Weekend update

AHRQ

Weekend update

David Ermer–ACA, AHRQ, Congress, COVID-19, COVID-19 vaccine–
Photo by Mark Tegethoff on Unsplash

The House of Representatives is engaged in committee work this week which will be followed by three weeks of district work. The Senate will engage in a floor voting, including a confirmation vote on the Secretary of Labor nominee Martin Walsh tomorrow, as well as committee work.

Healthcare Dive reports that

  • The House passed a bill Friday to extend the pause on Medicare sequester cuts until Dec. 31. The cuts have been on hold for a year but are set to go back into effect at the end of March.
  • The bill passed on a 246-175 bipartisan vote and also exempts the latest $1.9 trillion pandemic relief bill from budget rules that would have imposed additional cuts on Medicare payments to providers.
  • “We now look forward to working with the U.S. Senate to achieve relief from the pending Medicare sequester cuts before they go into effect,” the American Hospital Association said in a Friday statement.

Medicare sequester cuts tend to boomerang on private sector health plans, including FEHB plans.

Following up on Friday’s Stats and More, the FEHBlog compared new weekly COVID-19 cases and deaths per 100,000 by age groups as of January 2, 2021, and last Wednesday March 17, 2021.

This chart has a left axis measured in hundreds
This chart’s left axis ranged from zero to sixteen.

Because the March 17 new deaths rates are not visible in this chart, here are those numbers that the FEHBlog copied from the CDC’s website for last week’s new death statistics by age group

 Week ended 3-17-202118-2425-3435-5455-6465-7980+
New Deaths  per 100,000 00000.010.03

That, my friends, illustrates the work of the COVID-19 vaccines over the past two and half months. The Wall Street Journal reports today

Both the production and administration of shots have picked up in recent weeks. Now, some 2.5 million people in the U.S. are vaccinated daily on average, up from about 500,000 in early January, though many who want a vaccine still can’t get it.

The increased output should be enough to fully vaccinate 76 million people in the U.S. in March, another 75 million in April and then 89 million more in May, according to estimates from Evercore ISI analysts. The Pfizer-BioNTech and Moderna vaccines require two doses.

By midsummer, 75% of Americans 12 years old and above should be vaccinated, according to Morgan Stanley. The vaccines aren’t currently authorized for anyone younger than 16, but companies may have results this spring for studies of the shots in adolescents 12 and older, which, if positive, could lead to vaccinations for that age group. The companies are also starting to test the vaccines in children younger than 12, but results of those studies aren’t expected until late this year. 

Keep your sunny side up.

In other healthcare news:

  • Katie Keith in the Health Affairs Blog informs us that the impact of American Rescue Plan’s new ACA marketplace subsidies will be made known to consumers on April 1, 2021.

Enhanced subsidies are available for the entire 2021 plan year to anyone who qualifies and enrolls in marketplace coverage. This includes individuals who enrolled during the 2021 open enrollment period (and have had coverage since January 2021), individuals who enrolled before the American Rescue Plan was enacted (during special enrollment periods in 2021), and individuals who will enroll during the rest of 2021.

Consumers will be able to see the availability of the enhanced subsidies at HealthCare.gov beginning on April 1. But the process to “claim” these enhanced subsidies will look slightly different for new consumers versus existing consumers. (This process will also vary for consumers in states with their own marketplaces, which may adopt policies and timelines that differ from those for HealthCare.gov.)

Just like any other year, individuals can choose to receive all or some of the enhanced PTC in advance (i.e., have it paid to the insurer on their behalf each month) or wait to receive PTC at tax time in 2022 (i.e., while paying full premiums to the insurer each month). Because the cost of health insurance is so high for so many people, most marketplace enrollees opt for advance PTCs to reduce the amount they owe in monthly premiums.

The federal ACA marketplace and many state ACA marketplaces are in the middle of a special Open Season that run until May 15, 2021.

  • The HHS Agency for Healthcare Research and Quality’s Director concluded Patient Safety Week with reflections available at this link. Among the observations were the following:

The quest to learn more about what contributes to diagnostic inaccuracies and delays has already been a focus area for AHRQ. We began investing in diagnostic safety and quality research in 2007 and have helped build interest around the topic. Diagnostic error harms too many and costs too much .  

When I think about options for tackling the issue of diagnostic safety, I’m reminded of the progress we’ve made with our successful Healthcare-Associated Infections (HAI) Program. AHRQ’s HAI Program is dedicated to understanding the problems that can harm patients, identifying what works to prevent infections, and then developing, testing, and refining tools to put that knowledge into practice on the front lines of care. AHRQ has achieved a great deal working alongside clinicians, patients, and other stakeholders focused on HAI prevention throughout government and the private sector.

Thursday Miscellany

David Ermer–AHRQ, Congress, Telehealth–
Photo by Juliane Liebermann on Unsplash

In the wake of yesterday’s announcement that Amazon is breaking into the employer sponsored plan telehealth market, there was plenty of news today about telehealth.

STAT News reports that

“The market for virtual care is still massively underpenetrated,” wrote Cowen analysts Charles Rhyee, Calvin Sternick, James Auh, and Gwen Shi in a research note Wednesday. While Teladoc expects to provide 10 million visits in the U.S. in 2021, each year the country sees roughly 850 million outpatient visits, plus 300 million additional visits specific to mental health, according to the Cowen analysts. “This is not a zero sum game by any stretch,” they added.

Med City News effectively seconds this point of view as follows:

Amazon will need to build out relationships with health plans and health systems, so it can have a referral network for patients who need to see a specialist.   Teladoc, for example, says it has partnerships with more than 50 health plans and 600 health systems, perhaps implying that it’s not going to be that easy.

“New entrants to virtual care will continue to confront many of the challenges Teladoc Health has overcome over the past decade as we have built worldwide capabilities to deliver, enable and empower whole-person virtual care,” a Teladoc spokesperson wrote in an email.

While that may well be true, what Teladoc and Amwell encountered and overcame was low utilization — something that Amazon won’t have to contend with given that Covid-19 has ramped up utilization and adoption sky-high.

It will be interesting to see the jockeying for market share, but no matter which company wins, telehealth has already come out on top.

In that regard, Healthcare Dive reports that “Virtual behavioral health visits surged in the first half of 2020 as the COVID-19 pandemic exacerbated mental health needs, according to a new analysis by Milliman and Well Being Trust.”

Healthcare IT News cautions us that “Telehealth experienced sudden and massive growth starting a year ago, but it didn’t happen everywhere. A new report from the RAND Corporation suggests that the biggest upticks in virtual care availability occurred in more affluent and metropolitan communities, and that telemedicine services were mostly enjoyed by patients with private insurance.”

Healthcare Dive offers an interview with Health Affairs editor in chief Alan Weil that features a discussion of telehealth.

In healthcare equity news

  • Health Payer Intelligence reports that “Blue Shield of California has enhanced its provider network to expand COVID-19 vaccine access in underserved communities.”
  • Fierce Healthcare reports that

The Blue Cross Blue Shield Association (BCBSA) is teaming with Feeding America for COVID-19 vaccine outreach in vulnerable communities.

Clinical information and educational materials highlighting the safety and efficacy of the vaccines will be made available at Feeding America’s 200 food banks, which reach 40 million people. BCBSA will provide physical handouts as well as social media posts with information from the Centers for Disease Control and Prevention and its own clinicians.

The materials will be available in both English and Spanish, BCBSA said, and aim to “dispel common myths” that may prevent people from getting vaccinated.

In other healthcare industry news

  • Healthcare Dive reports that the Senate confirmed the President’s nomination of Xavier Becerra to be Health and Human Services Secretary by a 50-49 vote. “Becerra has the support of payer and provider groups including the American Hospital Association and American Medical Association.”
  • Also coming out of Congress,

Senators Dianne Feinstein (D-Calif.) and Chuck Grassley (R-Iowa) and Representatives Scott Peters (D-Calif.) and John Curtis (R-Utah) today introduced the Methamphetamine Response Act, a bill declaring methamphetamine an emerging drug threat which would require the Office of National Drug Control Policy (ONDCP) to develop, implement and make public a national plan to prevent methamphetamine addiction and overdoses from becoming a crisis.

 “In a single year we’ve seen psychostimulant-related overdose deaths, which include meth, spike by 42 percent,” said Feinstein. “The meth available on our streets is pure, potent and cheap and law enforcement is seizing more of the drug than ever. Two of the largest seizures on record occurred in California last year and in just a five month period, U.S. Customs and Border Protection seized more than 75,000 pounds of methamphetamine. Clearly we are in the midst of a meth crisis and we must implement a national, comprehensive plan to address this threat before it claims even more American lives.”

No bueno.

In further celebration of Patient Safety Awareness Week and because the FEHBlog believes that communication plays an important role in patient safety here’s an AHRQ article on using better communication to improve drug safety / avoid medication errors.

Tuesday Tidbits

David Ermer–AHRQ, CDC, COVID-19 vaccine, U.S. Healthcare, Uncategorized–
Photo by Patrick Fore on Unsplash

Fortune offers an insightful story about CVS Health’s CEO Karen Lynch.

Smart Brief discusses news from last week’s AHIP National Policy Conference.

The Society for Human Resource Management offers a helpful list of American Rescue Plan Act provisions impacting employers.

Medscape encouragingly reports that

Vaccination of about 88% of Americans who received the first dose of Pfizer/BioNTech or Moderna’s COVID-19 vaccines was complete, a study of over 12 million people by the U.S. Centers for Disease Control and Prevention (CDC) showed. * * * According to the analysis, about 3% of people in the United States who received the first dose of either vaccine did not get the second dose needed to complete vaccination. The agency said 8.6% had not received the second dose, but were still within the allowable interval to receive it.

As of today, 64.6% of the U.S. population over age 65 has received at least one dose of the COVID-19 vaccine and 36.6% of that group (including the FEHBlog) are fully vaccinated.

Healthcare Dive informs us that “Independent primary care docs more financially stable, but fed up with vaccine exclusion.” The FEHBlog heard today that vaccine distribution will open to more sites of care, including physician offices, once the Food and Drug Administration gives full marketing approval to the COVID-19 vaccines. The FEHBlog, however, could not find a projected date for that action, but he will keep looking.

Healthcare Dive also reports that “Virtual care company Doctor on Demand and clinical navigator Grand Rounds have announced plans to merge, creating a multibillion-dollar digital health firm.” The companies’ joint press release explains

The new company will combine Grand Rounds’ data-driven clinical navigation platform and patient advocacy tools with Doctor On Demand’s preeminent virtual care offering to provide an unparalleled member experience. It will accelerate the adoption of virtual care in key areas including primary care, specialty care, chronic condition management, and behavioral health. Owen Tripp, CEO of Grand Rounds, will serve as the CEO of the expanded business. Both companies will continue to operate under their existing brands for the time being.

“No one has done this before, combining navigation and virtual care delivery. We think it’s the future,” said Owen Tripp, co-founder and CEO of Grand Rounds. “People make unguided healthcare decisions every day, often with higher costs and worse outcomes. Now, with Doctor On Demand, we’ll offer them coordinated support on all fronts—physical, behavioral, financial, administrative—and we’ll do it for everything from acute issues to life-long health. This is truly complete care, and it’s what we all need.”

“We’re building a next-generation virtual care company with a nationwide practice of diverse, dedicated providers and a multidisciplinary care team,” said Hill Ferguson, CEO of Doctor On Demand. “By fully integrating medical and behavioral healthcare with clinical navigation, we’re impacting healthcare where it actually happens—between a patient and their provider—and ensuring that experience is seamless, personalized, and can follow the patient wherever they go.”

In continuing recognition of Patient Safety Awareness Week, here are links to the Agency for Healthcare Research and Quality’s blog post on accelerating progress in patient safety and an AHRQ article on the importance of good communication skills to achieving patient safety.

Monday Roundup

David Ermer–AHRQ, CMS, COVID-19, COVID-19 vaccine–
Photo by Sven Read on Unsplash

“The ides of March are come.
Soothsayer: Ay, Caesar; but not gone.” Wm. Shakespeare

From the COVID-19 vaccine front —

The Centers for Medicare and Medicaid Services (“CMS”) announced today that

Effective for COVID-19 vaccines administered on or after March 15, 2021, the national average payment rate for physicians, hospitals, pharmacies and many other immunizers will be $40 to administer each dose of a COVID-19 vaccine. This represents an increase from approximately $28 to $40 for the administration of single-dose vaccines, and an increase from approximately $45 to $80 for the administration of COVID-19 vaccines requiring two doses. The exact payment rate for administration of each dose of a COVID-19 vaccine will depend on the type of entity that furnishes the service and will be geographically adjusted based on where the service is furnished.  

CMS, along with the Departments of Labor and Treasury, is requiring that most private health plans and issuers cover the COVID-19 vaccine and its administration, both in-network and out-of-network, with no cost sharing during the public health emergency (PHE). Current regulations provide that out-of-network rates must be reasonable, as compared to prevailing market rates, and reference the Medicare reimbursement rates as a potential guideline for insurance companies. In light of CMS’s increased Medicare payment rates, CMS will expect commercial carriers to continue to ensure that their rates are reasonable in comparison to prevailing market rates.

Medscape reports that “AstraZeneca Plc is preparing to file for U.S. emergency use authorization (EUA) for its COVID-19 vaccine later this month or early April after accumulating enough data to judge the inoculation’s efficacy, sources with knowledge of the ongoing clinical trial told Reuters on Friday.” STAT News in its article titled the “Curious Case of the AstraZeneca’s COVID-19 vaccine” concludes

The U.S. study, started last September and including 30,000 patients, is, like the studies for the Moderna and Johnson & Johnson vaccines, being run with the U.S. National Institutes of Health. It’s the best hope for settling any questions or concerns about the AstraZeneca vaccine once and for all.

STAT News also informs us that Biden Administration is about to embark on a $1.5 billion public relations campaign to convince Americans to receive the COVID-19 vaccine. “Much of the project’s funding comes from the sweeping $1.9 trillion Covid-19 relief bill Biden signed last week. The administration has also already pledged over $500 million in additional funds to address vaccine uptake, health literacy, and equity in the vaccine distribution, including $250 million to fund local health literacy projects and another $255 million for the CDC to fund local government efforts to focus on equity and confidence in underserved communities.”

The Federal Times reports that “Washington, D.C. Mayor Muriel Bowser released an updated vaccination timeline March 15 that outlines when, among other essential professions, federal government and Postal Service employees can expect to become eligible for a COVID-19 vaccine. * * * Just under seven percent of federal employees are located in Washington, D.C.”

Also, Fierce Healthcare offers UnitedHealthcare scientist and Healthcare Dive offers hospital executive reflections on the first anniversary of the great hunkering down.

The HHS Office of Inspector General has unveiled a new website about the agency’s oversight of COVID-19 response and recovery. The website calls attention to the agency’s updated list of COVID-19 scams.

During this Patient Safety Awareness Week, HHS’s Agency for Healthcare Research and Quality calls attention to its Chartbook on Patient Safety. “This Patient Safety chartbook is part of a family of documents and tools that support the National Healthcare Quality and Disparities Report (QDR). The QDR includes annual reports to Congress mandated in the Healthcare Research and Quality Act of 1999 (P.L. 106-129). This chartbook includes a summary of trends across measures of patient safety from the QDR and figures illustrating select measures of patient safety.”

Tuesday Tidbits

David Ermer–ACA, AHRQ, COVID-19 vaccine, OPM, U.S. Healthcare–
Photo by Patrick Fore on Unsplash

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 population2018 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 groupOverall percentageBottom 50%Top 50%Top 10%Top 5%
0–1722.630.614.56.45.8
18–4435.243.227.320.818.9
45–6425.420.130.733.436.3
65+16.86.027.539.439.0

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.

Friday Stats and More

David Ermer–AHRQ, CDC, COVID-19, U.S. Healthcare–
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 PSQIA.RC@ahrq.hhs.gov 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.

Midweek Update

David Ermer–AHRQ, Congress, COVID-19–

FYI this is the 3,001st FEHBlog column since 2006. My how time does fly.

The Wall Street Journal reports tonight that

Democratic leaders signaled Wednesday they were prepared to reduce their demands for the next round of coronavirus relief, fueling hopes that an agreement could be reached with Republicans by year’s end to boost struggling businesses and households.

Congressional leaders have been mired in disagreements for months. In a sign that the partisan standoff was easing, however, House Speaker Nancy Pelosi (D., Calif.) and Senate Minority Leader Chuck Schumer (D., N.Y.) said that a new, bipartisan $908 billion relief proposal released Tuesday should serve as the starting point for talks with GOP leaders and the White House. 

If a compromise is reached, those COVID-19 relief provisions would be included in the omnibus spending bill for the current federal fiscal year which must pass before December 12. The only alternative would be to pass a short term funding bill in order to punt the COVID-19 relief provisions into the next Congress which begins on January 3, 2021.

The Journal explains that “Few lawmakers want to linger in the Capitol beyond what is necessary. House Majority Leader Steny Hoyer (D., Md.) said Wednesday that congressional leaders hoped to finish up by the end of next week to give lawmakers time to quarantine before Christmas.” How 2020 is that?

The Centers for Disease Control released updated guidance today on COVID-19 quarantine periods (approaches to reducing the quarantine period for 14 to 10 days) and domestic holiday travel (don’t do it).

A friend of the FEHBlog shared this interesting Health and Human Services infographic on COVID-19 testing in our country.

This friend also pointed out this news about

A free online course developed by the Johns Hopkins Bloomberg School of Public Health on the basics of contact tracing has enrolled more than one million people over the past six months, teaching hundreds of thousands of individuals around the world how to deploy an epidemiological tool considered critical to slowing the spread of COVID-19.

The six-hour course, COVID-19 Contact Tracing, is hosted by Coursera and is open to anyone. Since its launch in May, it has attracted participants from every U.S. state and territory as well as more than 150 countries around the world. To date, more than 520,000 people have completed the course.

Pretty cool effort.

The Agency for Healthcare Quality and Research informs us about its partnership with Google to develop

a new online tool to help patients plan for medical visits. The new Google visit planning tool is built on the same evidence behind AHRQ’s QuestionBuilder app. It makes it easy for patients and those who care for them to privately list and prioritize their questions in preparation for a medical visit. When people use Google to search for a healthcare provider, they will have the option to create their own private visit plan.

Asking the right questions—and making sure you understand the answers—has always been at the heart of AHRQ’s “Questions Are the Answer” public education initiative. Launched in 2007 through a series of public service announcements with the Ad Council, the Questions Are the Answer message highlights the vital role patients and families play as part of their healthcare team.

That’s a helpful tidbit for health plans to share with their members.

Tuesday Tidbits

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

The FEHBlog spent two hours this morning listening to the oral argument in the latest Affordable Care Act (“ACA”) constitutionality case to reach the U.S. Supreme Court, California v. Texas (No. 19-840). This activity resulted in the FEHBlog learning a new word hortatory and receiving confirmation that his hunch is correct, to wit, There is no chance that the Supreme Court will disrupt the ACA status quo as a result of this case. Indeed the Supreme Court clearly took the case to preserve, not disrupt, the status quo. If you are interested, Amy Howe from the SCOTUSblog has written a legal analysis of the oral argument.

Following up on yesterday’s good news about Pfizer’s COVID-19 vaccine, the Wall Street Journal informs us that

In Kalamazoo, Mich., Pfizer has turned a stretch of land the size of a football field into a staging ground outfitted with 350 large freezers, ready to take delivery of millions of doses of Covid-19 vaccine before they can be shipped around the world.

To make sure its Covid-19 vaccine doses arrive at hospitals and clinics frozen and potent, Pfizer created its own container to ship them.
The temperature-controlled container can store between 1,000 and 5,000 doses for 10 days at minus 70 degrees Celsius before requiring re-icing.

From that site, and another in Puurs, Belgium, the pharmaceutical giant said it wants to deliver up to 100 million doses this year and another 1.3 billion in 2021.

One person needs two doses of the vaccine in order to be protected, again assuming that the phase III study of the vaccine remains on its currently successful course.

The Journal further reports that

U.S. health officials on Monday authorized use of the first treatment for people with earlier-stage Covid-19 who aren’t hospitalized, filling a gap in treatment.

The U.S. Food and Drug Administration said Eli Lilly LLY 2.97% & Co.’s antibody drug should be used for patients ages 12 and up with mild to moderate Covid-19, based on a study showing it helped improve symptoms and kept many patients out of the hospital.

The drug is named bamlanivimab [and it is infused into the patient]. Lilly said it will begin shipping the drug immediately to AmerisourceBergen Corp. ABC 3.59% , a national drug distributor, to distribute it as directed by a federal allocation program [which is described in this HHS announcement issued today].

The Journal also discusses ongoing U.S. problems with COVID-19 testing

The U.S. is running more Covid-19 tests each day than at any other point during the pandemic, but the increased testing doesn’t fully explain recent case surges across the nation, data show. Altogether, testing data suggest Covid-19 diagnostic tests are still severely underused in the U.S. And inconsistencies in data collection and reporting systems are hampering efforts to understand and contain the virus’s spread as the holidays approach, public health and testing executives say.

Because the FEHBP covers a large cadre of senior citizens, it is worth pointing out this AHRQ funded report finding that

Healthcare costs for seniors who needed emergency services after a fall averaged $26,143 in the year following the event, according to an AHRQ-funded study published in The Journal of the American Geriatrics Society. Those costs significantly exceeded the average $8,642 in healthcare costs in the year prior to the event

In civil service news,

Federal employees would not receive an across-the-board increase in pay next year under provisions outlined in a series of fiscal year 2021 funding bills released by the Senate Appropriations Committee Nov. 10. Unlike FY2021 funding passed in the House earlier this year — which simply did not include any provision addressing federal pay — the Senate bill actively sets 2021 pay levels at the same rate as 2020. That difference would override any planned pay increase out of the White House, which was set at 1 percent in President Donald Trump’s February budget proposal.

The Senate is pushing through these measures in order to create a baseline for negotiating an omnibus continuing resolution with the House, which has completed its appropriations bills work, before the current continuing resolution expires on December 11.

  • Federal News Network reports on the Biden Administration’s transition team. Of note,

Kiran Ahuja, a former chief of staff at the agency, will lead the OPM team. Ahuja served at OPM during the aftermath of the agency’s cybersecurity breaches. Prior to her OPM service, she led the Obama administration’s White House Initiative on Asian Americans and Pacific Islanders. Today, she’s the CEO of Philanthropy Northwest, a non-profit organization. The rest of the team is filled with OPM alums who served at the agency as senior advisors during the Obama administration.

Weekend update

David Ermer–AHRQ, Congress, COVID-19, Mental health care, Telehealth, U.S. Healthcare–
Lincoln Memorial in the Fall

The House of Representatives is on the campaign trail. The Senate will join them tomorrow after a confirmation vote on Judge Amy Coney Barrett’s nomination to the Supreme Court. Her nomination narrowly cleared a cloture vote at the Senate today. If you want to understand why the Supreme Court will not strike down the Affordable Care Act this term even with Judge Barrett on its illustrious bench, click here.

There is only one Congressional hearing this week — a Senate Commerce Committee hearing on Wednesday morning, October 28, about the federal internet liability shield. The witnesses will be the CEOs from Twitter, Alphabet/Google, and Facebook, large companies that currently benefit from this shield. Congress returns to its legislative business on November 16 following the Presidential and Congressional election on November 3.

Today, the Department of Health and Human Services shared news on how States and the District of Columbia will use the rapid COVID-19 BinaxNOW tests that the federal government purchased on their behalves. “HHS also provided all CLIA-certified nursing homes over 11 million rapid, point-of-care tests. The tests include the following FDA-authorized antigen diagnostic tests: Abbott BinaxNOW and either a Quidel Sofia 2 or Becton, Dickinson and Company (BD) Veritor™ Plus System instrument(s).”

The Washington Post’s Lily website offers an interview with a 14 year young lady, Anika Chebrolu, who was awarded a $25,000 prize “for her discovery: a compound that can bind to the coronavirus [COVID-19-, inhibiting its ability to infect people. She beat out nine other finalists — whose own projects ranged from a robotic glove to a device that detects invisible particles in water — to be named America’s top young scientist.” Ms. Chebrolu modestly explains that “my effort to find a spike protein binder isn’t unique in its methodology, and it may appear to be a drop in the ocean, but it adds to all these efforts and therefore is quite substantial.” Congratulations.

It’s also worth pointing out this Healthcare Dive article informing us that

Medical device funding hit a new high in the third quarter, growing 63% year on year to top $5 billion for the first time in CB Insights’ dataset. Investments in robotic surgery startups was a major driver of the increase. The analysts listed the progress of neuromodulation devices and Medtronic’s deals in diabetes and neurosurgery as other medical device highlights of the quarter.

The Mayo Clinic explains that “Robotic surgery, or robot-assisted surgery, allows doctors to perform many types of complex procedures with more precision, flexibility and control than is possible with conventional techniques. Robotic surgery is usually associated with minimally invasive surgery — procedures performed through tiny incisions.”

The International Modulation Society further explains that

Neuromodulation is technology that acts directly upon nerves. It is the alteration—or modulation—of nerve activity by delivering electrical or pharmaceutical agents directly to a target area.

Neuromodulation devices and treatments are life changing. They affect every area of the body and treat nearly every disease or symptom from headaches to tremors to spinal cord damage to urinary incontinence. With such a broad therapeutic scope, and significant ongoing improvements in biotechnology, it is not surprising that neuromodulation is poised as a major growth industry for the next decade.

Most frequently, people think of neuromodulation in the context of chronic pain relief, the most common indication. However, there are a plethora of neuromodulation applications, such as deep brain stimulation (DBS) treatment for Parkinson’s disease, sacral nerve stimulation for pelvic disorders and incontinence, and spinal cord stimulation for ischemic disorders (angina, peripheral vascular disease).

Cochlear implants to treat deafness, for example, are intermodulation devices.

The FEHBlog noticed on Twitter today that the HHS Agency for Healthcare Quality and Research has made available in the Apple Store and Google Play an app to help patients to develop questions for the doctor visits.

On the healthcare survey and report front

The top 12 reasons for using telehealth, according to the 2020 survey, are listed below, with the 2019 ranking and percentages in parentheses:

  1. Convenience, 51 percent (1, 64 percent)
  2. Safety, 46 percent (12, 13 percent)
  3. Speed – ability to receive care quickly, 44 percent (2, 53 percent)
  4. Quality care, 30 percent (6, 25 percent)
  5. Condition covered by telehealth visit, 28 percent (7, 22 percent)
  6. Ease of access to health information, 27 percent (3, 34 percent)
  7. Convenient communication channels, 26 percent (4, 33 percent)
  8. Lower overall cost, 23 percent (5, 30 percent)
  9. Difficult to travel to medical office, 21 percent (7, 20 percent)
  10. Recommendation, 19 percent (7, 20 percent)
  11. Reputation, 19 percent (11, 14 percent)
  12. Past experience, 17 percent (9, 19 percent).
  • Health Payer Intelligence reports that

Around a third of Millennials [ages 24 – 39] have a behavioral health condition, emphasizing a greater need for behavioral healthcare options and coverage as well as a new approach to millennial member engagement, the latest Blue Cross Blue Shield Association (BCBSA) report revealed. * * * Not only do Millennials have a high percentage of behavioral health conditions but their rate of developing a behaioral health condition is rising by double digits. Over five years from 2014 through 2018, the prevalence of major depression rose by 43 percent, ADHD rose by 39 percentage percent, and psychotic disorders rose by 26 percent among Millennials.”

Tuesday Tidbits

David Ermer–AHRQ, CDC, Congress, COVID-19, COVID-19 vaccine, Federal employment benefits, OPM, Telehealth–

The U.S. Office of Personnel Management released its first of four Benefit Administration letters for the upcoming Federal Benefits Open Season which which will run from Monday, November 9, 2020 through Monday, December 14, 2020. Here are links to the BAL, a sample email to employees and a Venn diagram displaying the interlocking aspects of the health, dental, vision, and flexible benefits programs that participate in this Open Season. The FEHBlog expects that COVID-19 public health emergency will tamp down the traditional Open Season health fairs. It will be an interesting experiment to see whether this change impacts the volume of plan changes one way or the other.

In anticipation of FDA approval of COVID-19 vaccine(s), an expert panel formed by the National Academies of Science has issued for public comment draft recommendations for staging an equitable distribution of the vaccines according to a STAT News report. A public hearing on the draft recommendations is scheduled for tomorrow. This report then goes to the Centers for Disease Control which has an Advisory Committee on Immunization Practices. The staging offered in the recommendations makes sense to the FEHBlog, e.g., first responders first etc.

The Wall Street Journal reports that Americans should add strong ventiliation to the Covid-19 prevention toolbox along with mask, social distancing, etc.

After urging steps like handwashing, masking and social distancing, researchers say proper ventilation indoors should join the list of necessary measures. Health scientists and mechanical engineers have started issuing recommendations to schools and businesses that wish to reopen for how often indoor air needs to be replaced, as well as guidelines for the fans, filters and other equipment needed to meet the goals.

There’s a recently renovated office building near the FEHBlog’s offices in downtown DC that has a big outside sign stating that its ventilation services are tops and known to be anti-COVID. The FEHBlog will retry to remember to post a picture of the sign later this week.

Becker’s Health IT discusses a Centers for Medicare and Medicaid Services proposed rule issued yesterday. “The Medicare Coverage of Innovative Technology proposed rule would speed up the FDA approval process for Medicare coverage of new medical technologies. * * * Often referred to as the “valley of death,” for innovative medical tech products, the lag time between the FDA’s approval and Medicare establishing coverage prevents seniors from accessing these new technologies during the coverage determination process.” Ouch.

Speaking of innovation, Econtalk podcast host and economist Russ Roberts speaks this week with author Matt Ridley about his fascinating book titled “How Innovation Works.” Check it out.

In other news

  • EHR Intelligence reports “Following vote in the House of Representatives to remove the bill prohibiting the use of federal funds for the adoption of a national patient identifier (NPI), the Premier Healthcare Alliance and the Patient ID Coalition call on the US Senate to also lift the ban.” Good luck.
  • FYI, here’s a link to Treasury Secretary’s Steven Mnuchin’s testimony before the COVID-19 subcommittee of the House Oversight and Reform Committee. The federal employee press does not suggest that fireworks exploded at the hearing.
  • The Department of Health and Human Services announced today that “The Federal Communications Commission (FCC), HHS, and U.S. Department of Agriculture (USDA) today announced that they have signed a Memorandum of Understanding to work together on the Rural Telehealth Initiative, a joint effort to collaborate and share information to address health disparities, resolve service provider challenges, and promote broadband services and technology to rural areas in America.” Perhaps another silver lining in the COVID-19 cloud.
  • And then another. The HHS Agency for Healthcare Research and Quality explains that

There is evidence that people who receive longer-term treatment with medications for addiction treatment (MAT) have better outcomes. But, keeping people with OUD on MAT is challenging. Now, the COVID-19 pandemic may be making retention of patients in MAT even more difficult.

Fortunately, we can report some good news that should help us fight the opioids epidemic even as we try to maintain safe distance. It appears that people with OUD will stay in treatment when given support remotely as they do in person—a major benefit that appears to be emerging during the COVID pandemic.