Weekend update

Uncategorized

Weekend update

David Ermer–Uncategorized–
Photo by Dane Deaner on Unsplash

The Senate remains on a State work break this week while the House of Representatives has scheduled a few Committee meetings but no floor voting.

The CDC’s Advisory Committee on Immunization Practices meets tomorrow and Tuesday to discuss expanding Pfizer/Biontech boosters to the age 16 and older population. Currently the boosters are only available for the moderately and severely immunocompromised population. (N.B. In Monday’s New York Times David Leonhardt writes an insightful column on the expansion question. He suggests that COVID-19 vaccine immunity may not be waning enough to justify the expansion.

Immunity does probably wane modestly within the first year of receiving a shot. For this reason, booster shots make sense for vulnerable people, many experts believe. As Dr. Céline Gounder of Bellevue Hospital Center told my colleague Apoorva Mandavilli, the C.D.C.’s data “support giving additional doses of vaccine to highly immunocompromised persons and nursing home residents, not to the general public.”

The current booster shots may do little good for most people. The vaccines continue to provide excellent protection against illness (as opposed to merely a positive Covid test). People will eventually need boosters, but it may make more sense to wait for one specifically designed to combat a variant. “We don’t know whether a non-Delta booster would improve protection against Delta,” Dr. Aaron Richterman of the University of Pennsylvania told me.

A national policy of frequent booster shots has significant costs, financially and otherwise. Among other things, the exaggerated discussion of waning immunity contributes to vaccine skepticism.

While Americans are focusing on booster shots, other policies may do much more to beat back Covid, including more vaccine mandates in the U.S.; a more rapid push to vaccinate the world(and prevent other variants from taking root); and an accelerated F.D.A. study of vaccines for children.

As always, we should be open to changing our minds as we get new evidence. As Richterman puts it, “We have time to gather the appropriate evidence before rushing into boosters.”

FCW interviewed “OPM’s Senior Advisor to the Director on Diversity, Equity, Inclusion and Accessibility Mini Timmaraju.” The President’s recent executive order on this topic set Oct. 3 as the deadline for agencies to finish a preliminary assessment of human resources practices and agency workforces.” Ms. Timmaraju’s team is helping other agencies prepare these documents. The article further explains that

At the same time, OPM is working on its own reorganization, which will reestablish an Office of Diversity, Equity, Inclusion and Accessibility as a standalone program office that reports directly to the OPM director.

It was absorbed into the Employee Services Center during the Trump administration, and its workforce has been “reduced” over the last four years, Timmaraju said.

Internal DEIA work at OPM is also moving from the agency’s Equal Opportunity Employment to Human Resources.

The new office will focus on governmentwide initiatives, according to OPM. It’ll have three sub-organizations, focused on policy and development, analytics and accountability and outreach and technical assistance.

The goal is to rightsize the team back to similar levels seen during the Obama administration, Timmaraju said. The office had 12 full-time equivalent employees in fiscal year 2016, according to budget documents.

OPM is also recruiting a Senior Executive Service-level director for the office. The job listing on USAJobs says that the agency is currently reviewing applications.

In healthcare news

  • The Wall Street Journal reports that “CVS Health is among several retailers including Walmart Inc. and Walgreens Boots Alliance Inc.,that are experimenting with offering counseling services in or near stores. They see potential as the Covid-19 pandemic has prompted more people to seek help for addiction, depression and other issues, according to federal data. “It’s creative and we certainly need the help,” said Ken Duckworth, medical director of the National Alliance on Mental Illness. “It’s an interesting idea to post a mental-health resource at a place where people already are at.” The FEHBlog heartily agrees.
  • The Food and Drug Administration approved on Friday August 27 “the MicroTransponder Vivistim Paired VNS System (Vivistim System), a first-of-its-kind, drug-free rehabilitation system intended to treat moderate to severe upper extremity motor deficits associated with chronic ischemic stroke—a stroke caused by a blockage of blood flow to the brain with long-lasting symptoms—using vagus nerve stimulation (VNS). ‘People who have lost mobility in their hands and arms due to ischemic stroke are often limited in their treatment options for regaining motor function” said Christopher M. Loftus, M.D., acting director of the FDA’s Center for Devices and Radiological Health’s Office of Neurological and Physical Medicine Devices. “Today’s approval of the Vivistim Paired VNS System offers the first stroke rehabilitation option using vagus nerve stimulation. Used alongside rehabilitative exercise, this device may offer benefit to those who have lost function in their upper limbs due to ischemic stroke.’” Cool.
  • The Drug Enforcement Administration offers ten strategies for keep youngsters and teenagers off drugs. A friend of the FEHBlog, who is a psychiatrist explained that brain development continues until the mid-twenties. If you start a bad habit before your late twenties it will be harder to break than a bad habit that begins after the mid-twenties. Business Insider sums it up as follows: “Neuroscientists are confirming what car rental places already figured out — the brain doesn’t fully mature until age 25. Up until this age, the prefrontal cortex — the part of the brain that helps curb impulsive behavior — is not yet fully developed.”

Friday Stats and More

David Ermer–ACA, COVID-19, COVID-19 vaccine, Government Contracting, U.S. Healthcare, Uncategorized–

Based on the Centers for Disease Control’s COVID-19 Data Tracker website, here is the FEHBlog’s chart of new weekly COVID-19 cases and deaths over the 14th week of 2020 through 33rd week of this year (beginning April 2, 2020, and ending August 18, 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 significantly exceed new deaths. Accordingly here is a chart of new COVID-19 deaths over the period (April 2, 2020, through August 18, 2021):

Finally here is a COVID-19 vaccinations chart over the period December 17, 2020, through August 18, 2021, which also uses Thursday as the first day of the week:

Here’s a link to the CDC’s weekly interpretation of its COVID-19 statistics.

Politico reports that “More than one million Americans received a dose of Covid-19 vaccine on Thursday[August 19] , a benchmark the nation has not met in nearly seven weeks amid a resurgence of the coronavirus pandemic.”

HealthDay informs us that

Antibodies generated by COVID-19 vaccines are effective against the Delta variant and other coronavirus variants of concern, new research shows.

The findings may help explain why most vaccinated people have avoided the surge of Delta variant cases sweeping across the United States.

“In face of vaccination, Delta is relatively a wimpy virus,” said study co-author Ali Ellebedy, an associate professor of pathology and immunology at Washington University School of Medicine in St. Louis.

Good to hear.

The Wall Street Journal tells us that

The Food and Drug Administration is expected next week to grant full approval of the Covid-19 vaccine from Pfizer Inc. and partner BioNTech SE, according to people familiar with the planning, an action that could spur more vaccination requirements by employers and encourage more people who are hesitant to get vaccinated. * * *

Once fully approved, the vaccine would be eligible for off-label prescriptions, such as booster doses, according to the FDA. However, analysts said, the critical element for broad boosting is a recommendation from the Advisory Committee on Immunization Practices to the FDA, as physicians often follow ACIP recommendations.

With full approval, Pfizer would likely be permitted to market the vaccine to doctors, providers and the general public as it does with other approved products. The FDA is permitted to restrict such communications with emergency authorization.

The Journal adds that

Of the three authorized vaccines in the U.S., only Pfizer has submitted all the required information to the FDA, according to the companies, and analysts expect it to be the first receive clearance. 

Moderna Inc., whose authorized two-dose shot uses similar mRNA technology as the Pfizer-BioNTech, has said it is still completing rolling data submissions.Johnson & Johnson, whose shot was authorized in February, has said it plans to file for full approval later this year.

Fierce Healthcare reports that Janet Woodcock will not be nominated for a promotion from acting to permanent Food and Drug Commissioner due in large part to Aduhelm fallout.

From the regulatory front

  • After issuing a minimalist Affordable Care Act (“ACA”) FAQ 48 earlier this week, the ACA regulatory departments issued a blockbuster ACA FAQ 49 about payer transparency rule implementation and enforcement delays and answering many No Surprises Act (“NSA”) implementation issues left hanging by the first NSA interim final rule (“IFC”) released July 1.
  • OMB’s Office of Information and Regulatory Affairs (“OIRA”) has scheduled more meetings on the second No Surprises Act IFC which concerns the independent dispute resolution process. Those listening sessions now run late into next week. That means that the IFC won’t be released before the week of August 30 but that still would be about a month before the statutory deadline.
  • The American College of Emergency Physicians and Blue Cross each met with OIRA this past week. Here are links to their supporting letters. BCBSA OIRA IDR 8.17.21.pdf and ACEP EDPMA Pre-IDR Rulemaking Letter (8.10.21).pdf Common sense as expressed in the Blue Cross letter must prevail if the parties want to avoid having the second IFC also create major system changes.
  • The Society for Human Resource Management informs us that “covered employers [such as FEHB plan carriers] now have until Oct. 25 to file their 2019 and 2020 EEO-1 reports, according to a recent announcement from the U.S. Equal Employment Opportunity Commission (EEOC). Although the reporting deadline has been delayed several times during the COVID-19 pandemic, the agency said it will not authorize any more extensions.”

Thursday Miscellany

David Ermer–Uncategorized–
Photo by Michele Orallo on Unsplash

The Wall Street Journal reports tonight that the Senate remains poised to pass the bipartisan infrastructure funding bill before the end of this week, notwithstanding an cautious Congressional Budget Report issued this afternoon.

From the Delta variant front

  • The Journal also informs us that “Covid-19 vaccination rates are ticking upward across the U.S., federal officials said, particularly in areas where the Delta variant is hitting hardest. Worries about the virus, growing confidence in the safety of vaccines and the influence of family and friends are all likely contributing to the increase in vaccine uptake, health authorities and residents say. More employers are also starting to institute vaccine mandates. The U.S. has administered more than 864,000 doses of Covid-19 vaccines in the past 24 hours, including 585,000 first shots, White House Covid-19 Response Coordinator Jeff Zients said Thursday during a media briefing. “Clearly, Americans are seeing the impact of being unvaccinated and unprotected,” said Mr. Zients.”
  • The New York Times tells us that “The powerful protection offered by Moderna’s Covid vaccine does not wane in the first six months after the second dose, according to a statement released by the company on Thursday morning in advance of its earnings call. But during the call, Moderna executives said they anticipated that boosters would be necessary this fall to contend with the Delta variant, which became common in the United States after the results were collected.
  • In that regard, according to the Journal, “The Food and Drug Administration expects to have a strategy on Covid-19 vaccine boosters by early September that would lay out when and which vaccinated individuals should get the follow-up shots, according to people familiar with discussions within the agency.”

On the No Surprises Act front, advocates are writing to the trig-agencies who are shaping the independent dispute resolution regulation for that law which is due on October 1. Fierce Healthcare reports that “A major hospital group is imploring the Biden administration to not tilt a dispute resolution process for handling surprise medical bills in favor of insurers. The Federation of American Hospitals (FAH) wrote to three cabinet members Thursday outlining its requests for an independent dispute resolution (IDR) to fairly resolve payment disputes for out-of-network charges. Congress called for the independent arbitration process in a law passed late last year that bans surprise medical bills.” Among other things FAH wants the tri-agencies to extend the dispute resolution deadlines set in the law. Also

FAH also wants more flexibility for batching medical claims together related to the treatment of a similar condition.“The statutory reference to ‘treatment of a similar condition’ should be broadly construed to allow batching of a wide range of clinical scenarios and payment methodologies,” FAH said. “The statutory language does not indicate that Congress intends to restrict bundling based on the diagnosis code or similar distinctions.”

The FEHBlog does not see an issue with batching emergency care but batching non-emergency care can only lead to confusion because the plan needs to know that the care was related to a confinement at an inpatient facility.

From the second quarter financial results front, Healthcare Dive reports

  • Cigna executives said Thursday that COVID-19-related costs were higher than expected in the second quarter, as was the amount of care not directly related to the virus as patients returned for services.
  • Still, the payer reported a 10% year-over-year increase in revenue to $43.1 billion, beating Wall Street expectations. The growth was driven primarily by its health services segment, Evernorth, which CEO David Cordani said was “clearly a standout” on a Thursday morning call with investors.
  • Use of behavioral health services among customers was up 40% in the quarter. Executives said on the call that they viewed this as a growth opportunity going forward as well, particularly for virtual visits considering Cigna’s acquisition of MDLive in February.

In miscellaneous news

  • Health Payer Intelligence interviews Angie Meoli, senior vice president of network strategy and provider experience at Aetna, about how the pandemic has impacted the value based care movement.
  • The federal government’s Get Smart about Drugs” site offers guidance on using over the counter medications safely.
  • Allysia Finley, a Wall Street Journal columnists, calls attention to growing evidence that that “inoculation confers significant protective benefits” beyond the targeted illness. “Growing evidence indicates that seniors who get vaccinated against illnesses such as tetanus and even the flu are much less likely to develop Alzheimer’s, the leading cause of dementia, characterized by a buildup of amyloid plaque and tau tangles in the brain. Scientists don’t completely understand why, but many hypothesize that vaccines generate a systemic immune response that can reduce inflammation in the brain, which results in neuron loss and cognitive decline.”

Midweek update

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

From the Delta variant front:

  • The Wall Street Journal offers a helpful set of FAQs on the Delta variant of COVID-19.
  • The Journal also reports that “President Biden is expected to announce Thursday that his administration will require federal employees to get vaccinated or be regularly tested for Covid-19, according to a person familiar with the discussions. * * * The person familiar with the situation said no decision has been finalized, and the policy is still under review. The person said the administration is also strongly considering more stringent masking protocols for unvaccinated federal workers. Such policies could affect millions of workers, depending on which categories of employees were included.
  • Federal News Radio writes out a laundry list of “tricky legal questions” posed by the vaccine mandate, according members of the bar. The FEHBlog expects that the courts will resolve these questions in the government’s favor expeditiously.
  • Bloomberg reports that vaccinations rates are up sharply in the areas of the country where the Delta variant is running amuk. In the end you can count on common sense prevailing.
  • The Journal also informs us that “Protection against symptomatic Covid-19 from Pfizer Inc. and partner BioNTech SE’s vaccine diminished over time but remained strong after six months, according to data released by the companies Wednesday. The efficacy of the vaccine protecting against symptomatic disease dropped every two months, to 84% after six months from a peak of 96% within two months of vaccination, a decline that may add urgency to Pfizer’s push to administer an additional dose to maintain protection. The companies reported that cumulatively the vaccine was 91% effective at preventing symptomatic Covid-19 during the first six months, in line with the analysis that was first reported earlier this year.”

On the new drug / drug research front

  • The Food and Drug Administration today approved for marketing “the first interchangeable biosimilar insulin product, indicated to improve glycemic control in adults and pediatric patients with Type 1 diabetes mellitus and in adults with Type 2 diabetes mellitus. Semglee (insulin glargine-yfgn) is both biosimilar to, and interchangeable with (can be substituted for), its reference product Lantus (insulin glargine), a long-acting insulin analog. Semglee (insulin glargine-yfgn) is the first interchangeable biosimilar product approved in the U.S. for the treatment of diabetes. Approval of these insulin products can provide patients with additional safe, high-quality and potentially cost-effective options for treating diabetes.” Outstanding.
  • The National Institutes of Health (NIH) announced that “Researchers have identified a cellular defect common to familial and sporadic forms of ALS [/ Lou Gehrig’s Disease]. The NIH-funded study may point to possible therapeutic target for the disease.” Encouraging.

In other NIH news, the director of the National HEAL Initiative provides an update on the program’s efforts. She describes her program as follows:

HEAL’s mission is to find scientific solutions to help end addiction long-term. And although this goal is concrete, it’s not always simple. We recognize that people face real-world challenges accessing high-quality care for pain and addiction, and our research needs to take this into account. As I’ll describe in the post, HEAL is funding several studies to accelerate research to practice to improve health, as well as to prevent unnecessary loss of life from overdose.

Good luck with that worthy effort.

In FEHB news, Reg Jones has posted a Fedweek column on children’s benefits under the program.

Healthcare Dive continues to report on second quarter financial reporting from health insurers. Today, Humana reported. According to Healthcare Dive,

Non-COVID-19 medical use bounced back faster than expected during the second quarter, Humana executives told investors Wednesday. The insurer was able to post net income of $588 million as COVID-19 treatment costs for its members fell faster than anticipated, compared to $1.8 billion a year ago as patients deferred care amid the pandemic.

Humana, which insures a large portion of seniors through Medicare, did disclose that is has noticed COVID-19 admissions increasing in recent weeks, a potentially troubling sign.

The payer experienced robust membership growth in its Medicaid business while it reported declines in the fully-insured commercial segment. Overall, total medical membership was up slightly compared to the prior-year period.

Tuesday’s Tidbits

David Ermer–Uncategorized–
Photo by Patrick Fore on Unsplash

GEHA, the largest employee organization sponsored plan in the FEHB, has a new President and CEO, Arthur A. Nizza, DSW. According to GEHA’s press release, “Dr. Nizza has more than 25 years of leadership experience in the health care industry and has held senior leadership roles at major integrated delivery systems in the Midwest and Northeast. His experience includes roles as Chief Executive Officer, Chief Operating Officer and Chief Information Officer at for-profit and non-profit companies, academic medical centers and faith-based institutions. Most recently, Nizza served as the Executive Vice President and Chief Operating Officer of UnityPoint Health (UPH) in Des Moines, Iowa.” Good luck, Dr. Nizza.

In the tidbits department for this Tuesday —

  • The Agency for Health Research and Quality issued a study of diagnoses causing U.S. hospitalizations in 2018. For example, “Of the 10 most common principal diagnoses among nonmaternal, nonneonatal inpatient stays in 2018, septicemia was the most frequent and accounted for the highest aggregate costs ($41.5 billion). The mean cost per stay was also higher for septicemia than for the other top 10 conditions, with the exception of acute myocardial infarction (AMI).” Healthline explains that “Septicemia is a serious bloodstream infection. It’s also known as blood poisoning. Septicemia occurs when a bacterial infection elsewhere in the body, such as the lungs or skin, enters the bloodstream. This is dangerous because the bacteria and their toxins can be carried through the bloodstream to your entire body. Septicemia can quickly become life-threatening. It must be treated in a hospital. If left untreated, septicemia can progress to sepsis.
  • Becker’s Hospital review tells us that “The pandemic led to a dip in emergency room visits, and the numbers may not recover, UnitedHealth CEO Andrew Witty said during the company’s July 15 earnings call. * * *While still speculative, Mr. Witty said urgent care centers may see the patients who turned away from the emergency room.”
  • The National Institutes of Health (NIH) informs us at a glance that “By combining parts of spike proteins from different coronaviruses, researchers developed an mRNA vaccine that protected mice against a range of coronaviruses. The results point the way toward a universal coronavirus vaccine that could prevent future pandemics.” Keep hope alive.
  • NIH Director Dr. Francis Collins discusses in his weekly blog research into genetic reasons for a person’s susceptibility to COVID-19 illnesses and more specifically to severe COVID-19 illnesses.
  • The Drug Channels blog discusses the state of the 340B program market in our country. According to HRSA, the HHS agency that runs the 340B program,

The 340B Program enables covered entities to stretch scarce federal resources as far as possible, reaching more eligible patients and providing more comprehensive services.

Manufacturers participating in Medicaid agree to provide outpatient drugs to covered entities at significantly reduced prices.

Eligible health care organizations/covered entities are defined in statute and include HRSA-supported health centers and look-alikes, Ryan White clinics and State AIDS Drug Assistance programs, Medicare/Medicaid Disproportionate Share Hospitals, children’s hospitals, and other safety net providers. See the full list of eligible organizations/covered entities.

  • Drug Channels observes that “The 340B Drug Pricing Program continues to expand far more quickly than the overall pharmaceutical market—and some channels are benefiting more than others. [M]ail and specialty pharmacies’ purchases of products that are eligible for 340B discounts have grown by an incredible 56% per year since 2017. That’s about six times faster than the overall mail and specialty market. 

No Surprises Thursday

David Ermer–ACA, COVID-19, OPM, Rx coverage, U.S. Healthcare, Uncategorized–
Photo by Josh Mills on Unsplash

The federal regulators, including the Office of Personnel Management, achieved their statutory deadline today for issuing the first round of No Surprises Act implementing rules. Here’s the regulators’ output, compliments of the Labor Department:

There is no doubt in the FEHBlog’s mind that the regulators did a fine job of making a silk purse out of sow’s ear / the poorly drafted statute. This rule will help carriers and providers meet the January 1, 2022, launch date. This law, if properly implemented, and signs are looking good now, will protect consumers from surprise medical bills, which was clearly Congress’s objective, but without creating an IT nightmare.

The regulators plan a second round of No Surprises Act rules for October 1, 2021. The second round will focus on the independent dispute resolution process.

From the COVID-19 front —

  • The New York Times reports that “The Johnson & Johnson coronavirus vaccine is effective against the highly contagious Delta variant, even eight months after inoculation, the company reported on Thursday — a finding that should reassure the 11 million Americans who have gotten the shot. The vaccine showed a small drop in potency against the variant, compared with its effectiveness against the original virus, the company said. But the vaccine was more effective against the Delta variant than the Beta variant, first identified in South Africa — the pattern also seen with mRNA vaccines.”
  • Medscape informs us that “The White House on Thursday announced it will send “strike teams” to 1000 counties where the COVID-19 Delta variant is spreading rapidly. The teams will be made up of health and logistics experts from several federal agencies and will conduct coronavirus testing, distribute medicines designed to fight the virus, and boost local and state efforts to increase vaccinations.”

In Thursday Miscellany —

  • GoodRx is tracking prescription drug manufacturer price changes which typically are made effecting January 1 and July 1.
  • The Centers for Medicare and Medicaid Services “is proposing actions that aim to close health equity gaps by providing Medicare patients battling End-Stage Renal Disease (ESRD) with greater access to care, through the ESRD Prospective Payment System (PPS) annual rulemaking. This proposed rule would update ESRD PPS payment rates, make changes to the ESRD Quality Incentive Program (QIP), and modify the ESRD Treatment Choices (ETC) Model.  The proposed changes to the ETC Model policies would aim to encourage dialysis providers to decrease disparities in rates of home dialysis and kidney transplants among ESRD patients with lower socioeconomic status, making the model the agency’s first CMS Innovation Center model to directly address health equity.”
  • The Aetna Foundation and U.S. News and World Report released their 2021 healthiest U.S. communities rankings this week.

2021 Healthiest Communities- Top 10

*See the full rankings here

Top 10 Counties

  1. Los Alamos County, New Mexico
  2. Douglas County, Colorado
  3. Falls Church, Virginia
  4. Loudoun County, Virginia
  5. Broomfield County, Colorado
  6. San Miguel County, Colorado
  7. Pitkin County, Colorado
  8. Howard County, Maryland
  9. Morgan County, Utah
  10. Routt County, Colorado

2021 Key Measures

Top 5 Communities for Health Outcomes

  1. San Juan County, Washington
  2. Marin County, California
  3. Carver County, Minnesota
  4. Stevens County, Minnesota
  5. Hunterdon County, New Jersey

Top 5 Communities for Access to Health Care

  1. Olmsted County, Minnesota
  2. Montour County, Pennsylvania
  3. Suffolk County, Massachusetts
  4. Johnson County, Iowa
  5. Perry County, Kentucky

Top 5 Communities for Mental Health

  1. Honolulu County, Hawaii
  2. Pitkin County, Colorado
  3. Fairfax County, Virginia
  4. Santa Clara County, California
  5. San Mateo, California

Memorial Day Weekend update

David Ermer–CDC, Congress, Congress, COVID-19, OPM, Rx coverage, SCOTUS, U.S. Healthcare–
Thanks to Justin Casey for sharing their work on Unsplash.

Congress is on a State / district work break this coming week. The Supreme Court has over thirty cases to decide, including the latest Affordable Care Act constitutionality case, before adjourning for the summer in late June / early July.

The federal employee news organizations have highlighted portions of the President’s fiscal year 2022 budget proposal which was released last Friday.

  • The Federal Times reports that “President Joe Biden’s fiscal year 2022 budget anticipates a more than 50,000 full-time-equivalent employee increase to the federal payrolls next year, as part of concerted efforts to attract young and expert workers to federal service. * * * ‘The Federal workforce continues to become older on average. Almost 30 percent (635,397) of employees are older than 55, while 8.1 percent (176,805) of employees are younger than 30. By comparison, in the private sector, 23 percent of the workforce is younger than 30. Every single agency has fewer employees younger than 30 today than they had in 2010,’ the budget proposal’s analytical perspectives state.
  • Govexec informs us that “President Biden on Friday formally proposed an average 2.7% pay increase for federal civilian employees in 2022 as part of his fiscal 2022 budget proposal. * * * It was unclear Friday how Biden’s proposal would be divvied up between an across-the-board boost to basic pay and increases in locality pay. In recent years, pay raise provisions have included a 0.5% average increase in locality pay, although it was frozen at 2020 levels this year. * * * The proposal also marks a return to the principle of pay parity between the civilian and military workforce, as service members would also receive a 2.7% pay raise in 2022. 

Federal News Network offers three brief stories on the U.S. Postal Service

The Postal Service sent its first reduction in force notices to non-union management employees Friday [no indication of how many notices were sent out], and is planning to set higher prices on its mail products well above the rate of inflation [first class stamp would increase by 5% from 55 cents to 58 cents].

The Senate, meanwhile, voted [by unanimous consent] to confirm [Anton Hajjar] President Joe Biden’s third nominee to serve on the USPS Board of Governors. The board is now fully staffed for the first time since 2010, and will help the agency get its 10-year reform plan off the ground.

Thus the Senate has confirmed all three of the President’s Postal Governor nominees who shared a confirmation hearing with OPM Director Kiran Ahuja while Ms. Ahuja waits for a confirmation vote.

In healthcare news —

  • Bloomberg tells us that “The U.S. reported the lowest level of infection since the early days of the pandemic and welcomed back sports fans to stadiums. The Indianapolis 500 was run before 135,000 fans, the largest crowd for a sporting event since the pandemic began [but 1/3 of capacity].  * * * The world needs the cooperation of the Chinese government to trace the origins of Covid-19 and prevent future pandemic threats, two leading U.S. disease experts said Sunday.
  • NPR reports that “For children in particular, the risk of serious consequences from COVID-19 is the same magnitude as the risk they face from the flu, she says. But many parents seem more worried about the new and less familiar disease. * * * [E]xperts urge parents to try not to worry too much.
  • Because many FEHB plans provide hypertensive members with at home blood pressure monitor, the FEHBlog wants to share the American Medical Association’s views on what doctors wish their patients knew about home blood pressure measurement.

Finally, the FEHBlog’s eyes were drawn to the weekend Wall Street Journal’s Heard on the Street column which discusses the efforts of Walmart and Amazon to enter the healthcare business.

Weekend update

David Ermer–Congress, COVID-19, COVID-19 vaccine, Mental health care, OPM, Rx coverage, Telehealth, U.S. Healthcare, Uncategorized–

FEHBlog opening note — The FEHBlog goofed by posting this May 7 COVID-19 charts in the May 14 Friday Stats and More post. The FEHBlog corrected his error on Saturday after the Friday post email went out. You can check out the website if you want to see the May 14 charts which are encouraging. In contrast, check out the Wall Street Journal’s charts on the COVID-19 situation in India which is still struggling with virus. Whereas 37% of the U.S. population is fully vaccinated, less than 5% of the much larger and younger Indian population has reached that status. In this regard, the Rome (N.Y.) Sentinel offers an Excellus Blue Cross consulting pharmacist’s valuable guidance on why people in the age 18 to 34 bracket should received the COVID vaccination.

Q: Katie [Abbott, Pharm.D.], you are in that age group. Why did you choose to get vaccinated? 

I trust the science behind the vaccines and believe they will help bring us back to how life was before the pandemic.

Q: Some, or most cases of COVID-19 in younger people are not severe. Why would a younger person get vaccinated if younger people aren’t really dying from COVID-19?

The younger population may not be seeing as many severe cases or deaths, but they are still at high risk of long COVID. Long COVID is when those who have recovered from COVID-19 experience lasting effects, including a range of symptoms such as fatigue, brain fog, chest pain, shortness of breath, cough, joint or muscle pain, depression, anxiety, and so much more. Long COVID can develop weeks or months after infection. It can happen to anyone who has had COVID, even if they had mild or no symptoms. Getting the vaccine remains a safe way to protect yourself, along with your community, family members, and those who cannot be vaccinated.

Returning to the regular weekend update, both Congress will be in session this week for Committee work and House and Senate floor votes. The House Oversight and Reform Committee will hold its third recent hearing on prescription drug costs on Tuesday morning. It’s worth noting that although the House Oversight and Reform Committee approved the Postal Reform bill (HR 3076) last week, the House Energy and Commerce and Ways and Means Committees also have jurisdiction over the bill. So we don’t know right now, when the bill may reach the House floor.

In OPM news, the Federal Times reports that

In anticipation of more employees returning to the office and in the spirit of May’s Mental Health Awareness Month, the Office of Personnel Management issued a tip sheet for agency human resource staff to better support employees at a vulnerable time. * * * In addition to communicating with employees about the usual resources available to them – such as the Employee Assistance Program and mental health treatments offered through Federal Employee Health Benefit plans – OPM encouraged agency work-life coordinators and HR professionals to be as communicative as possible about office safety procedures and available work schedule adjustments to ease any potential employee anxiety.

In other healthcare news,

  • mHealth Intelligence discusses the work of University of West Virginia researchers who are seeking to determine the best mix of in-person and virtual care. “With telehealth use skyrocketing over the past year and a half due to the coronavirus pandemic, some have wondered if there’s a limit to its effectiveness. Is there a certain number of virtual visits that a patient – especially one with a chronic condition – should get, after which the technology outlasts its value? The answer, according the researchers at the University of West Virginia, is … uncertain.” While that outcome is surprising to the FEHBlog, the researchers have gone back to the drawing board.
  • Fierce Healthcare reports that “GoodRx, a telehealth and drug-pricing comparison software company, acquired competitor RxSaver for $50 million in cash. The company closed the deal in late April, GoodRx reported during its first-quarter 2021 earnings call Thursday. RxSaver, which was owned by Vericast Corp., the payment and marketing company controlled by billionaire Ronald Perelman, operates a price comparison platform to provide discount offerings through partnerships with pharmacy benefit managers (PBMs). The acquisition will expand GoodRx’s business capabilities and consumer reach, particularly with respect to its prescription offering, the company said in its first-quarter 2021 earnings report.”
  • Health Payer Intelligence informs us that ” To help combat racial care disparities in communities of color, Blue Shield of California (Blue Shield) provided $300,000 to 12 different nonprofit organizations in California that promote the mental health and well-being of youths in their communities.   This act supports the health equity strategy of Blue Cross Blue Shield Association (BCBSA), Blue Shield’s parent company, as it seeks to improve racial care disparities by collaborating with local community leaders. By contributing $25,000 to each organization, Blue Shield is providing opportunities for youths of color that can improve their mental health.”
  •  Healthcare Dive reports that “Piedmont Healthcare signed a non-binding letter of intent to acquire Augusta, Georgia-based University Health Care System, which operates three hospitals as well as skilled nursing facilities and urgent care clinics along Georgia’s eastern border with South Carolina. * * * Just last week, the 11-hospital system announced plans to buy four additional hospitals from HCA Healthcare for $950 million. The sale is expected to close in the third quarter of this year. The hospitals in the HCA deal circle the outskirts of the Atlanta region. * * * Altogether, the two most recent deals would give Piedmont a total of 18 hospitals in Georgia, in addition to more ancillary services.” Healthcare Dive adds that the two deals are likely to face regulatory scrutiny.

Weekend update

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

Happy Mothers’ Day.

Congress will be engaged in Committee business and floor votes for the next two weeks. The Hill reports on what we can expect from Congress in the near term.

From the COVID-19 front, Bloomberg informs us that

The share of U.S. hospital beds occupied by Covid-19 patients fell to 5.37%, the lowest since Oct. 5, according to the U.S. Department of Health & Human Services. Michigan had the biggest percentage of beds occupied by Covid patients at 13.3% followed by Maryland at 10.8%, according to the latest HHS data, which reflect the situation on Thursday. Florida had 3,504 hospitalized Covid patients, the most of any state, followed by Texas with 3,080.

The U.S. added fewer than 35,000 cases on Saturday, sending the seven-day rolling average of new infections to the lowest since the end of September. While reporting often lags on weekends, the data collected by Johns Hopkins University and Bloomberg is the latest sign that the pandemic in America is easing.

Another 625 people nationwide died of Covid-19, bringing the toll to more than 581,000 since the outbreak began. Detroit and New York City had the most deaths per capita among major metro areas in the week through Wednesday, according to a Centers for Disease Control and Prevention report dated May 6.

According to the CDC’s website, nearly 7.5 million doses of COVID-19 vaccine were administered over the past three days. Approximately 43% of the U.S. population over age 18 and 71% of that population over age 65 is fully vaccinated against COVID-19. All of these facts are clearly related.

Govexec reports on the Postal Service’s first quarter 2021 financial results.

USPS lost just $82 million in the second quarter of fiscal 2021, a marked improvement over the same quarter the previous year. When excluding inflationary adjustments to the agency’s workers’ compensation liabilities that are outside of management’s control, however, the agency experienced $1.7 billion in losses from January through March compared to $1.9 billion in that period of fiscal 2020. 

Total revenue jumped 6% over the same period last year, led by a 34% spike in package business. The shift from regular mail—where plummeting volume persisted—to packages continued to add costs to the postal system, as packages entail additional personnel and transportation costs. * * *

The Postal Service’s costs jumped by 4% in the most recent quarter, which management attributed to package delivery and paid leave related to the pandemic. The agency’s total net loss of $82 million was down from $4.5 billion in the same period last year. 

Joe Corbett, the USPS chief financial officer, speculated the agency would break even by fiscal 2023 or fiscal 2024, provided DeJoy’s plan is implemented. USPS is relying in large part on Congress to pass reforms that would remove much of its liabilities for retiree health care costs from its balance sheets.  

Fredric Rolando, president of the National Association of Letters Carriers, said the postal revenue increases demonstrate those retiree health care reforms are the primary change needed.  The uptick in business drives home “how much the American people and their businesses rely on the essential work of the Postal Service,” Rolando said

If the the Postal Service’s healthcare reforms would save money and the Medicare Part D integration would create a gusher of savings, why not just apply those reforms across the entire FEHB which would avoid the additional administrative cost of creating a new Postal Service Health Benefits Program within the FEHB Program?

Thursday Miscellany

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

Today is the first day of National Nurse’s Week. The well-deserved celebration begins each year on May 6th and ends on May 12th, Florence Nightingale’s birthday. What a marvelous profession.

Meanwhile Healthcare Dive reports that

  • Last year marked a historic shift in the organization of medicine, with fewer than half of U.S. doctors working in a private practice, according to the latest American Medical Association Physician Practice Benchmark Survey. And among those private practices that continue to operate, many are trending toward a larger size.
  • According to the report, 50.2% of physicians were employees, up from 47.4% in 2018 and 41.8% in 2012. The proportion of doctors working in a private practice was 49.1% last year.
  • Hospitals are one of the largest employers of physicians, with the proportion increasing nearly 50% between 2012 and last year. And with the vast majority of doctors under the age of 40 now employees rather than employers, it suggests the trend will continue over the long term.

The Raleigh (NC) News-Observer reports that

CVS [Health] announced Wednesday it’s joining the list of pharmacies offering people the coronavirus vaccine without requiring an appointment, spokesperson Matt Blanchette told McClatchy News. Same-day scheduling as soon as one hour ahead of time is also available.  Walk-ins are available at 8,300 CVS locations across the country, Blanchette said. The company has more than 9,900 locations across 49 states, Washington, D.C., and Puerto Rico. 

The New York Times adds that “Chains like Walmart, Walgreens, Safeway and Stop & Shop have said that they are now offering vaccines to walk-in clients at some locations or in mobile clinics. Other pharmacies preceded the president’s announcement. Rite Aid said that it would accommodate walk-ins on a limited basis last week, for example.” Let’s go.

Forbes reports that Pfizer-Biontech and Moderna will apply for full FDA marketing approval of their respective COVID-19 vaccines later this month.

The FDA authorized the Moderna vaccine under an EUA on Dec. 18, after granting the same authorization to the Pfizer Covid-19 vaccine. The FDA can grant emergency use authorizations when a panel of experts determine the “known and potential benefits outweigh the known and potential risks,” and when the secretary of Health and Human Services determines a health crisis deems emergency use of unapproved products “appropriate.” Pfizer announced Monday it would file for full FDA approval, and it’s likely Johnson & Johnson, manufacturers of the only other Covid-19 vaccine authorized for emergency use in the U.S., will file for full FDA approval as well. Emergency use authorizations can be revoked when public health crises subside, and FDA approval would allow companies, like Moderna and Pfizer, to directly market their vaccines to consumers. 

FLASH: Politico reports that Pfizer/BioNTech applied for full FDA approval on Friday May 7.

Errata: The FEHBlog included in a post last month an erroneous report that Moderna had filed for FDA approval. He had understood that the application was overdue. Whoops.

Forbes further informs us

Moderna announced Wednesday its booster shot showed a positive immune response against the Covid-19 variants found in South Africa and Brazil. Moderna is testing booster shots in individuals who already received their two-dose Moderna vaccine regimen. [Moderna CEO Stephane] Bancel has said he expects booster shots will be necessary, and Pfizer CEO Albert Bourla said it’s “likely” vaccinated individuals will need a booster within a year of being fully vaccinated. 

From the healthcare business front —

  • According to the Wall Street Journal “Walmart Inc. said Thursday it purchased telehealth provider MeMD and plans to offer nationwide virtual healthcare services, another sign of the retail behemoth’s healthcare ambitions. The acquisition will allow Walmart to expand its Walmart Health service around the country, the company said. The retail giant didn’t disclose the financial details of the transaction.
  • The Journal further reports that ‘The MeMD deal opens another front in which Walmart and Amazon will compete, as Amazon recently announced plans to provide its telehealth service, Amazon Care, to its nearly 1 million U.S. employees by summer. Amazon Care, which now serves company workers in Washington state, will also be offered to other employers.” STAT News informs us that “Amazon Care signed its first enterprise customer this week, a significant milestone as the virtual-first health care platform looks to expand its footprint. The client, Precor, is a fitness business that was recently acquired by fitness technology company Peloton for $420 million in cash. Although small financially, the deal is a significant opener for Care.”
  • Healthcare Dive adds that “Nearly two out of three healthcare leaders say they’re currently prioritizing investment in telehealth as the pandemic continues, but that could change over the next few years, when investing in artificial intelligence shoots up the list of priorities, according to a new report from health tech giant Philips.”