, meals, and incidental expenses of federal employee business travel within the contiguous United States effective for the next federal fiscal year beginning October 1, 2020. What’s more,

There are, however 319 non-standard areas (NSAs), which have higher per diem rates than the standard CONUS allowance. GSA added one area, Albuquerque, New Mexico, as a new NSA location this year. Four locations came off the NSA list from 2020 and will now receive the standard per diem rate: Gainesville, FL; Atlantic City, NJ; College Station, NJ, and Abingdon, VA.

These rates also apply to government contracts such as experience rated FEHB carriers that are subject to the Federal Acquisition Regulation’s Cost Principle. The GSA assumes, of course, that business travel will resume next year, and in view of the low cost saliva test, it just might.

Friday Stats and More

David Ermer–CDC, COVID-19, HSA, U.S. Healthcare, Uncategorized–

Based on the CDC’s Cases in the U.S. website, here is the FEHBlog’s chart of new weekly COVID-19 cases and deaths over the 20th through 32nd weeks of this year (beginning May 14 and ending August 12; 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:

Beckers Hospital Review reports that

The U.S. government is working with commercial health insurers to make future COVID-19 vaccines free of charge with no copay, an HHS official told The Wall Street Journal.

Paul Mango, deputy chief of staff for policy at HHS, said government health insurance programs such as Medicare and Medicaid will cover the cost of administering COVID-19 vaccines, and a federal fund created by the CARES Act will provide the shots free for uninsured people.

A collaboration between the federal government and the healthcare industry will handle the distribution of the vaccines, and the government will announce distributor contracts soon, Mr. Mango told the Journal.

Indeed, the Wall Street Journal reports this afternoon that

McKesson Corp., MCK 4.26% one of the world’s largest drug wholesalers and the biggest vaccine middleman in the U.S., will be a main distributor of Covid-19 vaccines nationwide should the shots prove to work safely, federal health officials said. The U.S. Centers for Disease Control and Prevention is exercising an option in an existing 2016 contract with McKesson for the distribution of a vaccine in the event of a pandemic, the U.S. Health and Human Services Department said Friday.

A friend of the FEHBlog shared this link to an interesting Harvard Business Review article from July 24 discussing the following three scenarios in which the COVID-19 emergency may play out.

1.A dream case in which everything goes as well as could reasonably be expected.
2.A catastrophic case in which everything goes badly.
3.A middle case in which some things go well, but others don’t.

It strikes that FEHBlog that we have been in the midst of scenario three since March. The FEHBlog does not think it can get worse, while he thinks that it may get better.

The FEHBlog was pleased to run across these DOL Office of Federal Contractor Compliance Program’s FAQs on its recent final rule exempting TRICARE but not FEHBP providers from its affirmative action rules.

If my company participates in the Federal Employees Health Benefits Program (FEHBP), are we covered under the amended regulations?

OFCCP did not adopt any regulatory changes related to FEHBP providers. OFCCP plans to issue sub-regulatory guidance to address concerns regarding FEHBP providers.

That’s a clearer update than what the FEHBlog noticed in the preamble to the final rule. The TRICARE exemption likely will not be useful to providers unless the FEHBP also is exempted, in the FEHBlog’s opinion.

The Congressional Research Service has updated its helpful report on Health Savings Accounts (HSAs). CRS reports that for tax year 2017 the IRS processed 11 million tax returns showing employer or employee contributions to HSAs.